NCG551819_Application_20240520

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ROY COOPER i 4"; -.\
Governor ��
ELIZABETH S.BISER ,.,,."^*
R M Secretary
RICHARD E.ROGERS,JR. NORTH CAROLINA
Director Environmental Quality
May 20, 2024
Douglas Jacobs, Owner
1401 W Academy St
Fuquay Varina, NC 27526
Subject: Permit Application
Application No. NCG551819
1401 W Academy St
Wake County
Dear Applicant:
The Water Quality Permitting Section acknowledges receipt of your application for a new NPDES WW permit, including
supporting documentation and your check number 11683 in the amount of $60.00 as payment of the application fee.
These items were received in our offices on May 20, 2024. Your application will be assigned to a permit writer within the
Section's NPDES WW permitting branch. The permit writer will contact you if additional information is required to
complete evaluation of your application. Your timely and direct response to any such request will help to expedite the
review process. Please note that acceptance of the application does not guarantee a NPDES permit will be issued for the
proposed activity. A permit will only be issued following a complete review of the application, concluding the proposed
discharge is allowable per applicable statutes and rules.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https://www.deq.nc.gov/permits-rules/environmental-application-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
Sincerely
1.,:..4ap z
Wren hedford
Administrative Assistant
Water Quality Permitting Section
cc: Kevin Dravidson, PE-Agri-Waste Technology, Inc.
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May 10, 2024
Mr. Charles Weaver RECEIVED
NPDES Permitting Program
Division of Water Quality MAY 2 0 2024/NP DES
1617 Mail Service Center
Raleigh,North Carolina 27699-1617 NCDEQ/DWR
RE: Application for Discharge System—Jacobs Residence
1401 W Academy St,Fuquay-Varina NC 27526
Dear Mr. Charles Weaver,
Enclosed please find information supporting an application for a discharge system for a 4-
Bedroom Single Family Residence (SFR) located in Wake County, North Carolina. The
proposed system will replace the failing, county permitted subsurface system that serves the
residence. The proposed system is to be sized for 4 bedrooms and has been designed to convey
all wastewater from the SFR, including greywater, to the proposed septic tank.
The following information is included with this letter:
- Notice of Intent(NCG550000). Attachment A
$60 check payable to North Carolina DENR.
Documentation from Wake County Environmental Services Attachment B
- Letter requesting coverage under the General Permit. Attachment C
Letter requesting Authorization to Construct. Attachment D
- Soils Evaluation report by Chris McGee, L.S.S. of AWT, Inc. Attachment E
Correspondence from USGS. Attachment F
Flow Path to"Blue Line" Water Feature. Attachment G
Information on Connecting to Regional Sewer. Attachment H
- Engineering Alternatives Analysis (EAA). Attachment I
Local Government Review Forms. Attachment J
Plans and Specifications for the Proposed System. Attachment K

The proposed discharge location is an unnamed tributary on the northwest corner of the
property. The system discharges to an unnamed tributary to Kenneth Creek. The
flow path is included in Attachment G. The discharge system will utilize the following
components:
Septic Tank with Effluent Filter
Recirculation Pump Chamber(Integrated into AdvanTex Pod System)
Discharge Pump Chamber(Integrated into Advantex Pod System)
AdvanTex Treatment Pod
UV Disinfection
Discharge Point with Rip-Rap
Flow Path to "Blue Line"Water Feature
The proposed discharge location is to an unnamed tributary to Kenneth Creek. A map
showing the path from the discharge point to the first "blue-line" stream, as shown on
the Wake County GIS Map, can be seen in Attachment G. The latitudinal and
longitudinal information presented below is the approximate location of the
confluence of the unnamed tributary with Kenneth Creek.
Receiving Stream Kenneth Creek
Stream Index 18-16-1-(-1)
Stream Class C
Latitude 35.573°
Longitude -78.837°
Notice of Intent
As part of the Notice of Intent, the feasibility of alternatives to discharging must be
addressed. The following alternatives are to be evaluated:
- Connection to a regional or municipal sewer collection system.
- Letter from the local or county health department describing the suitability
or non-suitability of the site for all types of wastewater ground adsorption
and innovative non-discharge systems, as well as documenting the repair
potential of the failed system.
Investigate land application such as spray irrigation or drip irrigation.
Connection to a Regional or Municipal Sewer Collection System
Connection to a sewer collection system is not feasible for this facility. Michael Wagner,
Public Utilities Director at Town of Fuquay-Varina, indicated that the property is not
within the Town of Fuquay-Varina sewer coverage area. The closest current city-
maintained sewer is approximately 3,500 linear ft. from the property and there are no
immediate plans for a sewer extension to the area at this time (Attachment H). At an
estimate of$150/ft, the sewer extension would cost over$525,000.

Letter from the local or county health department describing the suitability or non-
suitability of the site for all types of wastewater ground adsorption and innovative
non-discharge systems. Document the repair potential of the failed system.
Wake County Environmental Services indicated that the site is unsuitable for installation
of a ground absorption septic system in a denial letter dated December 19, 2023
(Attachment B). The letter indicated that a repair permit cannot be issued due to
insufficient space, unsuitable soil depth, and unsuitable soil wetness conditions.
Investigate Land Application such as spray irrigation or drip irrigation.
Per the soil evaluation by Chris McGee of Agri-Waste Technology, Inc., the soils on the
subject properties are unsuitable for conventional and alternative subsurface wastewater
systems due to unsuitable soil wetness condition, insufficient available space, and
unsuitable soil depth. Surface application/irrigation systems do not qualify for this lot
due to insufficient space based on required setbacks, slope, and depth to restrictive
features limiting soil water movement(Attachment E).
7Q10 Flow Estimate
The United States Geological Survey (USGS) was contacted to determine the 7Q10 flow
estimate for the proposed wastewater discharge point. The proposed discharge point
flows into an unnamed tributary to Kenneth Creek. The analysis from USGS indicates the
7Q10 discharge for the point in question is between 0 and 0.0046 cfs (Attachment F).
Engineering Alternatives Analysis
An Engineering Alternatives Analysis (EAA)has been completed for this site and is
included as Attachment I. In my opinion, the completed EAA demonstrate that a
wastewater treatment system permitted under the NCG550000 General Discharge
Permit is the only feasible option for this site. We have exhausted all other options for
this site as follows:
a.) connection to a municipal or regional sewer collection system
- Not feasible due to costs.
b.) subsurface disposal
- Inadequate soil for a subsurface absorption system.
c.) single-family residence wastewater irrigation (drip and spray)
- Inadequate soil and insufficient space for a non-discharge
ground absorption system.
d.) reclaimed-water systems
- Inadequate soil and not feasible due to fill soil costs for a
reclaimed water system. No reasonable ability to operate
as a bulk distributor of reclaimed water.
e.) Any viable combination of the above
- There are no viable combinations of the above due to soil
and cost limitations.

Local Government Review Forms
As part of the EAA, Local Government Review Forms were sent to Wake County and the
Town of Fuquay-Varina. A copy of the submittal is included as Attachment J. To date,
the Wake County form and the Town of Fuquay-Varina forms have yet to be signed and
returned.
I appreciate your time and efforts in reviewing this application. If you have any
questions or comments,please feel free to contact me at 919-367-6313.
Best Regards,
Kevin D. Davidson,P.E.
V.P. of Engineering

Attachment List
Attachment A Notice of Intent (NCG550000)
Attachment B Documentation from Wake County Environmental Services
Attachment C Letter Requesting Coverage Under the General Permit
Attachment D Letter Requesting Authorization to Construct
Attachment E AWT Soils Evaluation Report
Attachment F 1. Correspondence from USGS
2. Stream Classification
Attachment G 1. Flow Path to "Blue Line" Water Feature
Attachment H Information on Connection to a Regional Sewer System
Attachment I Engineering Alternatives Analysis
Attachment J Local Government Review Forms
Attachment K Plans and Specifications for the Proposed System

Attachment A
Notice of Intent (NCG550000)

National Pollutant Discharge Elimination System FOR AGENCY USE ONLY
(NPDES) Date Received
Division of Water Resources
Application for SURFACE DISCHARGE Year ,` Month Day
Environmental Certificate of Coverage (COC)Under Roo q 65 AD
Quality
General Permit NCG550000 Certificate of Coverage(COC)
For Single-Family Residences and Similar Discharges NC G 55 0 6 7 2
100%-domestic wastewater-<1,000 gallons per day Check# Amount
N Cg SG► C;1 Assigned to:
The Division of Water Resources will not accept an application package unless all instructions are followed.
Failure to submit all required items may result in the application being returned. For more information, visit
the Water Quality Permitting Section's NPDES Permitting Unit website. (Press TAB to navigate form)
1. Regional Office Contact: Please contact your DWR Regional Office before submitting this
application. If you have not met with your appropriate DWR Regional Office Representative,the
application will be returned.
Please list the DWR Regional Office representative(s)with whom you have discussed this project:
Name(s): Jane Bernard Date: 3/5/2024
2. Owner's Contact Information:
Applicant Type: ® Individual ❑ Corporation ❑ Partnership
Owner Name and Title: Douglas Jacobs,Owner
Street Address: 1401 W Academy St.
City: Fuquay-Varina State: NC Zip: 27526
Telephone#(H): Telephone#(W): -
Cell/Mobile#: [phone] Email: [e-mail]
3. Location of Facility Producing the Discharge: Please list the address of the facility.If the facility is not
yet constructed,give street address or lot number.
Street Address: 1401 W Academy St.
City: Fuquay-Varina State: NC Zip: 27526
County: Wake Telephone#: - Cell/Mobile#: [phone]
Website: -
4. Site-Location Narrative:
Please describe how to get to the facility from the nearest town,major highway,or identifiable roadway
intersection(use street names, state road numbers,and/or distances and directions).
From Fuquav-Farina,take AV academe St going west for 2.3 miles.The property will be on the left.
Page 1 of 7 Revised:A. Orlando NPDES 21Sept2017

Application for Certificate of Coverage(COC) and/or Authorization to Construct(ATC)
under General-Permit NCG550000
5. Describe the nature of the project. ["New"means has not yet been physically constructed,
"existing"means system already physically exists. Please see 15A NCAC 02H .0103(11) for further
clarification].
❑ Installation of a New Wastewater Treatment System (If yes, skip to Number 9.)
❑ Expansion of an Existing Wastewater Treatment System(for example,adding bedrooms) (If yes,
skip to Number 9.)
® Replacement of an Existing Wastewater Treatment System (If yes, go to Number 6.)
6. Describe the Existing Wastewater Treatment System:
® Conventional Septic Tank/Leach-field—Discharge to Sub-Surface Soils. If previously permitted,
please attach a copy of the permit or enter the permit number:Wake County Permit#C018100
If you are not aware of an existing permit, check here. ❑
❑ Sandfilter—Discharge to Surface Waters[or other,as defined 15A NCAC 02H.0103(11)]. If
previously permitted,please attach a copy of the permit or enter the permit number. If you are not
aware of an existing permit,check here. ❑
❑ Filter Media System(Pod System)—Discharge to Surface Waters [or other,as defined 15A NCAC
02H.0103(11)].If previously permitted,please attach a copy of the permit or the permit number.
If you are not aware of an existing permit,check here. ❑
❑ Other
❑ Check here if submitting proposal for a new system or if no treatment system exists.
7. Check all EXISTING wastewater treatment components:
® Septic tank ❑ Dosing tank ❑ UV disinfection
❑ Primary sand filter ❑ Secondary sand filter ❑ Recirculating sand filter(s)
❑ Chlorination ❑ Dechlorination ❑ Other components:
❑ Self-Contained POD system [describe]
® Leach Field
❑ Post Aeration (specify type)
8. Provide Details of Single-Family Residence(SFR)or Similar Facility:
Page 2 of 7 Revised:A. Orlando NPDES 21Sept2017

Application for Certificate of Coverage(COC) and/or Authorization to Construct(ATC)
under General-Permit NCG550000
a) Type of facility:
®Residential ❑Commercial
❑Other:
b) Amount of wastewater discharged:
- Residential:Number of bedrooms 4 x 120 gallons per bedroom= 480
gallons per day(flow)
- Commercial: How many employees?(25 gpd/person)N/A
c) Is your existing treatment system failing? Yes ® No 0
d) Has the Health Department formally condemned your existing system
"unsuitable for repair?" Yes ® No ❑
X If yes,please name the Health Department[local,county,or state],and provide the site-inspection
date [attach Health Department's judgement letter, if available]: Wake County Environmental
Services, 12/19/2023
If previously permitted [local,county,or state],provide permit number and date issued [attach
copy, if available]: Click here to enter text.
9. Check all PROPOSED new system components
• Septic tank 0 Dosing tank ® UV disinfection:
Primary sand filter ❑ Secondary sand filter ❑ Recirculating sand filter(s)
❑ Chlorination ❑ Dechlorination ❑ Other components:
® Self-Contained POD system [describe] AdvanTex AX20-RT UV Pod
® Post Aeration (sped type) rip rap at discharge
❑ Proposed Modifications to Existing Treatment System-Explain in detail the nature of the
modification.Attach all site maps,plans and specifications, signed by an NC Certified Engineer.
If prepared by others,plans must conform to 15A NCAC 02H.0139.
• Proposed New Treatment System for Surface Discharge(not constructed)-Attach all site maps,
plans and specifications,to be signed by an NC Certified Engineer. If prepared by others,plans
must conform to 15A NCAC 02H .0139.
Expanding Flow?-Do you propose to increase permitted or existing flow? ['Yes ® No
Provide details of the Proposed NEW Discharge [Flow and Source Water]:
® Check if same as 6.
Existing: Amount of wastewater currently discharged: Number of bedrooms 4 x 120 gallons per
bedroom= 480 gallons per day to be permitted(design flow)
Page 3 of 7 Revised:A. Orlando NPDES 21Sept2017

Application for Certificate of Coverage(COC)and/or Authorization to Construct(ATC)
under General-Permit NCG550000
Expanding: Amount of wastewater proposed to be discharged:Number of bedrooms x
120 gallons per bedroom= gallons per day to be permitted(design flow)
10. Evaluate Alternatives to Discharge to Waters of the State. Please address the feasibility of
discharge alternatives as instructed in the NCDEQ Engineering Alternatives Analysis(EAA)
Guidance Document found here. (Note:Evaluation for endangered species is not required)
a) Connection to an Existing Wastewater Treatment System-Provide the distance
to the nearest connection,such as a regional or municipal sewer system,and the
estimated cost per foot to connect including fees. —3,500 ft.with a cost of
$150/foot($525,000)+additional costs for design,permitting,and tap fees
b) Land Application—Assess the land application disposal alternatives such as spray
irrigation,drip irrigation, individual/community onsite subsurface systems,and/or
innovative ground-absorption. Questions to consider:
(1) Are on-site soils suitable for land application? Yes ❑ No
(2) Is there sufficient area on-site? Yes [ No
c) Wastewater Reuse—Evaluate reusing all or a portion of the wastewater
generated, such as for golf course irrigation,crop irrigation(e.g.,hardwood or
pine plantation,grasses),athletic field irrigation, landscape uses,and/or
commercial/industrial uses.Not feasible
d) On-Site Soil Evaluation—Submit an evaluation of the soils on-site,
documented by a certified report from a NC Professional Soil Scientist,or by
your local or county health department report(if available).Not sufficient
suitable soil or space,denial by Wake County Environmental Services
(12/19/2023)and evaluation by LSS(03/05/2024)
e) Cost of Alternatives—Provide an estimation of the cost of each discharge
g
alternative or combination of alternatives. Cost to connect to sewer estimated at
over$525,000—not feasible.
11. Provide Regional Information: Please provide the following information. If you need assistance in
obtaining this information,please contact your local DEQ regional office.
a) Stream Classification-Verify the stream classification for the nearest downgradient named
waterbody. The NC Surface Water Classification map can be found by clicking here.
Kenneth Creek: C(Stream Index 18-16-1-(1))
b) Is it a High-Quality Water?If so,check if it is by definition or by designation?In order to check
this,ask the Planning Unit. NO
c) Map-Provide a map locating the nearest downstream waters-of-the-State(i.e.where the effluent
reaches an unnamed tributary,creek, stream,river,or lake via any surface-water conveyance).
Map included in package detailing flow path to Kenneth Creek
Page 4 of 7 Revised:A. Orlando NPDES 21Sept2017

Application for Certificate of Coverage(COC) and/or Authorization to Construct(ATC)
under General-Permit NCG550000
d) Site Evaluation-Contact DEQ's local Regional Office for a site evaluation to confirm the
proposed discharge flow path to the nearest waters-of-the-State.The wastewater/stream
confluence and stream class must be verified in the field by DEQ's Regional Staff. Please list the
Regional Office staff member you contacted for the inspection.
e) Flow Path-Display graphically the flow path of the discharge to the nearest surface Waters of
the State. Document any potential hydrologic trespass or right-of-way infringement on any
neighboring property(i.e. note all properties encountered prior to reaching waters-of-the-State).
Provided.
f) 7Q10/30Q2 Estimate-Contact USGS J. Curtis Weaver(919-571-4043)to provide the estimated
7Q10 and 30Q2 stream-flow estimates for the first downstream point-of-contact with waters-of-
the-State. 7Q10: from 0 to 0.0012 cfsm;30Q2: from 0.0078 to 0.14 cfsm
12. Certificates of Coverage/Notices of Intent to Discharge/Authorizations to Construct - Check ALL
of the following information has been provided. Incomplete Applications will be returned.
• An original letter[two(2)copies]requesting coverage under NCG550000.
® This application [two(2)copies].Your signature on this application, certifies that you are legally
responsible for the proposed treatment system(see page 6 of 6)for the COC/NOI/ATC.
• A check or money order for$60.00 permit fee made payable to NCDEQ.
13. Additional Application Requirements
a) Narrative Description of the treatment system. This narrative should present treatment components
in order of flow—influent to outfall, including anti-erosion structures and sample-port location(s).
b) Final Plans and Specifications for a wastewater treatment system shall be signed by a North
Carolina-registered Professional Engineer,or if prepared by others,must conform to 15A NCAC
02H.0139. All_documents are to be stamped"Final Design-Not Released for Construction."
Submittal shall include a site map showing the proposed outfall and the effluent proposed path to
surface waters-of-the-State.(see Item I for location verification by DWR Regional Office staff)
c) Submittals by a Consulting Engineer or Engineering Firm shall include:
1. A copy of your written authorization to represent,signed by the legal
permit Applicant; and
2. Upon completion of proposed work,a signed copy of DWRs Engineer's
Certification form attesting that the project was completed in accord
with the DWR approved COC/ATC,as issued.
*******************************************************************************
CERTIFICATION
Page 5 of 7 Revised:A. Orlando NPDES 21Sept2017

Application for Certificate of Coverage (COC) and/or Authorization to Construct(ATC)
under General-Permit NCG550000
I certify that I am familiar with the information contained in this application and that to the best of my
knowledge and belief such information is true,complete,and accurate.
Printed Name of Person Signing: Douglas Jacobs
Title: Owner
(Please review 15A NCAC 02H .0106(e)for definition of authorized signing officials)
the)/ l
(Signature of Applicant) (Date Signed)
NOTE: Treatment System Maintenance is Required-Upon receiving a Certificate of
Coverage/Authorization to Construct(COC/ATC),the Division recommends that the Perntittee solicit
Page 6 of 7 Revised:A. Orlando NPDES 21 Sept2017

Application for Certificate of Coverage(COC) and/or Authorization to Construct(ATC)
under General-Permit NCG550000
manufacturer-certified training, or solicit a qualified contractor or service to regularly inspect and
maintain this treatment system. The Permittee is responsible under this COC/ATC to maintain all
components of the approved treatment system,designed to meet Surface Water Quality Standards [see
attached Operation and Maintenance Agreement].
Compliance duties include:
• paying your annual fee [due on the anniversary of COC/ATC effective date],
• following the manufacturer's guidelines,
• conducting and documenting inspections, in compliance with General Permit NCG550000,
• establishing sources for OEM spare parts and supplies,
• taking discharge samples for analysis,and logging the results,
• making necessary repairs,documenting said maintenance in logs,and
• keeping logs onsite for the life of the permit, available for DWR inspection.
North Carolina General Statute tz 143-215.6B provides that:
Any person who knowingly makes any false statement representation,or certification in any application,record,
report,plan,or other document filed or required to be maintained under this Article or a rule implementing this
Article; or who knowingly makes a false statement of a material fact in a rulemaking proceeding or contested
case under this Article; or who falsifies, tampers with, or knowingly renders inaccurate any recording or
monitoring device or method required to be operated or maintained under this Article or rules of the Commission
implementing this Article,shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed ten
thousand dollars($10,000). 18 U.S.C. Section 1001 provides a punishment by a fine or imprisonment not more
than 5 years,or both,for a similar offense.
Application must be accompanied by a check or money order for$60.00
made payable to:
NCDEQ
Mail this application and one copy of the entire package (with check) to:
NCDEQ/DWR/NPDES
Attention: John Hennessy, Supervisor
Compliance and Expedited Permitting Unit
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
Attn: John Hennessy
Note: Submission of this document insures DWR's consideration, but does not
guarantee issuance of a Certificate of Coverage/Authorization to Construct.
Page 7 of 7 Revised:A. Orlando NPDES 21Sept2017

Attachment B
Documentation from Wake County Environmental Services

TEL [phone]
FAX [phone]
WAKE E nvi ro n m e nta I Water Quality Division
COUNTY Services 336 Fayetteville Street•Raleigh,NC 27602
NORTII CAROIINA www.wakegov.com
December 19, 2023
FIRST CLASS MAIL/CERTIFIED MAIL-RETURN RECEIPT REQUESTED
Douglas Jacobs Jr.
1401 W Academy St
Fuquay Varina,North Carolina 27526-8213
Reference: Denial of Repair for1401 W Academy St, Fuquay Varina,North Carolina 27526-8213
PIN# 0646834697
Dear Doug Jacobs:
This letter is to inform you that a site evaluation was conducted on the above referenced property on
December 14, 2023. This property was determined to be Unsuitable for the use of a subsurface sewage
treatment and disposal system in accordance with the"Regulations Governing Wastewater Treatment and
Dispersal Systems in Wake County"(and 15A, Subchapter 18A, Sections .1901-.1969 of the North
Carolina Administrative Code, adopted by reference in the Wake County Regulations).
The site evaluation findings revealed the following limiting factors:
❑ Unsuitable topography and/or landscape position, .1940
❑ Soil Characteristics Morphology, .1941
® Soil Wetness Condition, .1942
n Soil Depth, .1943
n Restrictive Horizons, .1944
® Available Space, .1945
❑ Other: The referenced parcel has a malfunctioning septic system and an application for a repair
permit was submitted to Wake County Environmental Services. Setback constraints relative to well,
power line,driveway etc.,as well as unsuitable soils conditions make this site unsuitable for a wastewater
repair. There is a soils area on site that contains a sizeable enough area for a replacement drain field. This
soils area has colors and textures that are provisionally suitable. However,there is too much free water in
the borings for suitability. Remedial measures have been taken in effort to create provisionally suitable
soil conditions conducive to a repair drain field. A curtain drain and an interceptor drain was installed to
protect these best soils within the best available space for this property. These drains did not dry this soils
area up enough to permit a repair drain field. Many follow up visits were made after the drains were
installed and each visit revealed too much free water in the soil borings. After collaboration from Wake
County Environmental Services staff soil scientists,Gary Morehouse,John Kase,David Ward and
Environmental Consultant Travis Howard,the consensus is that this site shall be denied for a repair
wastewater disposal permit.

Please refer to the enclosed soil evaluation form and site plan for additional information related to
limiting factors.
The Regulations allow for the reclassification of unsuitable sites to provisionally suitable status if the
conditions of 15A NCAC 18A, Section .1948(d)are met. "A site classified as UNSUITABLE may be
used for a ground absorption sewage treatment and disposal system specifically identified in Rules .1955,
.1956,or.1957 of this Section or a system approved under Rule .1969 if written documentation, including
engineering,hydrogeologic, geologic or soil studies,indicates to the local health department' that the
proposed system can be expected to function satisfactorily. Such sites shall be reclassified as
PROVISIONALLY SUITABLE if the local health department determines that the substantiating data
indicate that:
(1)a ground absorption system can be installed so that the effluent will be non-pathogenic,non-
infectious,non-toxic,and non-hazardous;
(2)the effluent will not contaminate groundwater or surface water; and
(3)the effluent will not be exposed on the ground surface or be discharged to surface waters where it
could come in contact with people,animals,or vectors."
You have two options available. First,you may hire a soil scientist to evaluate your property(PIN#
0646834697)and submit a proposal(layout and waste water design)to Wake County Environmental
Services. Second,you may also appeal this decision with submission of adequate substantiating
documentation under the provisions of North Carolina General Statute(NCGS) 130A-24(b)&(c)and
Wake County Human Services Board Rules of Appeal by letter to:
Wake County Human Services Center
Attn.: Brittany L.Hunt,Executive Assistant
4401 Bland Road
Raleigh,North Carolina 27609
and
Wake County Department of Environmental Services
Attn: Joseph Threadcraft,Ph. D.,P.E.,Director
Waverly Akins Wake County Office Building
P.O.Box 550
Raleigh,North Carolina 27602
The Department asks that you send copies of the request for an appeal hearing to both parties to insure
prompt processing of your request. An appeal must be made within 30 days of receipt of this letter or
your appeal rights are forfeited.
If you have any questions or wish to setup a meeting,please contact Travis Howard at(919)369-5974 or
via email at [e-mail] Monday through Friday between 8:30 am and 5:15 pm.
Sincerely, . 1 th-L A k
Travis Howard,R.E.H.S.
' Wake County Environmental Services Department

Environmental Consultant
Water Quality Division
Wake County Environmental Services Department
Enclosures:
cc: Kenneth R. Murphy,Esq., Wake County's Attorney's Office
Joseph Threadcraft,Ph. D., P.E.,Director,Wake County Department of Environmental Services
Jie Liu, P.E., Environmental Health Program Manager,Wastewater Management
Theo Udeigwe,Ph. D.,CPSS, Water Quality Director,Wake County Department of
Environmental Services

SITE EVALUATION REPORT
PIN NUMBER: 0646834697 "D" PERMIT#:
OWNER/APPLICANT: Douglas Jacobs Jr
SUBDIVISION: LOT NUMBER:
LOCATION OF SITE: 401 S into Fuquay Varina,TR HwX 42 towards Sanford.Site on left 1401 W Academy St.
FACTORS AREA 1 AREA 2 AREA 3
1. Topography S El PS❑ U❑ S ❑ PS ❑ U El S❑ PS El U El
Slope(%) —13 =4 —13
2. Landscape Position S❑ U ❑ S❑ U ❑ S❑ U El
(Upland, Sideslope, Upland/Sideslope Upland/toeslope toeslope
Depression,etc.)
3. Soil Texture S❑ PS® S® PS El S El PS
(Group&Texture) SCL-CL SL-L SCL-CL
4. Soil Structure S ❑ PS El U ® S ❑ PS El U ® S ❑ PS ® U❑
(Granular, Blocky,etc) mod sbk-massive wk gr-massive mod sbk
5. Clay Mineralogy S® U El S El U ❑ S® U El
(Type&Consistence) s exp fr ss sp NA s exp fr ss sp
6. Soil Wetness S❑ PS ❑ U ® S❑ PS ❑ U ® S❑ PS El U
Munsell Color free H2O 12-19,mottling free H2O 0-17 chr 2/wetness 33-36
30+ 0-23
7. Soil Depth(In.) S❑ PS ® U ❑ S ❑ PS ® U ❑ S❑ PS® U ❑
Total Soil Depth 36 36 36
8. Restrictive Horizons S El PS❑ U ❑ S El PS ❑ U❑ S❑ PS El U ❑
(Fragipans, iron pans,
plintite)
9. Saprolite S PS ID U S ❑ PS U ❑ S❑ PS U ❑
Depth
Texture/Group
10. Other(specify) S El PS El U ❑ S❑ PS ❑ U El S❑ PS ❑ U ❑
11. Investigation Method
Borings 3 5 3
Pits
12. Classification of Area S El PS❑ U ® S ❑ PS ❑ U ® S ❑ PS❑ U
13. L.T.A.R. gpd/sgft gpd/sqft gpd/sgft
14. Available Space: Yes ❑ No El
15. Site Classification: Area 1-Unsuitable Area II-Unsuitable Area III-Unsuitable * Note area III could be
reclassified Provisionally suitable; however insufficient available space due to well,powerline&curtain drain
setbacks.
(Suitable,Provisionally Suitable, Unsuitable)
Comments/Recommendations/Possible alternative or modified system under Wake County Regulations:
Soils Area 1 for this site was viewed initially as having potential to be reclassified to provisionally suitable for an At Grade
horizontal panel block repair drain field. 2-60' panel block drain lines flagged. The texture&colors of soil within this
area is good&structurally good,to a depth of being provisionally suitable,for this system type. Concern of free water
within the borings called for second opinion of site suitability. Gary Morehouse(staff soil scientist)visited site for second
opinion. Concluded that there is too much external water impacting this site to issue repair permit. The homeowner was
given the option to have a curtain drain &an interceptor drain installed as an attempt to capture& divert subsurface
water&surface water away from this potential repair drain field space. The owner advised to consult with the private soil
scientist(s)working for him to consider all options& make decision. Owner decided to have a curtain drain & interceptor
drain installed, understanding that this may or may not dry site up enough to permit the panel block repair field. On
9/12/23 the curtain drain/berm installed above the potential panel block drain field area,as well as an interceptor drain
installed below the drain field area to help pull subsurface water away from area. At this point ground water&surface
water is controlled & it was time to monitor the site for progress. Follow up visit 9/20/23 revealed drain outlet running

water steady,but still too much free water in borings. Follow up visit 10/9/23 revealed drain outlet running water steady,
but still too much free water in borings. Follow up visit 10/24/23 revealed drier conditions on site but still too much free
water in A horizon. Noteable here is this was a very dry time& expectation was to observe much drier soil conditions.
Follow up visit 11/16/23 revealed drain outlet running water steady with still too much free water in A horizon with Bt
horizon mostly dry. Follow up visit 12/8/23 revealed drain outlet running water steady with more of the same conditions of
too much free water in the A horizon to permit repair field. Decided at this point to coordinate a site meeting with staff soil
scientist(s)to make a call on how to handle this repair situation,as conditions had been as dry seasonally as could expect&
drains had been in almost 3 months. Follow up visit 12/14/23. Gary Morehouse,John Kase& David Ward,all staff soil
scientists visited site with Travis Howard to collaborate. This group evaluated soils,current site conditions& considered
all field data.The group concluded that soils Area II has no repair potential. Soils Area III has the most repair potential
but is severely lacking with regard to available space. The available space for this area is miminal& insufficient due to
setbacks from well, powerline,& recently installed curtain drain. The collaborative conclusion made to deny this repair
application.This soil evaluation represents the basis for the denial of this repair for 1401 W Academy St.
Travis Howard,Gary Morehouse,John Kase,David Ward
Evaluation by: Date: various dates,see notes
Verification by: Date:
**Note: If engineering,geologic,soil and environmental studies indicate that a system or alternative system can be
expected to function satisfactorily and all conditions of 15NCAC18A.1948(d)are met,the classification may be changed to provisionally
suitable.
**SEE ATTACHED SITE PLAN OR IMPROVEMENTS PERMIT SITE PLAN FOR LOCATION OF SOIL AREAS.

soil tvaluauonn-lela Iv otes ror Kepair uenlal
A curtain drain&interceptor drain installed
on this site in effort to d up the site enough
Boring 1 Boring 4 Boring 7 Boring 10 to insta a onzon a panel-M-0c arairrneia 1 o
0-29 SL 0-24 SL 0-13 SL 0-25 SL 2-60'lines flagged. It was reasonable to tiLg.
q
29+SCL 29+SCL 13+Loam 25-36 CL think this could work as the texture&colors 8. n
free H2O 19 free H2O 19 wetness 13 of soils are good within this potential panel a'6.block drain field area,however,there is too N v"s
0.
much free water.Numerous follow up visits $ $ "
Boring 2 Boring 5 Boring 8 Boring 11 did not show enough improvement to permit this repair. 1tl , `- 5
°i. € a H
0-34 SL 0-36 SCL 0-13 SL 0-24 SL t € ri
34 SCL massive wetness 17 13+Loan 24-36 CL *Wake County Environmental Services b a 2 e
free H2O 12 wetness 13 r _ d ro
collaboration from Travis Howard,Gary a� � 4
Morehouse,John Kase&David Ward = ;0 a
tt3aoro
Boring 3 Boring 6 concluded that the installed curtain drain& ; v z
0-25 SL 0-36 SL Boring 9 interceptor drain did not effectively dry the v „ a
25-36+CL wetness 23 0-wetness site up enough to install the potential ;.. Z`
dEEHE
massive 36 top down wet horizontal panel block drain field. This � �' ,,,-c
free H2O 17 unsuccessful attempt at drying the site up d `-x o
E E M u y c
15'setback to overhead leaves no other viable repair option due to o > . .
powerline available space&soil conditions. A repair `" o
for this site is denied due to available 8 x fi 'm,
space&soil wetness conditions.
.4/ELL =
p r,•—'
1Cj ..ring 1 , R
-s ill I
burin•o tree v •0'potential horizontal panel
1E b`,. k repair lines flagged - v-
•ree • — oht treeborin.,, II
treeN Uboring 1 •9iill
- Interce. r Drain —
•y
Niik
of
�d Approximate locati m ofisThg
n9 z 6boring eptic tank&drain field
\IIN1:41\.
o—
Powerline bng 9 ZApproximate creek location
Curtain Drain
�, :ring 8
\ L'il
0•
41
Outlet for curtain
ill' drain/interceptor drain O.
Soils Area 1 N
borings 1-3 ••-
th a
F Soils Area 2
'b., borings 5-9 Cr
2. 4j
Soils Are. . U)
borin•: •,10, 11 ;+
E
as
. V
Q
ri
0
1

11 Wake County Health and Human
Services Board Rules Of Appeal
Board Procedure 300 2.8
WAKE Department: Health and Human Divisions: Public
COUNTY Countywide or X Services & Health/Environmental Health
Environmental Services
Supersedes: Wake County Human Services, Department of Original Effective Date:
Environmental Services Rules of Appeals dated 03/28/2002 8/25/2011
Authority: North Carolina General Statute (NCGS) 130A-24(b),(c),(d) and (e)
Originating Department: Health and Human Services& Environmental Services
Document Classification: Public Non-Published (Unrestricted)
Purpose: To provide a single Wake County Health and Human Services Board appeals process
that applies to all functions under the purview of the Board. This procedure specifies how any
aggrieved person may request an appeal hearing to contest a decision or ruling of the Director
or Designee, or Delegate regarding the interpretation and enforcement of State or Wake
County health regulations, rules adopted by the Board, or the imposition of administrative
penalties. This document meets requirements or partial requirements for Public Health
Accreditation Benchmark 35.1.
II. Procedure Statement:
1. Hearing Request: Any aggrieved person may request an appeal hearing under these rules
to contest a decision or ruling of the Director regarding the interpretation and
enforcement of State health regulations; rules adopted by the Board; or the imposition of
administrative penalties if:
a. The request is submitted in writing to the Director within thirty (30) days following
receipt of the decision or ruling; and
b. The notice contains the following information:
i. The name and mailing address of the Appellant;
ii. A description of the challenged decision or ruling;and
iii. A statement of why the decision or ruling is incorrect.
c. The Director or the Director's Delegate or Designee shall, within seven (7) working
days after receipt of the notice of appeal, transmit to the Hearing Panel the notice
of appeal and all papers and materials upon which the challenged decision or ruling
was based.
2. Notice of Hearing:
a. The Hearing Panel shall schedule and hold a hearing within fifteen (15) days
following receipt of the notice of appeal from the Director or the Director's
Delegate or Designee. The Board shall issue notice to Appellant of the date, time,
and place of the hearing not less than seven (7) days prior. If notice is sent by
United States Mail, the Hearing Panel shall mail the notice not less than ten (10)
days prior to the hearing.
b. The Appellant may waive notice by supplying the Board with a written statement
Page 1 of 8
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signed by the Appellant to that effect.
3. Continuance, Waiver of Hearing:
a. The Appellant may, for good cause, request a continuance of the hearing. The
Panel shall determine if a continuance should be granted, and shall inform the
Appellant of its decision at least one day prior to the scheduled hearing.
b. An Appellant waives his right to a hearing if:
i. He fails to file a notice of appeal with the Director within thirty (30) daysof
the decision or ruling;
ii. He fails to attend a scheduled hearing after sufficient notice; or
iii. He submits a written waiver to the Panel of his right to a hearing.
4. Filing of Written Answer: The Appellant who has been served with notice of a hearing may
file a written response. Said response shall not be included in the record of the hearing
unless served upon the Panel,through the Director or the Director's Delegate or Designee, at
least three (3) working days before the hearing.
5. Discovery: Pre-hearing discovery shall not be available to any party.
6. Pre-hearing Conference:
a. Prior to appearing before the Hearing Panel, the appellant shall appear at an
informal pre-hearing conference. The conference shall be held and directed by the
Environmental Services Director or Designee, or by the Health and Human Services
Division Director for Public Health or Designee.
b. The persons attending the conference will:
i. Simplify issues;
ii. Stipulate facts or findings;
iii. Identify areas where evidence will be needed;
iv. Discuss the needs for consolidation of cases or joint hearings;and
v. Consider any other means to expedite disposition.
7. Disqualification of Panel Members: If any Panel member cannot attend the hearing or
feels they cannot conduct a fair and impartial hearing in a particular case, or any
Appellant objects to a member of the Panel, and files a written objection at least two (2)
working days before the hearing date,the Board shall appoint a substitute member to the
Panel to conduct the hearing.
8. Oath: No person may testify or present any evidence, oral or written, to be admitted into
the record without first being put under oath or affirmation. The Panel, its Clerk, or its
attorney shall have the power to administer oaths or affirmations.
9. Conduct of Hearing:The Panel shall have complete control in conducting the hearing,
including:
a. The responsibility of preparing a complete record of all testimony and exhibits
presented at the hearing.
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b. The order of the calling of witnesses or the prosecution of evidence.
c. Excluding irrelevant, immaterial, repetitious or redundant testimony or evidence.
d. The responsibility of determining the adequacy of the room in which the hearing
is held for the safety of the Panel and of those persons involved in the hearing or
observing the hearing. The room shall be large enough to ensure a safe
environment and a setting conducive for the rendering of an impartial decision by
the Panel. Security shall be provided by Wake County as reasonably requested by
the Chairperson of the Panel, by a majority of the Panel, or as deemed appropriate
in the discretion of the Panel's attorney.
10. Evidence at Hearing:The rules of evidence as applied in general courts of justice shall not
apply at the hearing. Any competent evidence, relevant to the decision or ruling in the
case shall be admissible in the record. The Panel may restrict or exclude unduly
repetitious or redundant testimony or exhibits.
11. Counsel: Appellant shall have an attorney to present the case before the Panel. A
representative of the County Attorney's Office shall be present to assist procedurally, and
to assist in the development of evidentiary aspects of the hearing.
12. Recommendation of the Panel: After all competent testimony has been heard and all
evidence presented to the Panel,the Panel shall deliberate in open session and:
a. Assimilate and review all evidence presented, and, based on clear and convincing
evidence, render a decision by majority vote;
b. Prepare proposed findings of fact and conclusions of law, based on the evidence
presented;
c. Prepare recommendations to the full Board to either affirm, modify, or reversethe
decision or ruling of the Director or Delegate on appeal;
d. Promptly transmit copies of the findings of fact, conclusions of law and
recommendations (the record) to the Board and to Appellant; and
e. Transmit a copy of the record and all exhibits of the hearing to the Board if either
party pursues further appeal.
13. Objection. Oral Argument before the Board:
a. The Appellant shall have ten (10) days from receipt of the Panel's recommendation
to file objections with the Board. Objections must be made in writing and actually
received by the Director within the ten (10) day limitation.
b. The Appellant may request the right to present oral argument to the full Board.
Such request must be made along with the objections described in subsections(a)
above.
c. Upon receipt of an objection and request for oral argument, the Board shall
schedule a time and date. The Board shall notify Appellant of the date,time,and
place of the argument at least ten (10) days prior to the scheduled date.
d. In presenting oral arguments to the Board, no new evidence shall be allowed.The
record below shall be the only evidence considered, and new evidence or written
argument shall not be received. Oral argument is limited to twenty (20)minutes
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Health and Human Services/Environmental Services HS Procedure BOARD 300 2.7
per side. The Board shall decide by simple majority vote based on a reasonableness
standard, whether or not the recommendations of the Hearing Panel should be
adopted, reversed, or modified.
14. Decision:
a. After review of the record and any oral argument presented to the Board,the
Board shall issue a binding written decision adopting, modifying or reversing the
proposal of the Panel. The Board shall notify all parties of its decision. The
decision shall contain a concise statement of the reasons for the decision.
b. Appeal from the Board's decision may be pursued under N.C.G.S. 130A-24(d), as
amended.
15. Record: The official record of contested case hearings shall be maintained by the Hearing
Office. Any person who wishes to examine the record shall submit a written request to
the Hearing Office in sufficient time to allow the record to be prepared for inspection and
all material properly held confidential to be deleted. The Hearing Office shall maintain the
record for a period of sixty (60) days following the decision of the Board. If an Appellant
appeals the Board's decision to the District Court pursuant to N.C.G.S. 130A-24(d),the
Appellant is responsible for notifying the Hearing Office to maintain the record and all
exhibits of the hearing for transmittal to the District Court.
16. Transcript: Anyperson who desires a transcript of a hearingorpart of a hearingshall
p
contact the Hearing Office,which shall require fees to be paid in advance of providing the
transcript. The Hearing Office shall delete from the transcript all materials properly held
confidential.
III. Definitions: For the purposes of these rules, these terms have the following meanings:
1. Appellant: Any aggrieved person appealing under this Section a decision or ruling of the
Wake County Health and Human Services director or his Delegate regarding the
interpretation and enforcement of State health regulations; rules adopted by the Board;
or the imposition of administrative penalties.
2. Board: The Wake County Health and Human Services Board.
3. Delegate: A staff member acting on behalf of the Health and Human Services Director
with the authority to issue decisions regarding the interpretation and enforcement of
State health regulations; rules adopted by the Board; or the imposition of administrative
penalties.
4. Designee: A staff member exercising the actual authority of a Delegate as directed bythe
Delegate.
5. Director: The Wake County Health and Human Services Director.
6. Hearing: An appeal hearing as provided for by NCGS 130A-24(b),(c),(d) and (e).
7. Hearing Office: The hearing may be scheduled at a Wake County Government location
convenient to the parties. However, if not otherwise specified, the location will be:
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Health and Human Services/Environmental Services HS Procedure BOARD 300 2.7
Wake County Health and Human Services Center
220 Swinburne Street, Raleigh, NC 27620
Phone: [phone]
8. Hearing Panel: A panel consisting of three members of the Board. The panel has the
authority to conduct hearings under these rules.
IV. Applicability and Exceptions:This procedure applies to all parties subject to decisions, rulings,
or administrative actions of the Director relating to State or Wake County health regulations
administered by the Health and Human Services or Environmental Services Departments.
V. Procedure Responsibility and Management:
A. Responsibility for the Procedure: The Board has responsibility for development and
implementation of this procedure. Within the department, the responsibility is delegated to
the HHS Director and the Executive Assistant to the Board.
B. Procedure Management: The Board Chair,The County Attorney's Office and the WCHHS
Director will review this procedure every 3 years from adoption or last revision date. The
Executive Assistant to the Board shall make any necessary revisions in accordance with
standard practice changes, statutes, or changes in the law. Any major procedure revision made
shall be submitted to the Board at the time of revision for approval and adoption.
C. Plan for communicating and training: The Executive Assistant to the Board will communicate
this procedure and any changes to the procedure to the WCHHS Board.
D. Contact Department/Division and number: WCHHS Director [phone] or the Executive
Assistant to the Board [phone]
VI. Procedure Responsibility and Management:
• The Environmental Services Director or the Health and Human Services Division
Director for Public Health, or their delegates, shall review this procedure at least every
two years to ensure currency.
• Employees who make decisions that are subject to these appeal procedures will be
trained on the appeals process during their new employee orientation.
• Approved protocol will be located on the departmental shared network drive.
VII. Related Publications: N/A
VIII. Appendices: N/A
IX. Legal and Regulatory References
Reference Document Reference Item Description
North Carolina General Statutes
130A-24 (b), (c), (d), and (e)
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Health and Human Services/Environmental Services HS Procedure BOARD 300 2.7
X. Approval History
Approval History:
Approval Date Version Approver(s) Role(s)
Dr.John Perry(on behalf of the full Health and
10/21/2021 2.7 WCHHS Board Chair
Human Services Board)
12/15/2022 2.8 Ms.Ann Rollins(on behalf of the full Health and WCHHS Board Chair
Human Services Board)
Page 6 of 8
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Health and Human Services/Environmental Services HS Procedure BOARD 300 2.7
Xl. Revision History:
Effective Date Version Section(s) Revised Author
12/15/2022 2.8 Annual Review—slight edits to wording Brittany Hunt, Executive
(changing "Health and Human Services Board" to Assistant to the Health
"Board" where applicable). and Human Services
Board
10/21/2021 2.7 Annual Review—Name of Board updated from Brittany Hunt, Executive
"Human Services Board" to "Health and Human Assistant to the Health
Services Board" in tandem with the same name and Human Services
change to Wake County Health and Human Board
Services.Added "Legal and Regulatory
References" and "Approval History" in line with
changes required to submit to new
protocol/procedure management system
PowerDMS.
8/27/2020 2.6 Annual Review—No revisions Brittany Hunt, Executive
Assistant to the Human
Services Board
9/26/2019 2.6 Reviewed corrections—No revisions Brittany Hunt, Executive
Assistant to the Human
Services Board
8/22/2019 2.6 Reviewed - Page 1, changed benchmark Brittany Hunt, Executive
activities listed from 31.1a and 34.5 to 35.1. Assistant to the Human
The accreditation benchmark activities had Services Board
changed over time and needed to be corrected
to reflect the current benchmark activities.
9/27/2018 2.5 Section Ill #7—Deleted first line listed in the Debra Baker, Executive
location "Office of the Human Services Assistant to the Human
Director, Room 5035". Listed the Wake County Services Board
Human Services Center at 220 Swinburne St.,
Raleigh, NC 27620 as the location if not
specified.
8/24/2017 2.4 Annual Review—No revisions Debra Baker, Executive
Assistant to the HS Board
8/22/2016 2.4 Page 3,#11,changed word to "shall" from Kenneth Murphy, Assistant
"may"to read "A representative of the County County Attorney
Attorney's Office shall be present"
Page 7 of 8
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Health and Human Services/Environmental Services HS Procedure BOARD 300 2.7
7/23/2015 Title Amended the title Amina Shah, Executive
from Assistant to HS Board
"Wake County Human Services
Wake County Environmental Services
Rules of Appeal"
to
"Wake County Human Services Board
Rules of Appeal"
4/2015 2.3 Reviewed—Changed Benchmark references B. Gunter, Division of
from "31.5a" to "35.1a" Administration
6/2014 2.2 Reviewed—No Changes B. Gunter, Division of
Administration
7/12/2013 2.2 Section—Section(s) Revised -corrected date for Laura Jernigan, Interim
"Replaces former rules of appeal" to 3/28/2002 Executive Assistant to the
instead of#/28/2002. Human Services Board per
-Corrected date for Regina Petteway's revisions discussion with Regina
to 2/12/2013 instead of 7/11/2013. Petteway, Director for
Administration.
7/11/2013 2.2 Section 1—Purpose, added "This document Regina Petteway, Director for
meets requirements or partial Administration per Board
requirements for Public Health Discussion/Instructions with
Accreditation Benchmarks 31.5a and 34.5." County Attorney at the June
Section 11.1.c—Added "or the Director's 2013 Human Services Board
Delegate or Designee", removed word "his" Meeting
Section I1.2.a,Added "or the Director's
Delegate or Designee"
Section 11.4,Added "or the Director's Delegate
or Designee"
Section 111.7, added "Office of the Human
Services Director, Room 5035"
6/27/2013 2.1 Section I,Added director"or designee" Scott Warren & Ken Murphy.
Section 1I.6.a, Added "or designee" Reviewed by Sue Ledford and
Section 11.9d—Added paragraph Joseph Threadcraft
Section II 12, Added "deliberate in open
session and"
Section 111.4.Added definition of Designee
12/2012 2.0 Reviewed—No changes Sue Lynn Ledford
8/25/2011 2.0 Replaced former Rules of Appeal approved on Scott Warren, Matt Roylance,
3/28/2002 Sue Lynn Ledford
Page 8 of 8
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Attachment C
Letter Requesting Coverage Under the General Permit

ANA/T
Engineers and Soil Scientists
Agri-Waste Technology,Inc.
501 N Salem Street,Suite 203,Apex, NC 27502
agriwaste.com I 919.859.0669
April 19,2024
Mr. John Hennessy
NPDES Permitting Program
Division of Water Quality
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
RE: Application for Discharge System—Jacobs Residence
1401 W Academy St,Fuquay-Varina,NC 27526
Dear Mr. Hennessy;
Please consider this letter as a request for coverage under the General Permit for a Multi-
Phase Filter System. The proposed discharge system is for a 4-Bedroom Single Family
Residence (SFR) located in Wake County, North Carolina. The proposed discharge
system will replace the failing, county permitted subsurface system that currently serves
the residence. The site has been deemed unsuitable for ground absorption sewage
treatment systems by the Wake County Environmental Services due to unsuitable soil
characteristics. The proposed system is to be sized for 4 bedrooms at 480 gallons/day.
The residence is located at 1401 W Academy St, Fuquay-Varina,NC 27526.
Thank you for your assistance in this matter.
Sincerely,
Kevin D. Davidson,P.E.
V.P. of Engineering

Attachment D
Letter Requesting Authorization to Construct

AMR"
Engineers and Soil Scientists
Agri-Waste Technology,Inc.
501 N Salem Street,Suite 203,Apex, NC 27502
agriwaste.com I 919.859.0669
April 19,2024
Mr. John Hennessy
NPDES Permitting Program
Division of Water Quality
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
RE: Application for Discharge System—Jacobs Residence
1401 W Academy St,Fuquay-Varina,NC 27526
Dear Mr. Hennessy;
Please consider this letter as a request for an Authorization to Construct a Multi-Phase
Filter System. The proposed discharge system is for a 4-Bedroom Single Family
Residence (SFR) located in Wake County, North Carolina. The proposed discharge
system will replace the failing, county permitted subsurface system that currently serves
the residence. The site has been deemed unsuitable for ground absorption sewage
treatment systems by the Wake County Environmental Services due to unsuitable soil
characteristics. The proposed system is to be sized for 4 bedrooms at 480 gallons/day.
The residence is located at 1401 W Academy St, Fuquay-Varina 27526.
Thank you for your assistance in this matter.
Sincerely,
Kevin D. Davidson,P.E.
V.P. of Engineering

Attachment E
AWT Soil Evaluation Report

OIL S.
Engineers and Soil Scientists f$Yoi� R,<F �
�: \'
Agri-Waste Technology, Inc. 4 a /1
.41
501 N. Salem Street, Suite 203 ,1�
Apex, North Carolina 27502 " , ;" ': '
919-859-0669
%
www.agriwaste.com 132401,
March 5, 2024
Soils Evaluation Summary
TO: Douglas Jacobs, Client
FROM: Chris McGee, LSS
SUBJECT: Soils Evaluation for 1401 W Academy St, Fuquay-Varina,NC (Wake County)
Agri-Waste Technology, Inc. (AWT)was contracted to perform a soils and site evaluation for
the purpose of on-site wastewater system suitability at the subject property in Fuquay-Varina,
NC. The evaluation was performed by Chris McGee of AWT. A single-family residence with a
failing subsurface system is located on the property. The lot has been evaluated by the Wake
County Environmental Services and deemed to be unsuitable for any subsurface on-site
wastewater system option.
The soils on the subject properties are unsuitable for conventional and alternative subsurface
wastewater systems due to unsuitable soil wetness condition, insufficient available space, and
unsuitable soil depth. Surface application/irrigation systems do not qualify for this lot due to
insufficient space based on required setbacks, slope, and depth to restrictive features limiting soil
water movement.
Therefore, the property does not comply with the requirements of 15A NCAC 18A Section
.1900—Sewage Treatment and Disposal Systems -or- 15A NCAC 02T Section .0600—SFR
Wastewater Irrigation Systems. The site is a likely candidate for a surface water discharge
system.
Please contact us with any questions, concerns, or comments.

Attachment F
1. Correspondence from USGS
2. Stream Classification

Doug Jacobs-7Q10/30Q2 Flow Report Request
Region ID: NC
Workspace ID: NC20240403173659613000
Clicked Point(Latitude, Longitude): 35.57302,-78.83710
Time: 2024-04-03 13:37:23-0400
.. _ tU
m -
u Kmghtwood Ro 4
of .4\
s
F �''.'.�._.
r
eta
,.1. F•,rr pa
' Hal 1 r iCk{r>
lit ,
Y�
oar
h,
1(:N. ; 0 Dr"
1.'Mims Ro =
+J \
The drainage area for the discharge location is-0.15 square miles.This requires an official request from the USGS to
determine the 7Q10/30Q2 for the area marked on the map above.
O Collapse All
Basin Characteristics
Parameter Code Parameter Description Value Unit
DRNAREA Area that drains to a point on a stream 0.15 square miles
124H50Y Maximum 24-hour precipitation that occurs on average once in 50 years 7 inches
LCO6IMP Percentage of impervious area determined from NLCD 2006 impervious dataset 5.01 percent
PCTREG1 Percentage of drainage area located in Region 1 -Piedmont/ Ridge and Valley 0 percent
PCTREG2 Percentage of drainage area located in Region 2-Blue Ridge 0 percent
PCTREG3 Percentage of drainage area located in Region 3-Sandhills 0 percent 1
PCTREG4 Percentage of drainage area located in Region 4-Coastal Plains 100 percent
PCTREGS Percentage of drainage area located in Region 5-Lower Tifton Uplands 0 percent
Peak-Flow Statistics
Peak-Flow Statistics Parameters [Region 4 CoastalPlain rural under 1 sqmi 2014 5030]
Parameter Code Parameter Name Value Units Min Limit Max Limit
DRNAREA Drainage Area 0.15 square miles 0.1 1
LCO6IMP Percent Impervious NLCD2006 5.01 percent 0.2 34.8
124H50Y 24 Hour 50 Year Precipitation 7 inches 6.51 10.9

Peak-Flow Statistics Parameters [Peak Southeast US NC 2023 5006]
Parameter Code Parameter Name Value Units Min Limit Max Limit 1
PCTREG1 Percent Area in Region 1 0 percent 0 100
PCTREG2 Percent Area in Region 2 0 percent 0 100
PCTREG3 Percent Area in Region 3 0 percent 0 100
PCTREG5 Percent Area in Region 5 0 percent 0 100
DRNAREA Drainage Area 0.15 square miles 0.08 8902
PCTREG4 Percent Area in Region 4 100 percent 0 100
Peak-Flow Statistics Flow Report [Region 4 CoastalPlain rural under 1 sqmi 2014 5030]
PIL: Lower 90%Prediction Interval, PIU: Upper 90%Prediction Interval,ASEp:Average Standard Error of Prediction,SE: Standard Error
(other--see report)
Statistic Value Unit PIL PIU ASEp
50-percent AEP flood 24 ft"3/s 10.8 53.1 40.8
20-percent AEP flood 41.3 ft^3/s 20 85.3 36.9
10-percent AEP flood 54.5 ft^3/s 26.8 111 36.7
4-percent AEP flood 72.4 ft"3/s 34.4 152 38.2
2-percent AEP flood 86.4 ft"3/s 39.7 188 40.2
1-percent AEP flood 101 ft"3/s 44.4 230 42.7
0.5-percent AEP flood 116 ft"3/s 48.3 278 45.4
0.2-percent AEP flood 136 ft 3/s 52.5 352 49.9
Peak-Flow Statistics Flow Report [Peak Southeast US NC 2023 5006]
PIL: Lower 90%Prediction Interval, PIU: Upper 90% Prediction Interval,ASEp:Average Standard Error of Prediction,SE:Standard Error
(other--see report)
Statistic Value Unit PIL PIU ASEp
50-percent AEP flood 19.4 ft^3/s 10.6 35.5 36.8
20-percent AEP flood 39.8 ft^3/s 22.3 71 35.8
10-percent AEP flood 58.4 ft^3/s 32.5 105 36.3
4-percent AEP flood 85.8 ft"3/s 45.7 161 38.4
2-percent AEP flood 112 ft^3/s 59.1 212 39.8
1-percent AEP flood 139 ft"3/s 71.8 269 41.3
0.5-percent AEP flood 168 ft^3/s 84.8 333 42.8
0.2-percent AEP flood 208 ft^3/s 103 422 44.4
Peak-Flow Statistics Citations
Feaster,T.D.,Gotvald,A.J.,and Weaver,J.C.,2014,Methods for estimating the magnitude and frequency of floods for urban and small,
rural streams in Georgia,South Carolina,and North Carolina,2011 (ver. 1.1,March 2014):U.S. Geological Survey Scientific Investigations
Report 2014-5030, 104 p. (http://pubs.usgs.gov/sir/2014/5030/)
Feaster,T.D.,Gotvald,A.J., Musser,J.W.,Weaver,J.C,Kolb,K.R.,Veilleux,A.G.,and Wagner, D.M.2023,Magnitude and frequency of
floods for rural streams in Georgia,South Carolina,and North Carolina,2017-Results:U.S.Geological Survey Scientific Investigations
Report 2023-5006,75 p.(https://pubs.er.usgs.gov/publication/sir20235006)
USGS Data Disclaimer:Unless otherwise stated,all data,metadata and related materials are considered to satisfy the quality standards relative to the purpose for which the data were
collected.Although these data and associated metadata have been reviewed for accuracy and completeness and approved for release by the U.S.Geological Survey(USGS),no warranty
expressed or implied is made regarding the display or utility of the data for other purposes,nor on all computer systems,nor shall the act of distribution constitute any such warranty.
USGS Software Disclaimer:This software has been approved for release by the U.S.Geological Survey(USGS).Although the software has been subjected to rigorous review,the USGS reserves
the right to update the software as needed pursuant to further analysis and review.No warranty,expressed or implied,is made by the USGS or the U.S.Government as to the functionality of
the software and related material nor shall the fact of release constitute any such warranty.Furthermore,the software is released on condition that neither the USGS nor the U.S.Government
shall be held liable for any damages resulting from its authorized or unauthorized use.
USGS Product Names Disclaimer:Any use of trade,firm,or product names is for descriptive purposes only and does not imply endorsement by the U.S.Government.

Application Version:4.19.4
StreamStets Services Version:1.2.22
NSS Services Version:2.2.1

Niko Carranza
From: Julie Davidson
Sent: Wednesday, April 24, 2024 9:34 AM
To: Niko Carranza; Bryan Isherwood; Isabel Manson
Subject: Fwd: USGS response to DWR USGS Low Flows request#2024-327 (dated 2024/04/08)
for UT Kenneth Creek Wake County...RE: [EXTERNAL] Low-flow request approval
Follow Up Flag: Follow up
Flag Status: Flagged
Doug Jacobs 7Q10-30Q2 report
Julie Davidson
Sr. GIS Analyst
Cell: 919.971.2326
Office: 919.376.6315
From:Weaver,John C<[e-mail]>
Sent:Tuesday,April 23, 2024 5:43:06 PM
To:Julie Davidson<[e-mail]>
Cc: Kebede,Adugna <[e-mail]>; Montebello, Michael J<[e-mail]>; Denard,
Derek<[e-mail]>; Litzenberger, Kristin S<[e-mail]>; Dowden, Doug
<[e-mail]>;Albertin, Klaus P<[e-mail]>; Weaver,John C<[e-mail]>
Subject: USGS response to DWR USGS Low Flows request#2024-327 (dated 2024/04/08)for UT Kenneth Creek Wake
County...RE: [EXTERNAL] Low-flow request approval
Ms. Davidson,
In response to your inquiry about the low-flow characteristics for a location on unnamed tributary to Kenneth Creek just
downstream from West Academy Street(NC Highway 42)southeast of Fuquay-Varina in southern Wake County, the
following information is provided:
A check of the low-flow files here at the USGS South Atlantic Water Science Center(SAWSC, Raleigh office)does not
indicate a previous low-flow determination for the point of interest, identified by the lat/long coordinates(35.57302, -
78.83710) provided via email dated 04/08/2024 from the DWR USGS Low Flows portal following your request
submission.
No USGS discharge records are known to exist for the point of interest.
In the absence of site-specific discharge records sufficient for a low-flow analysis,estimates of low-flow characteristics at
ungaged locations are determined by assessing a range in the low-flow yields(expressed as flow per square
mile drainage area,or cfsm)at nearby sites where estimates have previously been determined.
A basin delineation completed using the online USGS StreamStats application for North Carolina
(https://streamstats.usgs.gov/ss/) indicates the drainage area for the point of interest(StreamStats adjusted
coordinates 35.57301, -78.83713 NAD83) is 0.15 sqmi, which confirms the drainage area submitted as part of the
request information.
i

For streams in southern Wake County, low-flow characteristics published by the USGS are provided in the following
reports:
(1)The first is a statewide report completed in the early 1990's. It is USGS Water-Supply Paper 2403, "Low-flow
characteristics of streams in North Carolina" (Giese and Mason, 1993). An online version of the report is available at
http://pubs.usgs.gov/wsp/2403/report.pdf. The report provides the low-flow characteristics (based on data through
1988)via regional relations and at-site values for sites with drainage basins between 1 and 400 sqmi and not considered
or known to be affected by regulation and/or diversions.
(2)The second is a basin-wide report for the Neuse River basin published in 1998. It is USGS Water-Resources
Investigations Report 98-4135, "Low-flow characteristics and discharge profiles for selected streams in the Neuse River
basin, North Carolina" (Weaver, 1998). The report is available online at
http://pubs.usgs.gov/wri/1998/4135/report.pdf. This report provides low-flow characteristics(based on data through
1996)for USGS continuous-and partial-record sites in the Neuse River basin where sufficient data was available for
analyses. However,the report does not provide statistical relations for estimating low-flow characteristics at ungaged
locations.
(3)The third is a basin-wide report for the Cape Fear River basin published in 2001. It is USGS Water-Resources
Investigations Report 01-4094, "Low-flow characteristics and discharge profiles for selected streams in the Cape Fear
River Basin, North Carolina,through 1998 " (Weaver and Pope, 2001). An online version of the report is available
through http://nc.water.usgs.gov/reports/wri014094/. The report provides the low-flow characteristics(based on data
through 1998)for continuous-record gaging stations and partial-record sites within the Cape Fear River basin. The
report also provides low-flow discharge profiles(7Q10, 30Q2,winter 7010, and 7Q2)for the Cape Fear River and
selected tributaries within the basin.
(4)The fourth is a statewide report published in March 2015. It is USGS Scientific Investigations Report 2015-5001,
"Low-flow characteristics and flow-duration statistics for selected USGS continuous-record streamgaging stations in
North Carolina through 2012" (Weaver, 2015). The report is available online at
http://pubs.usgs.gov/sir/2015/5001/. The report provides updated low-flow characteristics and flow-duration statistics
for 266 active (as of 2012 water year)and discontinued streamgages across the state where a minimum of 10 climatic
years discharge records were available for flow analyses.
Low-flow characteristics estimated for point of interest:
For the record: Plotting the location for the point of interest against an overlay of the underlying geologic units(North
Carolina Geological Survey, 1985) places the point of interest in vicinity of the transition from the poorly drained soils
(Triassic basin geologic unit) in western Wake County to the moderately well-drained soils underlain by granitic rocks
more characteristic in central and eastern Wake County.
For the record:There are very limited USGS streamflow records for small to very small basins in North Carolina.
Inspection of the above reports indicates the presence of seven (7) nearby selected USGS partial-record sites(7) and
continuous-record streamgages(0)across southeast Wake County and northern Harnett County in relatively close
vicinity of the point of interest where low-flow characteristics were published. Among these 7 index sites,the low-flow
discharge yields for the indicated flow statistics are as follows:
Annual 7Q10 low-flow yields==>from 0 to 0.012 cfsm (average about 0.0026 cfsm, median about 0 cfsm) (zero flow at 4
of 7 index sites)
Annual 30Q2 low-flow yields==>from 0.0078 to 0.14 cfsm (average about 0.056 cfsm, median about 0.021 cfsm)
Winter 7Q10 low-flow yields==>from 0.0057 to 0.098 cfsm (average about 0.036 cfsm, median about 0.021 cfsm)
2

Annual 7Q2 low-flow yields==>from 0 to 0.075 cfsm (average about 0.025 cfsm, median about 0.011 cfsm) (zero flow at
1 of 7 index sites)
Average annual discharge yields==>from 1.1 to 1.2 cfsm (both average and median about 1.1 cfsm)
Application of the above range in yields to the drainage area (0.15 sqmi)for the point of interest results in the following
estimated low-flow discharges:
Annual 7010 low-flow discharges==>from 0 to 0.0046 cfs(average about 0.00099 cfs, median about 0 cfs)
Annual 30Q2 low-flow discharges==>from 0.003 to 0.053 cfs(average about 0.021 cfs, median about 0.008 cfs)
(rounded down to zero flow)
Winter 7Q10 low-flow discharges==>from 0.0022 to 0.037 cfs(average about 0.014 cfs, median about 0.008 cfs)
(rounded down to zero flow)
Annual 7Q2 low-flow discharges==>from 0 to 0.029 cfs(average about 0.0095 cfs, median about 0.0042 cfs) (rounded
down to zero flow)
Average annual discharge discharges==>from 0.42 to 0.46 cfs(both average and median about 0.42 cfs)
Please note:
(1)The estimated flows are provided in units of cubic feet per second (cfs).
(2)The low-flow yields provided above are rounded to 2 significant figures. Estimated low-flow discharges less than 1
cfs are rounded to 2 significant figures. If between 1 and 100 cfs,then rounded to 1 decimal place; if greater than 100,
then rounded to the nearest whole number(zero decimal places).
(3)The information provided in this message is based on a preliminary assessment and considered provisional, subject
to revision pending collection of future data and further analyses.
These provisional streamflow statistics are provided via the DWR USGS Low Flows cooperative agreement between
the USGS and the N.C. Department of Environmental Quality, Division of Water Resources.
Hope this information is helpful.
Thank you.
Curtis Weaver
J. Curtis Weaver, PE
Assistant Director for Data- North Carolina
USGS South Atlantic Water Science Center(GA-SC-NC)
3916 Sunset Ridge Road I Raleigh, NC 27607
Mobile: [phone]
From:Albertin, Klaus P<[e-mail]>
Sent: Monday,April 8,2024 11:27 AM
To:[e-mail]
Cc:Weaver,John C<[e-mail]>;Albertin, Klaus P<[e-mail]>; Kebede,Adugna
<[e-mail]>; Montebello, Michael J <[e-mail]>; Denard, Derek
3

<[e-mail]>; Litzenberger, Kristin S<[e-mail]>; Dowden, Doug
<[e-mail]>
Subject: [EXTERNAL] Low-flow request approval
This email has been received from outside of DOI - Use caution before clicking on links, opening
attachments, or responding.
Your request has been approved and will be forwarded to USGS. A response from USGS usually takes 7 -
10 business days.
Request Flow Statistic Approval
Request ID: 327
Requestor: Doug Jacobs
Requestor e-mail:[e-mail]
Requestor Phone: [phone]
Local Government:
Public Water Supply:
Consultant: Agriwaste Technology
Contact: Julie Davidson
Reason: NCG550000 requirement
River/Stream: unnamed tributary to Kenneth Creek
Drainage Area (sq. mi.): 0.15
Latitude: 35.57302
Longitude: -78.83710
Other Information:
Statististics: ["7Q10","30Q21
Approved by: Albertin, Klaus P
4

Email correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties by an authorized
state official.
5

Stream Classification
fe Mat ircJt Ln
J.KA Y 1 km Kt karo ws se
P i
ee Or
fi
O
Malisse I r.
'%, Surface Water Classifications: m .. a
0
p,.
�, (vs=o..m s sk
ra
`Qrf. Stream Index. 18 16 1(1) a
Stream Name. Kenneth Crock
Descnpt on From source to Wake Hamer.
County Dnc 1j
Class heat an C ` �?
f
yap»1" Date of Class. July 3t,1998
Whet does th':s Class.means s
R.ver Basin. Cape fear
144,
r au.'se y—cn
Source: NC DEQ: DWR Surface Water Classification Map

Attachment G
Flow Path to "Blue Line" Water Feature

Flow Path to Classified Water
, �: t , \ ...
Discharge Point:Directly to OP i ' L �`;��,,�I,", ����
`11/4, r '
l Stream on Subject Property . (�
11111P IOW
s ....
, --,,,,,
mi
toi of „„,. .., ......,„ 4„„
I ` �. �'� IN ao
I�Nail .. lot
,' ,. t- �`iti��=i gm ra +IIUnnamed Tributary Converges
IIV
� \ -s AIN A._... ��. �= �=al 7 with Kenneth Creek
iiifr
41111 , ,4k Pia 7- ' /443 num — — "op%
iieswght 4, •40Not _-\\-",, _ _ A.
MIN an
: / .. ` � �� �j� �� ♦ I
Unnamed Tributary
to Kenneth Creek, ' ow& if', v '
1 , lk 1 kS $7 IIII
,0 -
mil, _ j/,
4_ , pl .__ ,
1
Stream Index: 18-16-1-(1)
Stream Name: Kenneth Creek
Stream Classification: C
Image Source: Wake County iMAPS

Attachment H
Information on Connection to a Regional Sewer System

Nicholas Carranza
From: Michael Wagner <[e-mail]>
Sent: Friday, April 5, 2024 11:46 AM
To: Niko Carranza
Subject: Re: Sewer Availability Request
Follow Up Flag: Follow up
Flag Status: Flagged
Good morning. Please see a link to our GIS and/or see the image below.https://www.fuquay-
varina.org/800/Maps-Geographic-Information-GIS
Maps &amp; Geographic Information (GIS) Fuquay-Varina, NC
View a varietyof local maps displayingthe features of the Fu ua -Varina community.
p q Y Y
www.fuquay-varina.org
1

, ,/.."`
,..,,i4,--;,,,,, \ \\1\-1,1„.3
Knigotw ad Rd cSit
--A41%oil i ..1
/MAIN re
01117111 Po 6i I
II 3
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ar
g` grarlimily ------ fitRNET 1 COUNTY
� MAi4TER BOOSTER
\Ili i TATI ,,,
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/ ,4011110.
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iiii,
FV PARCEL: 1401 W ACADEMY ST
}4404011111111111pri". ! ADDRESS
EID 020070
REID PROPERTY More info
LINK
• GOOGLE MAP LINK More info
.,777,
D o r-N D D[?"r\! I f"1') D L7 fl D f
2

Michael Wagner 1415 Holland Road
Public Utilities Director Fuquay-Varina, NC 27526
Town of Fuquay-Varina www.fuquay-varina.org
Office: Facebook Instagram Twitter
E-mail correspondence to and from this address is subject to North
Carolina's Public Records Act, N.C. Gen.Stat. Sec. 132, and may be
disclosed to third parties. However Federal and State law protects
personal health and other information that may be contained in this
e-mail from unauthorized disclosure. If you are not the intended
recipient, please delete this e-mail and any accompanying
documents and contact the sender immediately. Unauthorized
disclosure, copying or distribution of any confidential or privileged
content of this e-mail is prohibited.
From: Niko Carranza <[e-mail]>
Sent: Friday,April 5, 2024 10:25 AM
To: Michael Wagner<[e-mail]>
Subject: RE: Sewer Availability Request
CAUTION:This email originated from outside of the organization. Do not click links or open attachments
unless you recognize the sender and know the content is safe.
Good morning Mr.Wagner,
Thank you very much for this information!Would you also happen to know how far the closest sewer line is to this
location (1401 W Academy St, Fuquay-Varina, NC 27526)?
Thanks again,
AWT Niko Carranza
Assistant Project Engineer
[e-mail] I Direct:919.729.5782
Engineers and Soil Scientists
Agri-Waste Technology,Inc.(AWT)
501 N.Salem Street,Suite 203,Apex, NC 27502
agriwaste.com I Office:919.859.0669
From: Michael Wagner<[e-mail]>
Sent: Wednesday, April 3, 2024 2:54 PM
To:Jonathan Joyner<[e-mail]>; Nicholas Carranza <[e-mail]>
Subject: Re: Sewer Availability Request
Mr. Carranza,
Good afternoon. The Town has no projects in the next ten years to extend sewer in this area. Sewer could
be extended by a developer to the parcel to the east before the Town gets to that point. As an FYI, the
3

property needs to be annexed into the Town prior to connection to water and sewer and pay applicable
fees.
Please let me know if you have any additional questions.
Thanks,
Mike
Michael Wagner 1415 Holland Road
Public Utilities Director Fuquay-Varina, NC 27526
Town of Fuquay-Varina www.fuquay-varina.orq
Office: Facebook Instagram Twitter
E-mail correspondence to and from this address is subject to North
Carolina's Public Records Act, N.C. Gen.Stat. Sec. 132,and may be
disclosed to third parties. However Federal and State law protects
personal health and other information that may be contained in this
e-mail from unauthorized disclosure. If you are not the intended
recipient, please delete this e-mail and any accompanying
documents and contact the sender immediately. Unauthorized
disclosure, copying or distribution of any confidential or privileged
content of this e-mail is prohibited.
From:Jonathan Joyner<[e-mail]>
Sent:Wednesday, April 3, 2024 1:15 PM
To: Nicholas Carranza <[e-mail]>; Michael Wagner<[e-mail]>
Subject: Re: Sewer Availability Request
Mr. Carranza,
Thanks for reaching out to me about information for this address, however, I can not answer your
questions. I have included our utilities director, Micheal Wagner, and he will be able to assist you further.
Jonathan
Jonathan Joyner 1415 Holland Road
Sewer Collection System Fuquay-Varina, NC 27526
Supervisor www.fuquay-varina.orq
Town of Fuquay-Varina Facebook Instagram Twitter
Office:
x
E-mail correspondence to and from this address is subject to North
Carolina's Public Records Act, N.C. Gen. Stat. Sec. 132, and may be
4

disclosed to third parties. However Federal and State law protects
personal health and other information that may be contained in this
e-mail from unauthorized disclosure. If you are not the intended
recipient, please delete this e-mail and any accompanying
documents and contact the sender immediately. Unauthorized
disclosure, copying or distribution of any confidential or privileged
content of this e-mail is prohibited.
From: Nicholas Carranza <[e-mail]>
Sent:Wednesday,April 3, 2024 11:55 AM
To:Jonathan Joyner<[e-mail]>
Subject:Sewer Availability Request
CAUTION:This email originated from outside of the organization. Do not click links or open attachments
unless you recognize the sender and know the content is safe.
Hello Jonathan,
I'm working a wastewater treatment system design for the Jacobs residence, and I have a sewer availability
request for the address of 1401 W Academy St, Fuquay-Varina, NC 27526(Wake Co PIN 0646834697). Could
you please let me know the approximate distance to the nearest sewer location?Also, if there are any plans for a
sewer line expansion towards the property in the next 5 years?
Thank you,
Niko Carranza
Assistant Project Engineer
[e-mail] I Direct:919.729.5782
Engineers and Soil Scientists
Agri-Waste Technology,Inc.(AWT)
501 N.Salem Street,Suite 203,Apex,NC 27502
agriwaste.com I Office:919.859.0669
5

Attachment I
Engineering Alternatives Analysis

Engineers and Soil Scientists
Agri-Waste Technology, Inc.
501 N Salem Street, Suite 203,Apex, NC 27502
agriwaste.com I 919.859.0669
Engineering Alternatives Analysis
Jacobs Residence
1401 W Academy St.
Fuquay-Varina, NC 27526
Wake County
Q SEAL ` s ri pi.
024582 -.046-1�(
•
Date: May 10, 2024
Design Engineer: Kevin Davidson, P.E.
Agri-Waste Technology, Inc.
501 N. Salem Street, Suite 203
Apex, NC 27502
Office: 919-859-0669

Engineering Alternatives Analysis (EAA) Guidance Document
North Carolina Division of Water Resources
STEP 1. Determine if the proposed discharge will be allowed
Before beginning any engineering evaluation of alternatives, you must first determine if the proposed
wastewater discharge will be allowed. Otherwise, time and money may be spent needlessly for an EAA
preparation that will ultimately be rejected on the basis of existing water quality restrictions. There are
several potential restrictions to a wastewater discharge to surface waters,including:
• Zero flow stream restrictions [15A NCAC 2B.0206(d)(2)] apply to oxygen-consuming waste in
zero-flow streams. In order to determine streamflow at the proposed discharge location, contact
the U.S. Geological Survey at 919-571-4000.
• Receiving stream classification restrictions [e.g., ORW, WS, SA, NSW, and HQ class waters
have various discharge restrictions or require stricter treatment standards]. Stream
classifications are available on the the DWR Classification and Standards/Rule Review Branch
website: (http://portal.ncdenr.org/web/wq/ps/csu), while wastewater discharge restrictions
for various stream classifications are presented in state regulations [ 15A NCAC 2B.0200].
• Basinwide Water Quality Plans. These basin-specific plans list NPDES permitting strategies
that may limit wastewater discharges to particular streams within the basin due to lack of stream
assimilative capacity,etc. Basin plans are available on the DWR website,or you may contact the
DWR Basinwide Planning Branch (http://portal.ncdenr.org/web/wq/ps/bpu)..
• Impaired waters and TMDLs. Certain waterbodies listed as impaired on the 303(d) list and/or
subject to impending TMDLs may have wastewater discharge restrictions. The list of 303(d)
impaired waters is located on the DWR website, or you may contact the DWR Modeling and
Assessment Branch (http://portal.ncdenr.org/web/wq/ps/mtu).
• Presence of Endangered Species. If endangered species are present in the proposed discharge
location, there may be wastewater discharge restrictions. Endangered species information may
be included in the Basinwide Water Quality Plan, or you may contact the U.S. Fish and Wildlife
Service (919-856-4520),N.C. Wildlife Resources Commission (919-733-3633), or the N.C. Natural
Heritage Program (919-733-7701).
Municipal applicants.
As a public service, the NPDES Unit will evaluate whether a proposed municipal discharge is considered
allowable. The municipality needs to initiate this review by submitting a letter request for Speculative
Effluent Limits to the NPDES Unit. You must obtain streamflow estimates for the proposed discharge
location to ensure that the receiving stream is not subject to zero flow restrictions. Low flow data
(specifically, drainage area, summer and winter 7Q10, average flow and 30Q2 flow statistics) can be obtained
for a nominal fee from the U.S. Geological Survey in Raleigh at 919-571-4000. The low flow data must be
submitted with the speculative limits request letter. If the proposed discharge appears to be allowable, the
NPDES Unit will prepare speculative effluent limits for a maximum of 2 flows and 2 discharge locations using
water quality models. The municipality can then use the speculative limits to prepare preliminary
engineering design and cost estimates for the direct discharge alternative within the EAA. In limited
instances where complex water quality models are necessary to develop speculative limits and determine
potential water quality impacts, some municipalities have undertaken the modeling effort (with DWR review)
in order to expedite this portion of the NPDES permit review process.
Response: N/A Non-municipal applicant
EAA Guidance Document Revision: October 2019
Page 1 of 12

Non-municipal applicants.
Due to staff constraints, the NPDES Unit cannot prepare speculative limits for non-municipal applicants.
Thus,it is your responsibility to make your own determination as to whether the proposed discharge might be
allowed by the Division, by evaluating the water quality factors listed above. It is highly recommended that
you discuss the proposed discharge with the applicable DWR Regional Office and/or NPDES Unit staff,who
may be able to provide input on the likelihood of a new/expanding discharge. As a first step, you must
obtain streamflow estimates for the proposed discharge location to ensure that the receiving stream is not
subject to zero flow restrictions. Low flow data (specifically, drainage area, the summer and winter 7Q10,
average flow and 30Q2 flow statistics) can be obtained for a nominal fee from the U.S. Geological Survey in
Raleigh at 919-571-4000. The low flow data must be submitted with the EAA, and will be used by the permit
writer to develop permit limits. You must also verify that the proposed action (i.e., construction of a
wastewater treatment plant and its appurtenances) is consistent with local zoning and/or subdivision
ordinances. You will need to request the local government(s) to complete a Local Government Review Form
(Attachment A), and include the signed and notarized form with your NPDES application package.
Response: The United States Geological Survey (USGS) was contacted to determine the 7Q10 flow estimate for the
downstream tributary of the proposed wastewater discharge point. The proposed discharge location is to an
unnamed tributary on the northwest corner of the property that flows to Kenneth Creek. The analysis from USGS
indicates the 7Q10 discharge for the point in question is between 0 and 0.0046 cfs(Appendix G of package).
All applicants.
If you conclude that the proposed discharge will pass the "allowable discharge" criteria, then begin the EAA
preparation by summarizing the following general information about the proposed project:
• Provide a description of the proposed project. If the project will be constructed in phases,
provide a schedule for constructing each additional phase, and provide the projected flow per
phase (see STEP 2).
Response: A wastewater discharge system is to be constructed for a 4-Bedroom Single Family Residence (SFR) located in
Wake County, North Carolina. The proposed system will replace a failing, county permitted system that
currently serves the residence. The proposed discharge location is onto an unnamed tributary on the northwest
corner of the property that flows to Kenneth Creek. The proposed treatment system will utilize the following
components:
Septic Tank with Effluent Filter
Recirculation Pump Chamber(Integrated into AdvanTex Pod System)
Discharge Pump Chamber(Integrated into AdvanTex Pod System)
AdvanTex AX-20-RT pod
UV Disinfection
Discharge Point with Rip-Rap
Construction of the proposed system will occur in a single phase with an anticipated completion time of
approximately 2 weeks after the start of construction activity.
• Applicant name,mailing address,phone number,contact person
Response: Applicant Information:
Name: Douglas Jacobs
Mailing Address: 1401 W Academy St.
Fuquay-Varina,NC 27526
Phone Number: 919-612-1532
Contact Person: Douglas Jacobs
EAA Guidance Document Revision: October 2019
Page 2 of 12

• Facility name, address,county,phone number,contact person
Response: Facility Information:
Name: Jacobs Residence Surface Discharge
Address: 1401 W Academy St.
Fuquay-Varina,NC 27526
County: Wake
Phone Number: 919-612-1532
• EAA preparer's name,mailing address, phone number,contact person
Response: EAA Preparer's Information:
Name: Kevin D. Davidson,P.E.
Mailing Address: Agri-Waste Technology, Inc.
501 N. Salem Street
Apex,NC 27502
Phone Number: 919-367-6310
Contact Person: Kevin D.Davidson,P.E.
STEP 2. Provide reasonable projections for population and flow
Residential Population Projections.
Facilities requesting an NPDES discharge permit for new or expanding domestic wastewater discharges
must document the population to be served within the service area over a 20-year planning period. The NC
State Demographics unit provides population data for each county and municipality and can be accessed on
the Internet at http://www.demog.state.nc.us. If 20-year population projections for specific areas are not
available, a linear extrapolation of population trends from the past decade should be used. Any deviation
from a linear projection method must be clearly justified. If population projections include future
annexations, include a proposed annexation schedule as well as any annexation requirements that must be
met.
Response: Because the wastewater treatment system is designed for a single-family residence, the population to be served
will be limited by the number of bedrooms at the individual residence. The existing house contains 4 bedrooms.
For the 20-year planning period, the system will be designed for a 4-bedroom residence with a flow of 480
gallons per day. At 2 people per bedroom,the system will be designed to serve 8 residents.
Municipal Flow Projections.
Justification of flow as well as a demonstration of need shall be provided. Mere speculation is not sufficient.
Flow projections should represent average anticipated flows, since permit flow limits are based on monthly
averages. Peaking factors used to design various components of the wastewater collection system (e.g.,
collector sewers, interceptor sewers,pumping stations) should not be used in the justification of the average
anticipated flow. For municipal wastewater dischargers, flow must be justified using the Clean Water Loan
Program (CWLP) Guidance for Preparing Engineering Reports available on the Internet at
http://portal.ncdenr.org/web/wi/cleanwater/er. Exceptions to these flow criteria may be approved on a
case-by-case basis provided adequate justification is supplied.
■ Current Flow- Provide current flows including residential, commercial, industrial, and
infiltration/inflow (I/I) based on actual flow data or water billing records. Current residential
flow and current commercial flow may be based on water billing records minus a 10%
consumptive loss. Current industrial flow may be based on dual metering to determine
consumptive losses.
• Future Residential Flow- Provide 20-year residential flows based on projected residential growth.
Multiply the projected growth in residential population by 70 gallons per day per capita.
EAA Guidance Document Revision: October 2019
Page 3 of 12

• Future Commercial Flow- Provide 20-year commercial flows based on projected residential
growth. Multiply the projected growth in residential population by 15 gallons per day per capita.
• Future Industrial Flow- Provide flow for future documented industrial flow. A nominal
allowance for future unplanned industrial expansions may be considered by the Division,
provided the basis is clearly justified and current land-use plans and local zoning allow for such
industrial growth.
Response: N/A Non-municipal applicant
Non-Municipal Flow Projections.
Flow may be justified in accordance with 15A NCAC 2H .0219(1) for various activities (e.g., new
subdivisions, new schools, various commercial activities). For other proposed discharges (e.g.,
groundwater remediation, water treatment plant filter backwash, industrial facilities), the flow projections
will be based on engineering design considerations and/or production projections rather than population
projections.
Response: Because the wastewater treatment system is designed for a single-family residence, the population to be served
will be limited by the number of bedrooms at the individual residence. The existing house contains 2 bedrooms.
For the 20-year planning period, the system will be designed for a 4-bedroom residence with a flow of 480
gallons per day. At 2 people per bedroom,the system will be designed to serve 8 residents.
STEP 3. Evaluate technologically feasible alternatives
Since a goal of the Clean Water Act is to minimize or eliminate point source discharges to surface waters,
any proposal for a new or expanding wastewater discharge must include evaluation of wastewater disposal
alternatives in addition to direct discharge. Particularly for dischargers of domestic wastewater, this
evaluation should investigate the feasibility of the following wastewater disposal alternatives:
• Connection to an existing wastewater treatment plant (public or private)
• Land application alternatives, such as individual/community onsite subsurface systems, drip
irrigation, spray irrigation
• Wastewater reuse
• Surface water discharge through the NPDES program
• Combinations of the above
In order for the applicant to eliminate a wastewater disposal alternative, you must either show that the
alternative is technologically infeasible, or that it would be cost prohibitive to implement relative to a direct
discharge alternative. Please note that for some alternatives, it might be easier to prove an alternative is not
viable based on high cost rather than technological feasibility. For example, for a large municipal expansion
that would require several hundred acres for a land application alternative, it might be easier to simply
assume that the required acreage could be purchased and calculate the present value costs (including current
market land costs) for this option, rather than evaluating whether land application is technologically
infeasible due to lack of available land and/or poor soil conditions. For those alternatives identified as
technologically feasible, you must develop and compare costs, based on a preliminary level design effort (see
STEP 4).
The Division recognizes that wastewater disposal alternatives may be limited for some non-domestic
wastewater scenarios, and a full alternatives evaluation may not be warranted. If there is some question as to
whether an alternative may be eliminated, contact the NPDES Unit staff. Some scenarios that might not
require a full alternatives evaluation include:
EAA Guidance Document Revision: October 2019
Page 4 of 12

• Water Treatment Plant Discharges. Discharges from water treatment plants (WTPs) that utilize
a membrane technology (e.g., reverse osmosis, nanofiltration) or ion exchange system tend to
generate highly concentrated wastestreams. These wastestreams are not amenable to land
application and do not have to be evaluated for this alternative. However, since these
wastestreams can also have a toxic impact on a receiving freshwater system, proposed new
discharges from these WTPs to freshwaters will not be considered for an NPDES permit unless
you can demonstrate that the environmental impacts would be minimal based on dilution
modeling. You should investigate whether the wastewater can be piped to a stream with
sufficient dilution, or whether a local WWTP might accommodate this discharge. Please note
that discharges from WTPs that utilize greensand filtration or conventional technology produce
a wastestream that is not saline, therefore no disposal alternatives can be automatically ruled out
as infeasible for these other WTPs. Refer to the NPDES website for permitting strategies for
reverse osmosis,ion exchange,greensand filtration, and conventional WTPs.
• Groundwater Remediation System Discharges. You will need to evaluate whether WWTP
connection, land application, infiltration galleries, in-situ groundwater remediation wells, or
closed-loop groundwater remediation wells are viable disposal alternatives. While land
application might be a feasible alternative in rural areas, it would not be a feasible alternative in
downtown Charlotte, where there is no land available for wastewater application. In this
instance, you may simply state that land application is infeasible based on land constraints
within the city. You will also need to evaluate connection to an existing WWTP (in accordance
with Alternative A), since there are some municipalities that have accepted this waste stream in
the past. If the municipality will not accept the waste stream, the connection alternative is also
considered technologically infeasible. Please note that in-situ and closed-loop groundwater
remediation wells are permittable well types and further guidance is available through the
Aquifer Protection Section.
Aside from these exceptions,you should proceed with the alternatives evaluation in accordance with the
following requirements. If you have any questions about these requirements,contact the NPDES Unit staff.
Alternative A. Connection to an Existing Wastewater Treatment System.
You must evaluate the feasibility of connecting to an existing wastewater treatment system served by a
municipality or other entity holding a valid NPDES or Non-Discharge Permit. All connection options
should include an evaluation of a gravity line and/or force main with pump station(s).
1. Existing Sewerage System:
(a) Identify whether there are existing sewer lines within a five-mile radius,or consider a greater
radius if cost effective for the project size.
Response: Connection to a sewer collection system is not feasible for this facility. Michael Wagner, Public Utilities Director
at Town of Fuquay-Varina, indicated that the nearest city-maintained sewer is approximately 3,500 linear feet
from the property. At an estimate of$150/ft, a sewer extension would cost over$525,000. There are no plans for
a sewer extension to the area.
(b) Provide a preliminary indication of flow acceptance from existing municipal or private
WWTPs under consideration for connection. If a municipal or private WWTP cannot accept
the wastewater, include a letter documenting such and consider this alternative
technologically infeasible.
Response: N/A No sewerage available
EAA Guidance Document Revision: October 2019
Page 5of12

(c) If an existing sewerage system will accept the wastewater, evaluate the
piping/pumps/resources necessary to connect to the existing wastewater treatment plant.
Attach a topographic map or a site drawing showing the physical route of this alternative.
Conduct a Present Value Cost Analysis per STEP 4.
Response: N/A No sewerage available
2. Planned Sewerage System: Determine if a regional sewerage system within a five-mile radius is
projected to be available within the next five years to receive waste from the project site. If
applicable, determine availability date and flow acceptance projection from appropriate
authority.
Response: As stated above,the property is not able to access city sewerage.
Alternative B. Land Application.
Land application disposal alternatives include individual/community onsite subsurface systems, drip
irrigation, and spray irrigation.
1. Provide an estimate of the best case hydraulic loading rate based on County Soil Surveys or from
a soil evaluation performed by a soil scientist. Include calculations showing the hydraulic
loading rate and the total area of land needed for the land disposal system,including buffers.
Response: Per the soil evaluation by Chris McGee of Agri-Waste Technology, Inc., the site does not have suitable soil to
accommodate a ground absorption or surface drip or surface spray wastewater system. (Appendix E of package)
Regardless of the fact that a subsurface ground absorption system cannot be designed or permitted for this site,
the potential size of a subsurface system has been estimated in the table below.
Subsurface Dripfield Design Alternative
# Bedrooms 4
Daily Flow 480 gpd = 120 gpd*#bedrooms
LTAR 0.1 gpd/sqft
Minimum Area Required (Nominal) 4,800 sqft =Daily Flow/LTAR
Estimation for Topographical Variation 1,600 sqft
Estimated Area Required (Actual) 6,400 sqft
Approximate Area Available 19,593 sqft
The current property's land available for the sub-surface system is 19,593 sq. ft. with setbacks and existing site
conditions. A schematic of this area is shown in Appendix A of the EAA. The land needed for a subsurface
dripfield design is a minimum of 6,400 sq. ft., so there may be sufficient space for this type of system at the
residence. However,the soils are unsuitable for supporting this type of system.
EAA Guidance Document Revision: October 2019
Page 6 of 12

For a surface system in this soil, the SFR loading rate group is likely restricted to a maximum annual loading
of 19.5 in/year. The sizing calculation for a non-discharge surface system is summarized in the table below:
Non-Discharge Surface Design Alternative
# Bedrooms 4
Daily Flow 480 gpd = 120 gpd•#bedrooms
Surface Loading Rate 19.5 in/year
Minimum Area Required (Nominal) 14,413 sqft
Approximate Area Available 4,439 sqft
The current property's land available for the system is 4,439 sq ft. A schematic of this area is shown in
Appendix A. The land needed for a non-discharge application system is estimated at 14,413 sq. ft., so there is
not sufficient space for a non-discharge surface system, and the unsuitable soil conditions do not allow for a
non-discharge surface system.
2. Assess the availability of land. If insufficient land is available onsite, assume that the necessary
land can be purchased and estimate the land purchase cost based on local real estate prices.
Alternatively,provide documentation to demonstrate that insufficient land is available for sale in
the project area (include letters from adjacent property owners indicating no interest in selling
property).
Response: The table below lists neighboring properties and the value of the land as listed by the Wake County GIS
website. The surrounding lots contain single-family residences. The values listed in the table do not reflect
the value of single-family residences.
Adjoining Property Values
Neighboring Property Area (ac) Vacant Price of Land ($)
Parcel PIN 0646833559 (West) 0.35 Y 1,400
Parcel PIN 0646729805 (South) 24.69 N 1,680,800
Parcel PIN 0646932960 (East) 45.76 N 2,600,436
EAA Guidance Document Revision: October 2019
Page 7 of 12

3. Provide a description of the wastewater treatment system and the non-discharge application
system. Include a site plan showing the proposed layout, the application area, any existing
structures,proposed structures, and other uses within the site.
Response: A typical subsurface drip system or a non-discharge surface spray or surface drip system with pretreatment
considers the following components:
-Septic Tank with Effluent Filter
-Recirculation Tank(Integrated in AX20-RT unit)
-AdvanTex Treatment Pod(1 AX20 Pod)
-Pump Tank(potentially integrated in AX20-RT unit)
-UV Disinfection(Integrated in AX20-RT unit)
-Headworks Box
-Control Panel
-Disposal Field(drip or spray)
Note: The proposed discharge system does not consider the pump tank,headworks box or disposal field.
Site drawings of these alternative systems showing the available application area are included as Appendix A
of the EAA. Due to the limitations caused by the soil characteristics and conditions, there is no ability to
consider any of these systems on this property.
4. Explain the proposed reuse plan if reclaimed water will be used by a third party.
Response: There is no reuse plan being considered either on-site or by a third party. The existing residential plumbing
infrastructure does not allow for reuse in the existing residence. It is not feasible to consider using reclaimed
water on the site or becoming a bulk distributor of reclaimed water. The table below summarizes the
amount of reclaimed water that could be beneficially used on site. As shown,there may be sufficient area to
utilize the daily flow of reclaimed water, however; a reclaimed system would be cost prohibitive for a
single-family residence.
On-site Utilization of Reclaimed Water
Daily flow through system 480 gpd
Available Area to Irrigate 20,321 sqft *Veg. cover on property
Application Rate 0.5 in/week *Fescue Grass
Acceptable Volume to Irrigate 847 ft3/week
= 905 gpd
5. Conduct a Present Value Cost Analysis per STEP 4. For the reclaimed water system include the
potential revenue generated by selling the water.
Response: A Present Value Cost Analysis is included as Appendix B of the EAA. An analysis was performed for a
sub-surface drip system, a non-discharge surface application system, and a reclaimed water system. A
summary of the analysis is included in STEP 4.
6. Provide all calculations, documentation, and maps as necessary to support assumptions and
conclusions.
Response: Calculations performed to evaluate land application alternatives are shown in Alternative B.
EAA Guidance Document Revision: October 2019
Page 8 of 12

7. Note: The design of land application systems must meet the treatment and design requirements
specified in 15A NCAC 2T .05 or 15A NCAC 18A.1900.
Response: The treatment systems specified above in Step B would meet the treatment standards required by these rules
as they pertain to single family residences. However, because of the lack of available space due to
unsuitable soil conditions,no land-based systems can be considered.
8. Note: Proposed discharges from groundwater remediation systems must evaluate the potential
for an infiltration gallery treatment alternative.
Response: N/A
Alternative C. Wastewater Reuse.
You must evaluate reusing all or a portion of the wastewater generated. Some municipalities are currently
reusing wastewater within the confines of their WWTP property for irrigation, toilet flushing, backwashing,
etc.,while other municipalities have established progressive reuse programs for residential irrigation. Reuse
applications might include golf course irrigation, crop irrigation (e.g., hardwood or pine plantation,
grasses), athletic field irrigation, landscape uses, and commercial/industrial uses. Some of these reuse
applications will be evaluated under Alternative B, Land Application. The design of reclaimed water
systems must meet the treatment and design requirements specified in 15A NCAC 2U.
Response: All reuse applications for this project scale were evaluated under Alternative B, Step 4. Wastewater reuse
was determined to be infeasible for this project.
Alternative D. Direct Discharge to Surface Waters.
1. No new or expanding (additional) discharge of oxygen-consuming waste will be allowed to
surface waters of North Carolina if both the summer 7Q10 and 30Q2 streamflows are estimated
to be zero, in accordance with 15A NCAC 2B.0206(d). Private applicants must contact the USGS
in Raleigh at 919-571-4000 and obtain (generally for a nominal fee), the receiving streamflow data
(7Q10, 30Q2, annual average streamflow) at the proposed discharge location. This information
must be included in the EAA, and will be used to develop permit limits.
Response: Because there is an estimated zero flow(or very low flow)at the discharge point,the discharge will be
considered on a case-by-case basis.The proposed discharge is 480 gpd.
2. All direct discharge systems of oxygen-consuming wastes should be evaluated both with tertiary
filtration [BOD5= 5 mg/I, NH3-N= 1 mg/I] and without, and assuming a weekly sampling
regime.
Response: Tertiary filtration is not required under the general permit, as the general permit requirements (monthly
average) are BOD5 = 30 mg/I and Total Suspended Solids = 30 mg/I. However, based on actual sample
results from similar treatment systems(other facilities using the same technology)in many cases,a BOD5 of
5 mg/I and NH3-N of I mg/I can be met. While weekly sampling of the treated effluent would confirm the
treatment results on a regular basis, the additional cost associated with the collection and testing of the
effluent would not be feasible for the homeowner.
3. Provide a description of the proposed wastewater treatment facilities, including a schematic
diagram of the major components and a site plan of the treatment facility with outfall line(s).
Response: Plans and schematic drawings can be found in Attachment B(of original application package).
4. Provide documentation of the availability of required land and/or easement agreements.
Response: The proposed discharge system will be located on land owned by the applicant. See Attachment B (of
original application package)for the proposed discharge system location.
EAA Guidance Document Revision: October 2019
Page 9 of 12

5. Conduct a Present Value Cost Analysis per STEP 4.
Response: A Present Value Cost Analysis for the discharge system is included in Appendix B. A summary of the
analysis is included in STEP 4.
6. Note: All direct discharge treatment systems must comply with Reliability Requirements
specified in 15A NCAC 2H.0124.
Response: The system serves a private facility that is served by a private well and does not have elevated water storage
tanks. In the event of a power outage,water will not be available to the residence. There is storage available
in the system to hold some waste from the house until power is restored to the system. If the power is out
for an extended period,ceasing water usage in the house or pumping of the septic tank may be required.
Alternative E. Combination of Alternatives.
You should evaluate the possibility of a combination of wastewater alternatives that would minimize or
eliminate a direct discharge alternative. For example, consider whether the facility can operate a land
application system during the dry season when streamflows are at their lowest and provide less dilution, and
operate an NPDES discharge system during the wet season when soils may not be as amenable to land
application and the receiving stream provides its greatest dilution.
Response: A non-discharge alternative is not feasible due to the soil constraints listed in Alternative B. The presence or
absence of a seasonal high-water table will not relieve the other constraints.
STEP 4. Evaluate economic feasibility of alternatives
To provide valid cost comparisons among all technologically feasible wastewater alternatives identified in
STEP 3, a 20-year Present Value of Costs Analysis (PVCA) must be performed. A preliminary design level
effort is considered appropriate for comparing feasible options and their associated costs. For the PVCA cost
comparison, all future expenditures are converted to a present value cost at the beginning of the 20-year
planning period. A discount rate is used in the analysis and represents the time value of money (the ability of
money to earn interest). Present value is also referred to as "present discounted value" or "present worth".
The PVCA should include all monetary costs associated with construction,startup and annual operation and
maintenance of a facility. All unit cost information must be provided, and costs must be referenced. Costs
can be referenced in paragraph format by summarizing the sources utilized (e.g.,vendor quotes, realtor land
quotes, past bids, Means Construction Index, etc). Vender quotes received for treatment units or other
components, as well as realtor land quotes, shall be included as well. For each treatment alternative
identified as technologically feasible,costs should include,but not be limited to, the following:
Capital Costs
• Land acquisition costs
• Equipment costs
• Labor costs
• Installation costs
• Design costs
EAA Guidance Document Revision: October 2019
Page 10 of 12

Recurring Costs
• Operation and maintenance costs (with replacement costs)
• Laboratory costs assuming a weekly monitoring regime for discharge systems and a monthly
regime for non-discharge systems
• Operator and support staff costs
• Residual disposal costs
• Connection fees and subsequent user fees
• Permit and compliance fees
• Utility costs (power,water, etc.)
Lost Opportunity Costs
PVCA Calculation Method.
The following standard formula for computing the present value must be used in all cost estimates made
under this evaluation:
n C/
PV= C +�
° ,_i (1 +r)`
Where:
PV = Present value of costs.
Co = Costs incurred in the present year.
Ct = Costs incurred in time t.
t =Time period after the present year(The present year is t= 0)
n = Ending year of the life of the facility.
r = Current EPA discount rate. EPA adjusts this rate annually on October 1, and it can be
accessed from the Internet at http:/www.nccgl.net/fap/cwsrf/201gui.html.
If recurring costs are the same in years 1 through 20,then Ct=C and the formula reduces to:
(1 +r)" -11
PV= C +C
r(1+ r)" J
As an example,assuming capital costs (Co) of$2 million, annual recurring costs (C) of$40,000, and a
discount rate (r) of 5.625%, the 20-year(n=20) present value of costs would equal:
PV= capital costs + recurring costs X [(1+0.05625)20—1] / 10.05625(1+0.05625)20]
PV= $2,000,000 + $40,000 X [1.98/0.168]
PV= $2,000,000 + $471,428
PV= $2,471,428
EAA Guidance Document Revision: October 2019
Page 11 of 12

PVCA Summary Table.
The EAA must include a Summary Cost Table, which summarizes present worth costs developed for all
technologically feasible wastewater alternatives. The summary should include a breakdown of capital costs
and recurring costs. In some situations, the Division may require the applicant to refine cost estimates for
some alternatives, or possibly collect actual soil data to better characterize the land application alternative.
Ultimately, the final determination on cost effectiveness is made by the Division with consideration of
monetary costs as well as potential environmental impacts.
Response: The following table presents the cost analysis for several types of wastewater systems. Given the
information presented above,the only technologically feasible alternative is the Discharge System. The
"Install Cost"includes the estimated cost to design and install the specific type of system. The"Present
Value of Costs" is based on a discount factor of 2.50%.
Cost Analysis for Four(4) Bedroom SFR
Present
Install 20 yr Total Cost Value
Cost Annual Cost 20 years of Costs
System Type ($) ($) ($) ($)
Sub-Surface System $54,950 $24,319 $79,269 $73,520
Non-Discharge System $70,800 $22,976 $93,776 $88,348
Reclaimed System $88,200 $27,300 $115,500 $109,057
Discharge System $34,500 $19,513 $54,013 $49,384
EAA Guidance Document Revision: October 2019
Page 12 of 12

Appendix A. Site Maps
For
System Alternatives Analysis
- Subsurface System Option
- Non-Discharge System Option
- Reclaimed Water Option

. 2 AW I'
Engineers and Soil Scientists
agnWecM Temnol°pr.ma
001 N.Salem Street.Soi200
- —. — — — — — — — — — — — — — — — — — — — — Npv,Nort91h 3lW!
evais859-0600
-- t
5pd6
pmnnme.can
C' e/ Jacobs Residence
nJ Surface Discharge
4). a Wastewater Treatment System
a °�
N58°03'40"E c, see
O sew.
I/01 W kmwlY st
pupuJ-WrM,NC 71326
296.50' i. Al (99)612-1531
NmMa mm
r O J A� %party Inrametlon:
r O CS) ^ Ib W,Ambnry A
Cr) SO°01'44"E O y e-va e,C i sse
°W 064681/697
M - - - — — — — 9.66' — CD• - - - — —
WS.RW Sig WaSSWASSORSWSSOWSE If /.' ,
g*SOO* 00 *O*000��'�r FOR
.e� •��•• 1��•e �I � EA REVIEW
I •*.•••.••.•••.•• UNRESTRICTED ONLY
1•• •••••.•••••, • • •
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OS Id 11 1 e* 0
14:1 'ED _0110011111 **OSS*W 0,1'
To ••, Shed le or
eE\� ^ OMImm WEIuovmu
Z � , gyp, .' x AREA = 19,593 sqft.
goo
y
Existing 4—BDR Dwelling `,
��r�a� , : ; Relevant
4. Setbacks Shown
I Fir �� _� � Property Line SHEET Tee
Shed , , ;211.74t, 10 Subsurface
Design:
Subsurface Drip
Dwelling
160.24' 15
S58°23'28"W
I S58°23'28"W 3.23' Driveway N.c,,n`a o0�'j 024
5' REVISED BY: REVISED Cel:
° n 5o Well RELEASE)BY: REIF.SEO ON:
I Shed Feet 50' DRAWING NU BER
SE-1

/ AEngirmeWirrs So
AprvVMN ream.....
501 N.Salem Strew.Sone 203
Ans.msnn Cam.*27502
910-0500ee0
—L — —
Jacobs Residence
C� Surface Discharge
1 Nastenater Treatment System
N OQ ONler Inferm0000
,_CZ)N58°03'40"E
296.50' ;,ss,
c �l12,i93
ifl ,a amZ ''^^nj v` Property
Mpe�rmaw�:
r 11•J' ^� w np
�sl
C CM SO°01'44"E °� 1W�r 1
7521
01 — — — — - — — — 9.66' — �4�_ — — — — -
- Z — — — — —
•
0*1.0*li FOR
Pa.. •• UNRESTRICTED REVIEW
• .I AREA ONLY
��
g�0111i �00f (outside setbacks)
CO , Shed •• ®^per C .. MED NE otmvnat
ch Qi AREA = 4,439 sqft.
Z co
IExisting 4—BDR Dwelling Relevant _
Setbacks Shown
I
/ Property Line
. 50' SHEET nRE
Shed .. .. :►!e Alternative Design:
Dwelling Non-Discharge Systems
15'
I 160.24'
S56°23'28"W Driveway MANN BY: CREATED at
S58°23 20 vv 3.23' 5' N.ceaanCC D2/05/2024
REVISED BY: BUSED ON:
0 25 so Well RELEASED BY: RELEASED ON:
Re.1 100'
Shed DRAW NUMBER
SE-2

• 1 WT EA and Soil Scientists
...erste corn— — — — — — — — — — — — — — — — b1 N.Se.Seem,Suae NM
Mee North Gretna 21S02
'tY-e59Ua59
Jacobs Residence
�� Surface Discharge
`a ^ Wadteaater Treatment System
N58°03'40"E -o,51 °M Infetettlee
�
296.50' `�"-"1'' "'e
rota)etsrotp 'eN0pme+-N.a.m....
o ? �� Ma�aN
�' ^ y Inhae Jacob
°:, O S0°01'44"E �� p in�e
Ch _ _ — 9.66'
Z *°••*.••� ••S,
••••••••••••.
0*••0*•••*•�
0*••0*•••*�
S••OS• 000 ` ' REVIEW
I •* 0•••S*•! ONLY
M r SI ••,i:$0°1 cp^ p7._.,:N . cv. MED sac =PM(
••• •.••ra Existing 4—BDR Dwelling �••;,,'
•••••.•••. '• u • • • + UNRESTRICTED iii
��• AREA
� • ti14ARemative Design:
• _ (outside setbacks Rlaimeer
160.24' �f�
S58°23'28"W '26°w 3.23' om+D BY: CREATED COO.23
N.Comma 02/a5/7014
REVISED BY: 'REVISED ON:
EAS
I Shed Fe.
0 25 50 AREA = 20,321 sqft. R° m B' a
DRAWING NUMBER
SE-3

Appendix B. Present Value Cost Analysis
For
System Alternatives Analysis
- Subsurface System Option
- Non-Discharge System Option
- Reclaimed Water Option
- Surface Discharge Option
p

Sub-Surface System
Co $54,950 Estimated Cost to Design and Install System
r 2.500%
PV C + y C
I (1 + r ) r
PV 1$73,520 (Present Value of Costs
Cost Summary Table
UV Replacement
Year Annual Fee Operations Fee Sample Cost Pumping Cost Cost Ct Total Ct PV
Increase 5%every 3 Increase 3%yearly Increase$50 every 5 Increase 3%yearly Annual Incurred Costs Annual Discounted Total Discounted Present Value of
years years ($) Cost($) Costs($) Costs($)
1 60 500 250 0 125 935 912 912 55,862
2 60 500 258 0 129 946 901 1,813 56,763
3 60 500 265 0 133 958 889 2,702 57,652
4 60 525 273 0 137 995 901 3,604 58,554
5 60 525 281 300 141 1,307 1,155 4,759 59,709
6 60 525 290 0 145 1,020 879 5,638 60,588
7 60 551 299 0 149 1,059 891 6,529 61,479
8 60 551 307 0 154 1,072 880 7,409 62,359
9 60 551 317 0 158 1,086 870 8,279 63,229
10 60 579 326 350 163 1,478 1,155 9,434 64,384
11 60 579 336 0 168 1,143 871 10,305 65,255
12 60 579 346 0 173 1,158 861 11,166 66,116
13 60 608 356 0 178 1,202 872 12,038 66,988
14 60 608 367 0 184 1,218 862 12,900 67,850
15 60 608 378 400 189 1,635 1,129 14,029 68,979
16 60 638 389 0 195 1,282 864 14,893 69,843
17 60 638 401 0 201 1,300 854 15,747 70,697
18 60 638 413 0 207 1,318 845 16,592 71,542
19 60 670 426 0 213 1,368 856 17,448 72,398
20 60 670 438 450 219 1,838 1,121 18,570 73,520
24,319

Non-Discharge System
Co $70,800 Estimated Cost to Design and Install System
r 2.500%
Py = C + E C
l ( I + r )
PV 1$88,348 'Present Value of Costs
Cost Summary Table
UV Replacement
Year Annual Fee Operations Fee Sample Cost Pumping Cost Cost C, Total Ct PV
Increase 5%every 3 Increase 3%yearly Increase$50 every 5 Increase 3%yearly Annual Incurred Costs Annual Discounted Total Discounted Present Value of
years years ($) Cost($) Costs($) Costs($)
1 60 500 200 0 125 885 863 863 71,663
2 60 500 206 0 129 895 852 1,715 72,515
3 60 500 212 0 133 905 840 2,555 73,355
4 60 525 219 0 137 940 852 3,407 74,207
5 60 525 225 300 141 1,251 1,106 4,512 75,312
6 60 525 232 0 145 962 829 5,342 76,142
7 60 551 239 0 149 999 841 6,182 76,982
8 60 551 246 0 154 1,011 830 7,012 77,812
9 60 551 253 0 158 1,023 819 7,831 78,631
10 60 579 261 350 163 1,413 1,104 8,935 79,735
11 60 579 269 0 168 1,076 820 9,755 80,555
12 60 579 277 0 173 1,089 810 10,564 81,364
13 60 608 285 0 178 1,131 821 11,385 82,185
14 60 608 294 0 184 1,145 810 12,195 82,995
15 60 608 303 400 189 1,559 1,077 13,272 84,072
16 60 638 312 0 195 1,204 811 14,083 84,883
17 60 638 321 0 201 1,220 802 14,885 85,685
18 60 638 331 0 207 1,235 792 15,677 86,477
19 60 670 340 0 213 1,283 803 16,480 87,280
20 60 670 351 450 219 1,750 1,068 17,548 88,348
22,976

Reclaimed System
Co $88,200 Estimated Cost to Design and Install System
r 2.500%
PV = C o + C ,
1 + r
PV I$109,057 'Present Value of Costs
Cost Summary Table
UV Replacement
Year Annual Fee Operations Fee Sample Cost Pumping Cost Cost C, Total Ct PV
Increase 5%every 3 Increase 3%yearly Increase$50 every 5 Increase 3%yearly Annual Incurred Costs Annual Discounted Total Discounted Present Value of
years years ($) Cost($) Costs($) Costs($)
1 60 600 275 0 125 1,060 1,034 1,034 89,234
2 60 600 283 0 129 1,072 1,020 2,054 90,254
3 60 600 292 0 133 1,084 1,007 3,061 91,261
4 60 630 300 0 137 1,127 1,021 4,083 92,283
5 60 630 310 300 141 1,440 1,273 5,355 93,555
6 60 630 319 0 145 1,154 995 6,350 94,550
7 60 662 328 0 149 1,199 1,009 7,359 95,559
8 60 662 338 0 154 1,213 996 8,355 96,555
9 60 662 348 0 158 1,228 983 9,338 97,538
10 60 695 359 350 163 1,626 1,271 10,609 98,809
11 60 695 370 0 168 1,292 985 11,594 99,794
12 60 695 381 0 173 1,308 973 12,567 100,767
13 60 729 392 0 178 1,360 986 13,553 101,753
14 60 729 404 0 184 1,377 974 14,527 102,727
15 60 729 416 400 189 1,794 1,239 15,766 103,966
16 60 766 428 0 195 1,449 976 16,742 104,942
17 60 766 441 0 201 1,468 965 17,707 105,907
18 60 766 455 0 207 1,487 953 18,660 106,860
19 60 804 468 0 213 1,545 966 19,627 107,827
20 60 804 482 450 219 2,015 1,230 20,857 109,057
27,300
J

Discharge System
Co $34,500 Estimated Cost to Design and Install System
r 2.500%
PV = C o + E C
I ( 1 + r ) `
PV 1$49,384 'Present Value of Costs
Cost Summary Table
UV Replacement
Year Annual Fee Operations Fee Sample Cost Pumping Cost Cost Ct Total Ct PV
Increase 5%every 3 Increase 3%yearly Increase$50 every 5 Increase 3%yearly Annual Incurred Costs Annual Discounted Total Discounted Present Value of
years years ($) Cost($) Costs($) Costs($)
1 60 350 200 0 125 735 717 717 35,217
2 60 350 206 0 129 745 709 1,426 35,926
3 60 350 212 0 133 755 701 2,127 36,627
4 60 368 219 0 137 783 709 2,836 37,336
5 60 368 225 300 141 1,093 966 3,802 38,302
6 60 368 232 0 145 804 694 4,496 38,996
7 60 386 239 0 149 834 702 5,197 39,697
8 60 386 246 0 154 846 694 5,891 40,391
9 60 386 253 0 158 858 687 6,578 41,078
10 60 405 261 350 163 1,239 968 7,546 42,046
11 60 405 269 0 168 902 687 8,233 42,733
12 60 405 277 0 173 915 680 8,914 43,414
13 60 425 285 0 178 949 688 9,602 44,102
14 60 425 294 0 184 963 681 10,283 44,783
15 60 425 303 400 189 1,377 951 11,234 45,734
16 60 447 312 0 195 1,013 682 11,917 46,417
17 60 447 321 0 201 1,028 676 12,592 47,092
18 60 447 331 0 207 1,044 669 13,262 47,762
19 60 469 340 0 213 1,082 677 13,939 48,439
20 60 469 351 450 219 1,549 945 14,884 49,384
19,513

Attachment J
Local Government Review Forms

N r
Engineers and Soil Scientists
Agri-Waste Technology,Inc. April 19,2024
501 N Salem Street, Suite 203,Apex, NC 27502
agriwaste.com I 919.859.0669
Mr. David Ellis
County Manager
Wake County
P.O. Box 550
Raleigh,NC 27602
RE: Local Government Review Form
Application for Discharge System—Douglas Jacobs
1401 W Academy St,Fuquay-Varina,NC 27526
Dear Mr. Ellis,
Enclosed please find a Local Government Review Form required for an Authorization to
Construct application supporting a proposed wastewater treatment system. The proposed
system will be permitted under the NCG550000 General Discharge Permit for Single Family
Residences. The proposed system will serve a 4-Bedroom Single Family residence (SFR)
located in Wake County, North Carolina. The proposed system will replace the failing,
county permitted subsurface system that currently serves the residence.
This site has been deemed unsuitable for ground absorption sewage treatment systems by
Wake County Environmental Services due to unsuitable soil wetness conditions and
insufficient space. It is my opinion that a wastewater treatment system covered by the
General Discharge Permit is the only technologically and economically feasible option for
this residence.
Please complete the enclosed form for inclusion in the application for the proposed system.
The residence is located in Wake County. Please note that this form is only meant to
determine zoning/jurisdiction information for the county and does not indicate your approval
of the proposed system.
I appreciate your time and efforts in completing this form. If you have any questions or
comments,please feel free to contact me at 919-859-0669.
Best Regards,
Kevin D. Davidson,P.E.
V.P. of Engineering

Jacobs Residence
1401 W Academy St
Fuquay-Varina,NC 27526
PIN 0646834697
Attachment A. Local Government Review Form
General Statute Overview: North Carolina General Statute 143-215.1 (c)(6)allows input from local governments in the issuance
of NPDES Permits for non-municipal domestic wastewater treatment facilities. Specifically, the Environmental Management
Commission (EMC) may not act on an application for a new non-municipal domestic wastewater discharge facility until it has
received a written statement from each city and county government having jurisdiction over any part of the lands on which the
proposed facility and its appurtenances are to be located. The written statement shall document whether the city or county has a
zoning or subdivision ordinance in effect and (if such an ordinance is in effect)whether the proposed facility is consistent with
the ordinance. The EMC shall not approve a permit application for any facility which a city or county has determined to be
inconsistent with zoning or subdivision ordinances unless the approval of such application is determined to have statewide
significance and is in the best interest of the State.
Instructions to the Applicant: Prior to submitting an application for a NPDES Permit for a proposed facility, the applicant
shall request that both the nearby city and county government complete this form. The applicant must:
■ Submit a copy of the permit application(with a written request for this form to be completed)to the clerk of the city and
the county by certified mail,return receipt requested.
• If either (or both) local government(s) fail(s) to mail the completed form, as evidenced by the postmark on the certified
mail card(s),within 15 days after receiving and signing for the certified mail,the applicant may submit the application to
the NPDES Unit.
• As evidence to the Commission that the local government(s) failed to respond within 15 days,the applicant shall submit a
copy of the certified mail card along with a notarized letter stating that the local governments) failed to respond within
the 15-day period.
Instructions to the Local Government: The nearby city and/or county government which may have or has jurisdiction over
any part of the land on which the proposed facility or its appurtenances are to be located is required to complete and return this
form to the applicant within 15 days of receipt. The form must be signed and notarized.
Wake County
Name of local government
(City/County)
Does the city/county have jurisdiction over any part of the land on which the proposed facility and its appurtenances are to be
located? Yes[ ] No[ ] If no,please sign this form,have it notarized,and return it to the applicant.
Does the city/county have in effect a zoning or subdivision ordinance? Yes[ ] No[ ]
If there is a zoning or subdivision ordinance in effect,is the plan for the proposed facility consistent with the ordinance? Yes[ ]
No[ ]
Date Signature
(City Manager/County Manager)
State of ,County of
On this day of , ,personally appeared before me,the said
name to me known and known to me to be the person described in
and who executed the foregoing document and he(or she)acknowledged that he(or she)executed the same and being duly sworn
by me,made oath that the statements in the foregoing document are true.
My Commission expires _. (Signature of Notary Public)
Notary Public(Official Seal)
EAA Guidance Document Revision:October 2019
Page 8 of 8

AW •
Engineers and Soil Scientists
Agri-Waste Technology,Inc. April 19,2024
501 N Salem Street, Suite 203,Apex, NC 27502
agriwaste.com I 919.859.0669
Mr. Adam Mitchell
Town Manager
Town of Fuquay-Varina
134 N. Main Street
Fuquay-Varina,NC 27526
RE: Local Government Review Form
Application for Discharge System—Douglas Jacobs
1401 W Academy St, Fuquay-Varina,NC 27526
Dear Mr. Mitchell,
Enclosed please find a Local Government Review Form required for an Authorization to
Construct application supporting a proposed wastewater treatment system. The proposed
system will be permitted under the NCG550000 General Discharge Permit for Single Family
Residences. The proposed system will serve a 4-Bedroom Single Family residence (SFR)
located in Wake County, North Carolina. The proposed system will replace the failing,
county permitted subsurface system that currently serves the residence.
This site has been deemed unsuitable for ground absorption sewage treatment systems by
Wake County Environmental Services due to unsuitable soil wetness conditions and
insufficient space. It is my opinion that a wastewater treatment system covered by the
General Discharge Permit is the only technologically and economically feasible option for
this residence.
Please complete the enclosed form for inclusion in the application for the proposed system.
The residence is located in Wake County. We acknowledge that the property may not be
located within the Fuquay-Varina limits. Please note that this form is only meant to
determine zoning/jurisdiction information for the county and does not indicate your approval
of the proposed system.
I appreciate your time and efforts in completing this form. If you have any questions or
comments,please feel free to contact me at 919-859-0669.
Best Regards,
Kevin D. Davidson, P.E.
V.P. of Engineering

Jacobs Residence
1401 W Academy St
Fuquay-Varina,NC 27526
PIN:0646834697
Attachment A. Local Government Review Form
General Statute Overview: North Carolina General Statute 143-215.1 c 6 allows input from local governments in the issuance
()( ) P
of NPDES Permits for non-municipal domestic wastewater treatment facilities. Specifically, the Environmental Management
Pg
Commission (EMC) may not act on an application for a new non-municipal domestic wastewater discharge facility until it has
received a written statement from each city and county government having jurisdiction over any part of the lands on which the
proposed facility and its appurtenances are to be located. The written statement shall document whether the city or county has a
zoning or subdivision ordinance in effect and (if such an ordinance is in effect)whether the proposed facility is consistent with
the ordinance. The EMC shall not approve a permit application for any facility which a city or county has determined to be
inconsistent with zoning or subdivision ordinances unless the approval of such application is determined to have statewide
significance and is in the best interest of the State.
Instructions to the Applicant: Prior to submitting an application for a NPDES Permit for a proposed facility, the applicant
shall request that both the nearby city and county government complete this form. The applicant must:
• Submit a copy of the permit application(with a written request for this form to be completed)to the clerk of the city and
the county by certified mail,return receipt requested.
• If either (or both) local government(s) fail(s) to mail the completed form,as evidenced by the postmark on the certified
mail card(s),within 15 days after receiving and signing for the certified mail,the applicant may submit the application to
the NPDES Unit.
• As evidence to the Commission that the local governments) failed to respond within 15 days,the applicant shall submit a
copy of the certified mail card along with a notarized letter stating that the local government(s) failed to respond within
the 15-day period.
Instructions to the Local Government: The nearby city and/or county government which may have or has jurisdiction over
any part of the land on which the proposed facility or its appurtenances are to be located is required to complete and return this
form to the applicant within 15 days of receipt. The form must be signed and notarized.
♦I 1
Name of local government City of Fuquay-Varina
(City/County)
Does the city/county have jurisdiction over any part of the land on which the proposed facility and its appurtenances are to be
located? Yes[ ] No[ ] If no,please sign this form,have it notarized,and return it to the applicant.
Does the city/county have in effect a zoning or subdivision ordinance? Yes[ ] No[ ]
If there is a zoning or subdivision ordinance in effect,is the plan for the proposed facility consistent with the ordinance? Yes[ ]
No[ ]
Date Signature
(City Manager/County Manager)
State of ,County of
On this day of , ,personally appeared before me,the said
name to me known and known to me to be the person described in
and who executed the foregoing document and he(or she)acknowledged that he(or she)executed the same and being duly sworn
by me,made oath that the statements in the foregoing document are true.
My Commission expires . (Signature of Notary Public)
Notary Public(Official Seal)
EAA Guidance Document Revision:October 2019
Page 8 of 8

Attachment K
Plans and Specifications for the Proposed Discharge System

AWIr FINAL DESIGN
NOT RELEASED FOR
Engineers and Soil Scientists CONSTRUCTION
Agri-Waste Technology,Inc.
501 N Salem Street,Suite 203,Apex,NC 27502
agriwaste.com I 919.859.0669
1401 W Academy St.
Fuquay-Varina, NC 27526
Wake County
Plans and Specifications for Discharge System
rriiiitri
y..�QEE.551. $7
¢� SEAL e. %L—p5.1 '
024582
cze
Date: May 10, 2024
Design Engineer: Kevin Davidson, P.E.
Agri-Waste Technology, Inc.
501 N. Salem Street, Suite 203
Apex,NC 27502
Office: 919-859-0669
Direct: 919-367-6318
Email: [e-mail]

AVVT FINAL DESIGN
NOT RELEASED FOR
Engineers and Soil Scientists CONSTRUCTION
Agri-Waste Technology,Inc.
501 N Salem Street,Suite 203,Apex,NC 27502
agriwaste.com I 919.859.0669
1401 W Academy St.
Fuquay-Varina, NC 27526
Wake County
Plans and Specifications for Discharge System
• Narrative Description of Discharge System
• Design Spreadsheets
• Drawings of Proposed System
• Tank Specification Sheets
• Access Riser Adapters, Risers, Lids
• Effluent Filter Specification
• Specification for AdvanTex AX-20 RT Pod
• Pump Vault Specification (Integrated into AdvanTex Pod System)
• Specification for Re-circulation Tank Pump (Integrated into AdvanTex Pod System)
• Specification for Control Panel and Float Controls (AdvanTex Pod System)
• Specification for UV System

Narrative Description
of
Discharge Treatment System
The Discharge System that has been designed considers the following components:
- Septic Tank
-AdvanTex AX20-RT Treatment Pod
-UV Disinfection
-Discharge Outlet
-Control Panel
Due to the advanced technology in this system, a Certified Operator should he contracted to
maintain this system.
Septic Tank
A new 1,250-gallon septic tank will be installed for this system. The septic tank will include an
effluent filter and risers. An Orenco 8" Biotube effluent filter will be installed in the outlet end of
the septic tank. New access risers will be installed on both the inlet and outlet ends of the septic
tank. To facilitate the installation of the access risers, riser adapters will be cast into the tank top
during construction. All wastewater from the single-family residence,including greywater,will be
routed into the septic tank. Waste that exits the septic tank will flow into the AdvanTex AX20-RT
Treatment Pod.
AdvanTex AX20-RT Treatment Pod
The treatment component of the system is an AdvanTex AX20-RT treatment pod. The pod is an
integrated unit that combines recirculation,treatment, and discharge modules into a single, sealed
unit. Liquid from the septic tank will flow via gravity to the inlet of the treatment pod and into the
recirculation tank portion of the AX-RT unit. Liquid from the recirculation tank will be periodically
applied across the filter fabric. Wastewater will be sprayed over the textile sheets. The wastewater
percolates down through the textile sheets and is distributed between the recirculation chamber and
discharge chamber by means of the tank baffle. The treated wastewater exits the AX-RT unit via
gravity to the discharge outlet. Prior to exiting the AX-RT unit, effluent passes through the UV
disinfection system.
The recirculation pump is controlled by a system of 3 floats that operate the recirculation pump in a
Timed Dose arrangement. Float 1 (lowest elevation) is a redundant off float. Float 2 is a Peak
Enable Float and Float 3 acts as a High Water Alarm. Under normal operation the redundant off
float will be engaged thereby activating the timer in the control panel. At the pre-set interval, the
pump will engage and distribute effluent over the textile fabric("on"cycle). Following this period,
the pump will turn off and rest for a designated time("off'cycle)". During periods of high water in
the recirculation portion of the tank,the Peak Enable float will engage and reduce the pre-set"off'
time and thereby send increased flow across the fabric. If the water level in the recirculation tank
continues to rise for a pre-set time period,the High Water Alarm will activate.
1

The discharge pump is located on the outlet side of the treatment pod. Flow to the discharge outlet is
managed using three(3)floats that control the discharge pump in a Demand Dose arrangement(due
to the timed dosed arrangement of the recirculation pump, in essence the discharge dosing pump is
timed dosed as well). Float 1 (lowest elevation is a"Pump OFF" float. Float 2 is the"Pump ON"
float, while Float 3 acts as a High Water alarm. Under normal operation, once the Pump OFF and
Pump ON floats are engaged, the pump will send effluent to the discharge outlet. The discharge
pump will shut-off once the Pump OFF float drops due to the dropping water level.
To prevent groundwater from affecting the pod,the pod will be installed on a bed of gravel. Anti-
flotation measures or a concrete ring installed around the mid-flange will be installed to provide
extra ballast to prevent the flotation of the pod during high water table conditions.
UV Disinfection
Disinfection for the system will be accomplished using a UV system. The UV light should operate
for approximately one year prior to needing to be replaced. If the UV light burns out or loses
sufficient intensity(below a set threshold)an alarm will activate and disable the system pump. An
alarm light on the control panel will also illuminate. When the alarm is activated,the homeowner
should reduce water use(laundry,dishes,washing)until the system is operating properly.
Discharge Outlet
The system discharges onto an unnamed tributary on the northwest corner of the property which
flows to Kenneth Creek. Riprap will be placed at the discharge location to provide aeration of the
water as it is discharged and also as erosion protection. Vegetation and debris should be kept clear
of the discharge location. A grate will be installed on the discharge pipe to prevent animals and
rodents from entering the discharge pipe.
Control Panel
One control panel will be installed with this wastewater system. This panel will control operation of
the re-circulation pump and UV system. If desired, this panel can be connected to a land based
phone line that will notify the operator of system operation.
2

Discharge Wastewater Treatment System Design Calculations
Date: 19-Apr-24
PROJECT: Jacobs Residence
Location: 1401 W Academy St.
Fuquay-Varina, NC 27526
County: Wake
SEPTIC TANK SIZING
Daily Flow Estimate
Flow/Unit
#of Units 'Units (gpd/unit) Flow/Day(gpd)
4 BR _ 120 480
TOTAL DAILY FLOW(Q)= 480 gpd
Septic Tank Volume/Size(based on maximum daily flow estimate)
For Single Family Residences with 5 bedrooms or less,
#Bedrooms 'Min.Volume(gal)
4 or less 1,000
5 1,250
For Single Family Residences with more than 5 bedrooms,
multiple dwelling units,places of business, or places of public assembly:
DDF 'Min.Volume(gal)
Q<_600 V=2Q
600<Q< 1,500 V= 1.17Q+500
1,500<_Q54,500 V=0.75Q+ 1,125
Q>4,500 V=Q
Required Minimum Tank Size= 1,000 gal.
per 15A NCAC 18E.0801 (a)
Septic Tank Volume/Size(based on AdvanTex Innovative Approval)
Flow(GPD) Min.Volume(gal)
500 1,000
501 -600 1,500
601 -750 2,000
751 - 1000 2,500
1001 - 1500 3,750
1501 -2000 5,000
2001 -2500 6,250
2501 -3000 7,500
Required Minimum Tank Size= 1,000 gal.
per Advantex Approval
Tank Size Provided= 1,250 gal.
SHOAF STB-389

RECIRCULATION TANK& POD SIZING
From INNOVATICE WASTEWATER SYSTEM NO:IWWA 2015-01-R1
Table 1 -AX-RT System and Septic Tank Volume
Design Daily Flow(qpd) Minimum Septic Tank AdvanTex AX-RT
Volume(gallons)
< 500 1,000 AX20-RT
501 -600 1,500 AX25-RT
Daily flow = 480 gpd
AX Unit Required = AX-20-RT
Timer Settings
Required Doses/Day 96
Recirculation Ratio 2.9 :1
Design Flow(Q) 480 gpd
Flow to Pods 1,392 gpd
Flow to ST 497 gpd
Pump Flow 1,889 gpd
Dose Volume to Pod 14.5 gallons
#of Pumps 1
Pod Flowrate 14 gpm
Return Flowrate 5 gpm
Pump Flowrate 19.00 gpm
#of Cycles/day 96
Cycle Volume 19.7 gallons
Cycle Run time 1.0 min
Cycle Off Time 14.0 min

Wastewater Treatment System Design Calculations
Septic Tank Buoyancy
Project: Jacbos Residence
Location: 1401 W Academy St.
Fuquay-Varina, NC 27526
County: Wake
Tank Size(nominal) 1,250 gallons
Properties/Assumptions:
Min. liquid level to be maintained in tank at all times after initial installation.
Assume groundwater table is equal to or higher than top of chamber.
(Buoyancy is the same as long as water table is higher than top of tank.)
Effluent Density 62.4 Ib/ft3(Specific Weight of Water)
Concrete Density 142.56 Ib/ft3
Soil Bulk Density 1.25 (typical value)
Soil Cover Over Tank 1.00 ft(min.)
Tank Dimensions(from supplier):
Exterior Interior
Length 10.46 ft 9.96 ft
Width 5.46 ft 4.96 ft
Total Tank Depth 5.13 ft 4.54 ft
Permanent Liquid Depth in Tank 0 in.
Area of Riser Openings 6.28 ft2
Tank Weight(est.) 11,000 lb. (based on manufacturer)
Buoyancy Force Calculation:
Buoyancy Force=Specific Weight of Water x Displaced Volume
Buoyancy Force 18,256 lb
Weight Calculation:
Tank Weight 11,000 lb
Water Weight in Tank 0 lb
Soil Weight Over Tank 3,956 lb
Soil Tension Force 4,037 lb
Total Weight 18,994 lb
Note: Total weight must be greater than buoyancy force
so that tank will not float during high water table conditions.

Wastewater Treatment System Design Calculations
AdvanTex RT Pod Buoyancy
Project: Jacbos Residence
Address: 1401 W Academy St.
Fuquay-Varina, NC 27526
County: Wake
Properties/Assumptions:
RT Model = AX20 Pump
All calculations are performed assuming completely submerged conditions,with no liquid in the unit.
Effluent Density= 62.4 Ib/ft^3 (Specific Weight of Water)
Net Beam Density= 67.55 Ib/ft^3
Net Soil Density= 67.6 Ib/ft^3
Unit Weight= 923 lb (based on manufacturer)
Supplemental Ballast Evaluation(Anti-Buoyancy Beam):
Depth from top of beam to tank bottom = 3.00 in
Tank exposure length = 6.00 in
Burial depth to beam = 5.25 ft
Width of beam = 0.69 ft
8.25 in
Buoyancy Force Calculation:
Buoyancy Force= 12,475 lb(based on manufacturer)
Weight Calculation:
Tank Weight= 923 lb
Soil Weight on Beam = 11,516 lb
Weight of Beam = 129.2 lb
Total Weight= 12,568 lb
Note: Total weight must be greater than buoyancy force
so that tank will not float during high water table conditions.
Specified Anti-Flotation Beam Dimensions
Beam Length = 89 in 7.42 ft
Beam Width = 8.25 in 0.69 ft
Beam Height= 2.25 in 0.19 ft

Wastewater Treatment System Design Calculations
Elevations
Project: Jacbos Residence
Location: 1401 W Academy St.
Fuquay-Varina,NC 27526
County: Wake
*Elevations based on GIS data
*Confirm all elevations in field prior to installation
Specifications
Septic Tank TS 1250 STB AdvanTex RT Pod AX-20 RT
Length 125.50 in. Length 102.00 in.
10.46 ft. 8.50 ft.
Width 65.50 in. Width 64.25 in.
5.46 ft. 5.35 ft.
External Height 61.50 in. External Height 72.00 in.
5.13 ft. 6.00 ft.
Bottom of 4"Inlet 11.50 in. Bottom of 4"Inlet 28.00 in.
*from Top of Tank 0.96 ft. *from Top of RT 2.33 ft.
Bottom of 4"Outlet 13.50 in. Bottom of 4"Outlet 37.00 in.
*from Top of Tank 1.13 ft. *from Top of RT 3.08 ft.
Elevations
Stubout(Assumed) 402.12 ft.
Septic Tank AdvanTex RT Pod AX-20 RT
DL Pipe Length to ST Inlet 40.00 ft. DL Pipe Length to RT Inlet 12.00 ft.
Ground Surface at Low Side of ST 401.62 ft. Ground Surface at High Side of RT 401.25 ft.
Cover over Low Side of ST 3.00 in. Exposed Height of RT 6.00 in.
0.25 ft. 0.50 ft.
Exterior Top of Tank 401.37 ft. Exterior Top of RT 401.75 ft.
Inlet Invert 400.41 ft. Inlet Invert 399.42 ft.
Slope of DL Pipe 4.27% Slope of DL Pipe 6.90%
*minimum 2%slope *minimum 1%slope
Outlet Invert 400.25 ft. Outlet Invert 398.67 ft.
Bottom of Excavation 395.75 ft. Bottom of Excavation 395.25 ft.
*beneath 6"gravel base *beneath 6"gravel base

DISCHARGE PUMP DESIGN
Date 4/19/2024
PROJECT: Jacobs Residence
Location: 1401 W Academy St.
County: Wake
Friction Losses
Suction Head= 0 ft. (submersible=0)
Elev. Difference(highest point from pump)= 10.52 ft.
Design Pressure At Outlet= 2 ft.
Supply Line- 1.25"Schedule 40 PVC from Pump to Discharge Point
Pipe Diameter(ID) = 1.36 in. Flow= 10 gpm
Pipe Length= 175 ft. Velocity= 2.21 ft/sec
Est. Friction Loss per 100'= 1.57 ft/100 ft.
Estimated Friction Loss= 2.74 ft.
SUB-TOTAL= 15.26 ft.
Friction Loss-Fittings (5%) = 0.76 ft.
TOTAL= 16.03 ft.
Motor Efficiency= 0.9 (assumed for electric pumps)
Flow= 10.00 gpm
TDH= 16.03 ft.
Pump Selection
Manufacturer: Orenco
Model: PF 1005
800
700 pn :�T PF10 Series.60 Hz.05-20 hp
1111111111111.11..111.1.01111111
600
500TEM.111.111111111111.1111111. Operating
..u..1.1111111...... Point
300 PFt111111111111111111111111111111111
��®11���������.�
«d
iQ ■■ PF1005-FC '�11■�2EM■
100 ■■ vig% flow ,■ 11P/■11 .
COMrolle► mmViimmi
0 2 4 6 B 10 12 14 16
Flow in gallons per minute(gpm)

. Awls
Jccobs Residence Surfccc Discncrce
Eepin<an a�W Soil ScierHiab
!gi'Wasia Txpnobpy.
✓ 501 N.Sabm Slreai.Suite 203
Ipaa.None Ceolma 3I501
919-059-0889
�T www.apMatlawm
Project Location: 1401 W Academy St. Jacobs Residence
Sulam Discharge
NEEFuquay—Varina, NC 27526 „° rTreatment System
Wake County SITE Ofon.maaaama
,of�.ra
w�ws.
PIN 0646834697 E - 2�26
(919)6I2-I132
ama..dwa>roa
flaps-Mmnalme
O1*A.wea
,b1 w at,,P R
(W.cy-WM�NC 3]5]8
Project Owner: Douglas Jacobs °M4°""°'4°"
1401 W Academy St. asrrssoat mewl SE,
Fuquay—Varina, NC 27526
(919) 612- 1532 11
doug©jacobsteamrealestate.com t" AP
VICINITY MAP i ` ap. , :-.-.1
Project Consultants: Kevin Dravidson, P.E. \'?4""c
,,may=v
kdavidson©agriwaste.com
Agri—Waste Technology, Inc.
501 N. Salem Street, Ste 203 ,,e.
DESIGN
Ap N C 2 7 5 0 2 NOT RELEASED FOR CONSIROCOON
M. ISSUED WE MORO
(919) 859-0669 Sheet Index
(919) 233- 1970 Fax
Sheet 1 : Cover Sheet
System Overview: Single Family Residence Sheet 2: Property Layout
Four (4) Bedroom, 480 gpd Sheet 3: System Layout
Design Standard — Discharge Sheet 4: System Detail # 1
SHEEITLE
AdvanTex AX-20 RT Pod Sheet 5: System Detail #2 "
Cover Sheet
with Single Bulb UV Disinfection Sheet 6: Excavation Safety w~BY: CREATEDON:
N.Canon- 04/19/2024
REVISED DT: REVISED ON;
1111111 --- - 1 RELEASED BC RELEASED ON:
I SHEET RAW:
WW-1
J

:Pond • / AllIrT
Engineers end Son Scientists
09,weele Technology...
— - _-`_ T - — — — — - — --_ — — — — — — I 50Ann,NorIN Cimino 27502
1 N.Salo.94aa1.9uea 303
-
919MYgee9
wwep e . iMM
(by.
�td` Jacobs Residence
\ surface Discharge
off Wastewater Treatment System
\ N58°03'40"E �o oline Mamalio,
296.50 Clop.
op Ja
lb,w ka6ary 6
ZO Z Zip ruquay-V°nm,NC 11626
ZO r r \ ' �4t4 (916J 612-1512
D \ 6�,� V'b 6°gg1°wheleenrwkslate mm
O _- — r.0--__ Ji •O: - . AaOe'1T IMwmation:
c M 408 M — / — \S0°01'44^E ° i' `°b w emery a
('/� 8.66' !0 1' — / ugiay-Valley Nc 21s26
_ — — — `- -- -Ze:,E — r — - - - - — — — — j — — — — —yam — rfq 0646e34697
,...- ---- ....---- _--- __- AO. ---- _. ____ _t___P
_, \ ` \ N (•; / PROFESSIONAL ENGINEER SEAL
/ -- Ic mnao.n u.em.a \ 7 / \ 1
bpL \I� \ \ /� \ \� 1
• \ /
I \ / \ \ �/ \ �\I ®a ;w y
J/
I \ \ / 1 \ / \ \I \ IP"' _,.+s+a
Unknown Tributa
\ . ` p`( \ \
° _ / to Kenneth Creek e a \ 2I \ �// \ N \ i \
co r
/ ii...
� IGN
o II Alp of �_ „ —r-� \ O �• : \
,' M , 1I /` Shed�'—4——�J \ \/ \` - orj ° '/ \ 1 N NOT Rana F FINK OR rloR
z II ��) / \ �\ � ° I \ N I ..........
�. a< a N
/ III
Existing 4—BDR Dwelling/
\ I i -
I .--�.__ � .fir ,_/ /
S`ed - ——— \ \ / SHEET TnIF
Qp6 //•!\ 4 Property Layout
85.01' I 160.24' N i \
S58°23'28"W I S58°23'28"W ses°23'28°w /
NOTE: Topographic Data from GAS. ---- \ \ CREAM DRAIN Ere '2°�"
40Q o zs so REVISED BY: REVISED ON:
Feet
I Shed I A RELEASED RI: RELEASED OW
DRAWING NUMBER
SCALED FOR A"X17"SHEET Property Layout WW-2
J

i
\ ,/,,,"hl�\\\\ / / Line Legend Engineers and Soli Scientists
/ 501 N.Salem Street.Suite]W
\\ Line Name Size Type
/ Tree Protection "°""„s,.�;;"
_ / c DL Drain Line 4.0" SCH 40 PVC tA»,..>am„ rem
J EDL Effluent Discharge Line 1.25" SCH 40 PVC
Jacobs Residence
ERL Effluent Return Line 1.0" SCH 40 PVC Surface Discharge
s Wasteeater Treatment System
Y S • U
o DL a) COMPONENT LEGEND Ownerufarm:Slo;
W Douglas+^roes
-CI NI c1 ST Septic Tank CP Control Panel Fe,-ketkety��
12-1552
E I - .c1 m RT Recirculation Tank UV UV Disinfection e;,�p ,,,,a„,al,,W,,,
E A AdvanTex Pod P Pump
m a .cn CO Cleainlet Teet EF Effluent Filter
n IT Inlet BV Ball Valve iaweeFw:• 17526
cq O Q SB Splice Box »ycewa.14027
/ RI O
�.�. t''.^^— 'S• 0 ` PROFESSIONAL ENGINEER SEAL
V/ El
Ns
�4. og m
�i , .SB
Gfor
�p•:�(ssa,�,.
�� T 50'Property Line Setback '(rem )
,
ERL i
�l�Y'v
0
r
a
0 �\ NOi FRFA EO GORS ISIPoICIION
d
WS esus WE DEWS*
a)
C
o a6). \
A
b P�oS �� ° Connect to Existing
v ' ° Building Sewer
DL (Field Verify Location)
SHEET TITLE
N System Layout
• _y F �s... Approximate Electrical Line
Existing ST
(to be abandoned) —— DRAWN BY: CREATED ON:
I,Feet _—"- N.Caa6nxa 04/19/7074
� _.._. REVISED BY: 'RDASED ON:
I RELEASED By: REIFASED ON:
M
SCALED FOR 11"X1T'SHEET
System Layout vow-3

NOTE,
1. Topographic data v A
FTP-0848-36 2. Septic Tank havee approved
ved Orenco Effluent
Filter model NC. Engineers,oe son saem;a,
alflw TlsTreanoraralea-IN Rare with fe OYch,11e yy,,....y ,gn-Wa:le echo bgr Inc
All
3. Treatment system to be 15'from residence, 501 n1 Salem Street Tune 203
" MODEL TS 1250 8TB - - 40'from property linen, 15'Irons onaite nose.noon gamma nsox
..,•r.ns '�•"" NON TRAFFIC •.'j_.we. w"'rs buildings, 100' from neighboring residences, stop..c
1230 Gallon Septic Tank •I n.�•■•■r■•■ ■ ■ ■ ■ % vmw..gmna,rvm
/ and 100'from any Well.Vei ficatlon of these
,a �� setbacks to be performed by contactor. Jacobs Residence
e�••,2 s I 1 �l/"'��JI .00e r� r;;:=
.....,_.....,,c.,
` ar a.,r. J1 ri I• — 4 Contractor shall bockPlldll a1-- Wel
� I •
1� • areas such foal storm Water 'e shed away Wmiswater treatment System
\//I\ �I— 1 /fora patental entry points.
'i �I� 5a •
. Invert elevations of all components to be
.o.,a...o.mew, '"•• a z,r rn,n,o rem---r,p•;rw ,.cnR�,.c.rank no,e verified in field by contractor to ensure proper F.n�1401 N kw*"a,
operation. react ywlw,IIC 2761,
ITK.CO 0.11.01141-MITU.OVID MUM,a^' eeug r12-ITV
"• 6. All system piping to be SCH40 PVC except �csll
,raca.nr.r nnra„ I
where noted. ga'sww�,,klonn,lbn.
" Lc e le 7. All gravity elbows to be long radius or Hpj p ko�denr St
, wc.o r„eo.w=w.ra. ra t1 lore sweeping t elbow..
19 I� � - 9 P 9 type Ipwr-Vwb,,NC 2752e
•a,,..a•.,,. al 11 IM a�y - mg O&89.H697
.a. r,n elm ""' - �•- I II 11l,.. --I II!If IlI• .''I _ 8. Actual inatallot'ron and placement of
w• — _— I �CII. ,mil; . .: Contractor.treatment�stem to be overseen by
1 I tea. ......
'.N I I", IPROFESSIONAL ENGINEER SEAL
�4%! ..1.,!V 9. Use Class'B'erosion control atone for
44,
." w.area nII�9 • . structural base for outlet stabilization structure.Imo-Y c Use/5 or#57 atone for sediment control.
I • Prunary rani aide Vim 1\'Ir Recrn.Sank-.5„k 1, Ilr..lurye<'NmAv-I:nJ View
IV .. sr10. Discharge line must be covered to a
• minimum depth of 18".Discharge pipe outlet
'a to have grate.
11. Flow from the receiving ditch back into the cv wear,
ap4.a .
system shall be prevented. jk.Olt.
e^'r''... ,.
12. Engineer Inape<tion final cod during system 1 I 'fie
Not to scale Not to scale inatauanon and of morn cornpletron, K�o-.' s
13. Contractor to seed and/or mulch - svzV
�Septic Tenk'{or-"equivalent) AX20-RT UV Adv.nTez Treatment System-FOR ILLUSTRATION ONLY disturbed areasto coincide with existing
-• •� " -" landscape. Area shall not be left with
uncovered soil.
'Note: 14. Upon system completion,Contractor to supply
Ensure lid is bolted shut prior to backfilling Engineer with docurnentotlon of
Treatment Pod. Ina temtlwasi d tails reed letter indicating
aye per approved design
Add water to Treatment Pod during Backfill or noting any deviation from approved
design. F1AL DESON
. In 1 (Match water level to backfill level). NOT RELEASED FOR CONSTRUCTION'°" "•" 15. Contractor to install phone line to VCOM
control panel- re. dmrm oat gtttl few
Clean,Tamped Backfil �... ~•+� 16. AdvanTez-RT Unit to be placed on gravel bed
:=:ri
"•`,y__F 1FL— and backfilled with gravel.
4"SCH 40 PVC . 1I 17 1111UII I,1111r �-
lass BRip Pa. w/Grate 4 - 41 r,.i=s_ ' 17. Mount Control Panel a minimum of 24"above
_ grade.Polder to panel to be Metalled by
`T`~.T`~ `v _ _ �� A. _ " _ control
electrician per code.
titI. �l •. .e� . .�� • -...V av 11,, _'-L_` .Art
•w�x� �r i•.��r�+ �.I-... 18, Leak test n_ �_ '�. required o .optic tank and pod.
��.iN 10
. ii f gai ^^ `� 19. Water spigot to be located on exterior of
;�•� -�_•� 'r 'a�:, ...y_-• "' residence within 50'of tanks, --
filter Fabric - ••• #57 Gravel Tr-,i'' ,, „._�'��,. a 20. Pour concrete collar stall ad flange of
" -�,� .C,L7�"-- treatment unit r Install antin-buoyancy beams
\ � r°"' "`"�Y _�' per manufacturer's recommendations.
lean,Tamped Backfill Undisturbed Earth O,:4 •---•"•-• SHEET MLE
� 21. Existing septic tanks to be properly abandoned.
. � - - Contractor shall provide documentation from System Detail II
;p --- Durham County. y 2
I ..n,r•� t Id 'till IIIII�N H,NO 22. All wastewater from the SFR,including
r_ jiiiiiimk;
' greywater,is to be conveyed to the septic
tank
owe 23. Separate circuits for pump and alarm/control DRAWN BR CHEMED ON.
panel arerequired(2-120V,20 N. SED BYI 05/00/024
amp; 1-120V, REVISED Bri. RE\15m ON:
16 amp).Separate conduits required for phone
- or Internet line.
RELEASED BY RELEASED aN:
Not to scale Not to scale Not to scale
u•,,., 24 Recirculation Timer Settings:
TIME ON/OFF:0.8/14.2 minutes DRAWING NUMBER ,1
Dlschar Ri Detail0. 14 gpm to Pod/5 gpm to Septic Tank. arirs�r._T
O pe prop Salary Net(Install:Sepac Tank Risers) Ane-8uoymtry Instelleaon W/\Y�Z�'//

WIT4X6 TREATED POST A
Engineers and Soil Scientists
11 MOUNT PANEL DIRECTLY oeS . Ilit w se. Mt S.m
CONTROL TO POSTS OR TO epee. North a 21102
PANEL ALUMINUM PLATE .050410013
etem.wnewm.mm
_
0000 (GRIND OFF PROTRUDING
...... SINGLE 0 SCREWS) Jacobs Residence
CONDUIT 1 Surface Discharge
�� � max. r„ (no splices) Wasteeater Treatment System
w.... I.
a w.~.. r°` O.... wa„e"m: n...r� rW� 2X4 TREATED-SECURE
r----, I t.e Om+,�,r CONDUIT WITH 4-3"DECK SCREWS a oMn'ax jr�y
tarn .....F. . .. �_ SUPPORT PER POST 1q1 a
-- ,u I,I 9.4... .... ..... ....... .....2• Ill 1111
4 Fwwr-ww. 27s16
u --A
y ow nr w _ (919)61I-1572
1Q;r lc '� r� X 2'(min.) eap)512-1 om.ol.ma.00m
_� II I 1._ - �nt� .� RISER OR IIIIII' kilemdm,
CORRUGATED PIPE vr�t!o�u0q���./Road
gym
1 � � � �-�j _ NCB
� I �-.....u. `�"�`�`�'b_ a wvn-y^^^^. :Tare
pig Oele6Mn]
w. °""' a/11
a\ COVER CONDUIT 1I I It GRAVEL
ee.w M.T. �� ...1 �� MINIMUM IB" ��e,ei.
-■'' '` PROCESSIONAL ENGINEER SEAL
\----1r ae0 a...sea rmOe" .•c..1....r TO RT UNIT J TO HEAD WORKS
re. TO POWER SOURCE
"' ALL CONDUIT
e""°^"Ewa '"e1w0.Er" `tor" INSTALL I TO BE 3/4"(min)
MULTIPLE
CONDUITS AS
NEEDED I I I I 3'BURIAL DEPTH
7 • 1•ceot ,
MINIMUM ?.4-kt.
Not to scale "'"
Not to scale U - '1:4•9?
System Detail•FOR ILLUSTRATION ONLY Control Panel Support(of equlvelenq >N199•Tr
�^
a fedlleatIons
Sepia 7atin T3 1250 57% AdvanT.x RT pod AAZO RT
FN1L OF.9CN
Length 125.90 in. Length 102.00 n. NOT RELEASED FOR coesisucnoe
10.!R. 0.50 IL
3' WWI, 66.50 in. Waft 64.251n. KY. 156F0011E 151901001011
5.46 R. 5.35 R.
.,kk k,t
Concrete Su ort k Support'� EstemdlYerpx 61.50 in. External Height 72.00 N.
PP Strap 5.13 R. 6.00 5.
Pad 18"u 18"x4" - Bottom of 4'Inlet 11.50 In.. Batem a n 4• Et 20.00 M.
Von Top of Tent 0.96 R. Ymm Top of RT 2.33 R.
) Bottom al4'Outlet 13.50 in Batton of4.Outlet 37.00 Is'Ron Top oe Tank 1.13 R. Tian Top of RT 3.00E
sevallom
q•
Stuaart(Assumed) 402.12 R.
MIN?COVER epee Tank AdvanT.x RT Pod AA-20 RT
Geotextile I
ravelFabric a rain Ho'. a Pipe Length to ST Inlet 40.0)R. a Pp Length to RT Inlet 12.00 R. SET ME
`m a,-ns,-am Ground u/ec ound Se te Low Sib au a ST 401.62 I. Ground Sutter*et high Sib a ITT 401.25 R
Mrs Cheer Der Low Sale of ST 3.02 In. Exposed Height of RT 0.00 In.
0.25 R 0.50 R System Detail #2
Galvanized Exerts Top of Tank 401.37II E#Npr Top a RT 401.75 R.
4"x4" Treated Pos Elbow Deer?molt 400.419. Inlet Invert 399.42 a.
48" burial (min) Slope da Pipe 4.27% SIp as Pip 6.90%
'm1Nmum 2%elope 'mnknum I%elope
Outlet Invert 400.25 a. WWI inner 390.67 R. DRAIN BY: CREATED ON:
Bottom of Exa.mbn 395.76 R. B.Itum a Esestlon 395.25R. N.Carrara. 04/19/2024
'beneath 6'gavel bane 'beneath 6-Fn./Out. REVISED BY: REUSED ON:
RELEASED BY MEMO ON:
Not to scale wow NL l ER
0 yard Hydrant,(If required) Elevation Determina6ons 'r l7'r T7_5

Trenching and Excavation Safety (c) Requirements
rOolt claselficatIon ley..means Mr the popes@ of this sub.rt•nwollIal of cal•ponErnp Sok end M.
The employer must comply wbh Me..ling and excavation rquirerre.d 26 CFR.26 65?and 1926 652 ..„0,,,a,r.,.„....yyy or...,,,...,...rye.e.nd,p.c.,,,,,,,,...„0 o,.,.0a.,oh.
or compere.OSHA-approved state pien revarornents pt.Cie...non of soil and no..posile Each soli end rock ded...11.closed.by a con.tertt Person (2I Manual teen Manual enahres of sod*enrols.is oonduded to.ermine qua...as wen as dual..°spoon.are date...essed on an map..of Me propert.md performance charestenstics of Me as Sta.RO.Type A Type B.or Type C in moo...h the delronons set fo.rn pang..of tag..of god and to pro.more mbrmanon in o.r to cies..soil pro.. Engin.,and Soil SCientists.....M•character..d...and.enwonmenbi cond..expo.
Inspection of Ex.valrons exte ep.r.rx
........n.n....1.'"....'."".."..*....1...nd rern... (2)Beets deli...Von 1.cis•sibutton of M•depoSitS me so rm.*beeN1 on the results of at 1.st o. III P.V.Mold a most or.1 sample of soil inN a ball and she.to roll it into Mr.ds as tn.. Agr5VVesle Tech nobs,Inc 04.1.n...dui.Mat a corno.nt poison insp.tr.ches derly and as oon.ons change Wont whrle exposed
vssuel end et least one manual analysis SuCh analyses sheA.cond..Oy•cOmpelent person usng 1.-tnch in dame.Co..rnalenat.n.smcesefully rolled into direeds ve.ut crumbing For 501 N Salem Street.S urte 203.rker entry to ensure•reninanon of exclo.on hue.A..0.1 person ts en indr.M.I.o ts.pable 0, Iheibmetged a-means soil which is underweter or a Ir.seeFeng
note....Perego.CO below or in other rec...rneale416 Of sorl classifiCatron and Wenn°Such exam..bat lesst•.o roil(50 nvn)length of 48-e.thread can be held on one end w...t Apex.North Carolina 27502
Afer.fying existrng and pr...haeards or workrng conchnone Oat ere hazar.us.oreandary.or dangerous
.Mose edophod by.Anon..Soc.y for Teen,.Alamners or Pre U S Department of Agnsuiture .nng the soil*cone. 91,659-0669
to...eol h.•nd probe.Systeme opused and who re auMpreed tO O.pr..com.ve 'TO...Mean.oboe.sods wet en Leon/Pool compress.strenget of/6 mit pr sm.pert(/••
texturat rimecerion Imm 00 Dry...mph If.so..end corn..on rts own or wth timbre.pressure into rnonAdual grains ...eon..oorn
measures to eliminste the.flan.and cook..
a.'.'...'a....'........E'.1''E....F.4.F 1....•.'.....• (II Visusl ere manual anal,.The ws.end manual en..wo,.those rimed as.ing...de in or fi.powder.ft'SM..,(any combinetron ol gravel.nd or.1 If the soil's dry end fells nto
ably clay loarn and sandy cley.rn Cemented Sabs such as ca...herchean me Ntso Son..r. aaaa,ad,../raw. „aaa a,aaa,,a da...aaa,a,„ ",,,ataa,aa ma p.p.,aaa...5.an, dumps which break up PM.Smaller dumps CM the 11111011e,clumps can only be trulsen up w.Boca.a.EPP.. A
Prelneeve triforinttion re may be necessary to Pont,beoPerrY Me PrOPern...dore end emd.n. diffIculty tt may.Om in any comOnanon wrth grAml..nd or.If I.dry soil.e.Into Clumps OSHA Standards require safe aMen and egraire to all excawkon•including ladder..S.M.rarnpe.p. Hovever no soil ts Type A/
affe.the crass...on d Inn auxua 0.do.break up tro smel/clumps an0 WIC"can only te..n.h M.,anci(4 there 4 nu Jacobs Residence
0,,,,,...arts of extt for employ.s wo.ng in tr....atons 4.p 22 meters)... 5) The.I is fissured or Layered SyMenal In a layered system.the sy.rn she.ciassifiect in.cordence.irs wee.sleyer vemil...non the sod rs asSured Ine soil may Pe considered unrilapred These dvicas Must be located within 15 feet(7 6 me..of ell w.e. (s)The sot.su.st to..tron from heavy bet.ole enving.or sober eff.s or
However eech dryer may be class.d rnsimdually v.'.a MOM Stade layer.n.a less SOON.). OP Thu.benetrebon The thumb pene.non.can be u.et to sum.Me unconfined so.... Surf ore DIscharwe
,III,The fol.,ban SP.POusly disturbed or
Recommendations (w)Th..pan of s stored.laye.SySternwnere the layers dip into the excevenon on a slope al four '''''......'....'P'.....•'Fa...a..r.e........P...... strength of con...sods(Pus teat re...on Me Mu.Pene........ Wastewater Treatment System
Mange III any v..the changeS shell.emilue.by s Competent person The Wooed shall. Society for Testing end MM..(AST.Standard.srarrabon 02468.'Standard Recommend.Hes,erturnmekt rend hm.should stay n far es pe.i.from the edge deny trench hortiontar te o.v..I nin1,or gr..pr
necessary to reheol.changed PrCumstances Pr...DescnOton of SOO(Visual.Manual Pro...1Typ.A sots s.an stn.../soave use pees under stelot.to mindnere ground pressures roe could lead to ficlures I.The ne.e.supect to other fectoo that..require b to.class.as a less so.malenal
compressive We..of I 5 Of can be reably rndanted by the thumb however.they oin.penetrated
S.means (d) Acceptable visual and manual tests s,im tnumb orey Nom vev great•Tort Tme C sots.en unconenerl compresson avenge d o 5 DOM Worn/ANN
(b) Definitions
5) cones.$ol/with an unconfined compressive strength greeter than 0 5 ter(46 kRaIbut less men 1 5 Ofe.h.e.SO Pmetreted Several Inch..by ent eye,and can 4 molded by light finse pressure Double.Oa.
This Ont.ourd be conducted on an tr.renotrea soil sem..smh as•le.P4Mp at Noel es soot-
.4(144 IsPar or 0 I VIS.I.IS VISLIS1 arms pa con...to del•rrnIM.111111..41In10,111.110‘k re...me eeceveoon Nos es Nem..eller excevabon to Nolo to•meirourn.Wenn d exposure tO( blog......S Ma f14°Loquay"-Vt!a 17710S'27526
-Corteretee ser rrean•*sal in WhICII Me par..are held together by•sr..erg.such as cams. A .Granular cones...erode mcluding ..c.v.(amber to crushed rack,Silt en loam sao•T in general the soil adamant to the excavation.the soil forrntng the sides d the open excavanon and the sort
car.nale such Met•hand...sample cannot be crush.MIO pOwder wr individual Sal parte.by finger wen a.in some us.why day.rn end se.y dm.m Won as sem...escape..'Palen. MO•Vellon is I.r expo.d to w.ng influence.(Fern In.ing1 Me Ansificaton d the.niuSt.
[phone] pressure
led OPP..Osturbed sols except Oboes v....db..be owes.,es Typ•C sot dump.a...5d,
P6/90Nobbeeroreolestole.com/Canoe.soir means clay(fine grain.soil)or soil voth•high clay content.,,,h..cohesive strength
(41 Soil.meets Me unconfined corner..sbength Or cementenon reputrements Mr 5 yrd A,pol. ()Obsom sern.s of so,Mat are ex...and sal to.ears a M.eauvlkon Es0..the ra5od Ov1 Other strength tests Ennui.of unconfined composer.etrength of soil•<an also baoblene0 by
Cones.sorl does rat cm..can be ems..wrObs•PI,Pal Sed•Slopes and is plertic when moat C... uaraa...aaam aa‘.....a.„ar
0.0...and t.retetwe amounts of the...saes SN. ...ply composed of use of a 0ocem pane..or ps slim,a hansissprated Sh.arane
1011 is hard to br.k up Moen by.end exhibi.Significant C011eSiOn when submerged Collastv•soils Include (v)Ory re.OM is not sta..or fine-gremed metenel MOW.III cones.material Soil corn...manly of coer.goned sand or .1 Orytng Mt T.baso purpose of the dry,.is to Offeren....en COhearra mat.wrth Properly Information
clayey sie send/clay ON clay cey ena merle ctey orb Menenal the.pert des...levered',stern where the I.e.dip into Me smovabon on•Slope Sast gres.f•granuler m.rel NMI.unfissured COhOSIV•material end menu.noMenal The procedure Mr tn.Owing test invo.s 00401 Id406
etymon sample of.,that iSeporPomatAy one inch th.(2 54.and six inches 115 24 sml. 1401 lb leablarny St
Vey esp.mama sob thet don not sr..osible wgns e mature content steep then four homontel to one verOcal(4H IV).but only/Ma m.ral woote otnerense...AM] MI 0.e.sol es 4 is exc...Sag that remains A slur...en excevated is coheerve Soil that
Ihesure,means a isoll matenel Mal hoe a tendency to break along definge plan.of free..1411e 21526 ogid
darneter untri 4 kr thoroug.dr,/ Fay-V.ne.brIC e•Teo.. Nemo up us.end do.not stay Ai etomPe 4 9...res6tance or a...banal Mat ash..open cr..smh as?moon vac.A an exposed surface (AI PI our sample der•logrl crKla•S it Ones sgn.nt fissures etne inbcated
(69
li. Samp
0.ehre Me side 0 th•opened.camMon a.the Surface Brae adjacent.the excave.n crodoirid P1511 0646831697 es mar Promemout creche°ere to be Nolan by Meld if conscierahle forces neces isary to
60ranuler•olf.memos prove.mod or sill(coarse grained soil)owe lere or no cey content Grenurer sob nu ..,...p.abpana
openings sucn as Winston cr..Muld indcate Pea,.rnatenal If chunks of sol spell Pre...1
no...strength Sem...granular soils ex,.apparent...on Grenuler sob...be(no. (1) Co..sob v.on uri.nfineda.preas.strength d 0 5 WI40 M.Ot..et era.sol code be hseurard Small sp.are golden.of mown°mound end an P.n.d Peak a sem.the sod has sondem(.hestve m.rel Content The Pot cak no ciess082 ss ak
when mom and crumbles vastly reten ory
(IO 0.....Ilncludog passel.sand and loamy sand.or pOtentally hazardous sr... ...red cone.mennal OT*Wwclomatao.e.rinase.shtb.mxmss1sy4aoet tamea krn.meisaaen l en•aw eddbi lslpi on elcaptoxo.n hnesrcbsme i nt.ao Aoslf l nmrs<oh.tcrsai okmm W boo.oOfrw Ochsohi c hteaheh.rssear rooalelb.orn.e wl obPeso.otktwnhfsfse ae.e reee.nnfauetso amr nlarbsbce.o.lde
e.o bM k tyis.pot etbe sto ecarn.m..hoenls,do iSe.vedek rws 0oe.iYl oC.aMutn nce traeare.nmlslyt n s.goe mooserh a .54.
ncae..l retn p to•r e r.osllc.oek.p.t.h.a Mt.l aeiSeya e.nlrdle..dS,tSe'ym'be,l,eet,ea..rnon s.rM.Ini.m•M Ne ret hee Lleayr eurnsn Pap into t d teeaereceoeexcavaod....bo.n e . .. .
(Ct tTf oa aerenn.gur.between Me Maonn dp h4h reert e.rth neor a e.fissdu rmOeutd en Icrsai oanln eross f c.Mone e m
ssea.fma.nwa•i tobh kr F lahy aeg.w.aan you rIlM fab Pry MMSeta
.
e.. . o .. . mgen P1,
1i1n,
g PROMSONIS Oa.SOL
app..V0111In•change
con be clererrntnee by tebormory nnting.or.timeted in the field us'ng a pocket penetrometer by thumb table
-smosas mir means•...oh Me rot.sm Mted Asth.ter SM..O..not repurre flow pens..teens a.other r.ho. Iwil 0.eree Mt are.adocent to M.excavenon and the am wrthin Me mosvanon for souron of..pon
.....o.ar.......o.to....61.11.....4 44.4..O....n...,."..."...'. 'WM nor means sod PP contains...a...re morsture Pan rroist sod.in such a renge of veruee Met may affect.estalyhty of the excevanon face
sheer vane
Mat corwswe mer..1 all slump m.o.to floe when vi..Go...ma..that would enihrbt mho.
prOdertaat when Mel wre 10.Mose cohesive pop..when..
EXCAVATIONS IN TYPE A SOILS EXGVATIONS IN TYPE 5 SOILS EXCAVATORS IN TYPE C SOILS EXCAVATIONS IS LAYERED SOILS
All aim.slop.(ma valtone 20 Not or less rn.0,an.nave a maximum mow..Mena er,41 MI sec.mope...ions 20 feetof.s in depth shall have a mark.enowede slope or 1 1 MI eimple slope excevatwe 20 le.or 465 in depth shell have a maximum allovade slope Of 120 1 All excavanons al fed Or Ina in depth rn.re in layered sole Shall have a mammurn silo.. step.,,,le et.,„4,6
sloe.tor ea.layer as sel forth below
17 Max (
7 (41'1' 16 ' Osl:,..._...„...„.‘•••.‘be-•OA
o.-
ExceOlon Simple Cope excavations whIch are
Open 24 POI.Or less(Mort term)and whrch
are 12.or less rn dep.Shall Pave a
SIMPLE SLOPE
maximum all...Pope d X 1 SIMPLE SLOPE B OVER A
All le.h.excevahons 20 feet or less in depth NMI NM CI rna.111,111
allowable slope d 1 1 and mapurn.nch dimensions as follows ,
All errevabons 20 Peet or Nes in Opel which ttave verMally sided lower p.m.that are C
20 M. ,,, .. • supported of ddooea eflafill.....urn al...Pope of BA/The sumac.or she. 't-
5.•M. sr This.rch allowed in syPem must ertend et tea..inches above Pe Pp Of the vert.side
cones..only A t FALL DESIGN
4'fa sr ' ,h•pay t
NOT REIEAS9)FOR CONSTRUCTOR
SIMP E BENCH MVL IPLE BENCH C OVER A
REV. 15.0 SATE OESCPPIXN
All 00400e0 exPavaltone 10.or less in eel.snali new a maximum allowable slooe or Ye 1
and mapum.ch Arnensions..... SINGLE BENG. i
,
20.1.1.
16•••Ann
3 5 Max
3 5 Pax
Pi now..8 tee w wm w nem
MULTIPLE BEN.
which have unsuppOrted vertically Pd.
VERTIC.ALLY SOED LONER PORTION
Pwer portions.°have a maximum
All ex.vations more than 8 red Out not C.
or IN me
enn mew of PS I. ----I
we
than 12 feet A depth wilt,unsupported veMeadY
a.loser portions Shall have a maximum odoef MO.exce....11.in acde.nce.h.ot.opt..wee.w Us.re4ret ,
All excavations 20.or.s in..which neve vett obly aded lower pornons tnal are
allowable Pope of 1 1 a.a Mari..verde,
SUppOrrad Of shielded Mall have...murk all..PC..I T.support or shield syetem
Ude of Onfeet
must extend at least 18 inches a.nre Me top of the.1.1. A OVER B
All excavations 20 le.or less rn.pth which h.e verneally ard.lower pornons that are support.re
en.dad Wall h.a maximum al.a.W.d nE 1 The support or sht.syst.must extend at
least 15 inchee above I.top of the vertmal St.
7::N' ', :=1' SteZET DILE
' 20 Max A OVER C
Excavation Safety
ne...r
20 Max i
ItN ,,,,: :7_ MANN FIT: CREATED ON:
N,Carom .04/19/2024
REVISED Ern REMDFD Ott
VERTICALLY SIDED e0.ER PORTION .
B OVER C RELEASED BYt RELEASO)ON:
Afi other sr...compound slope and...sided lower portton excavatrons shall he In Mr crhser sloped excavahone Snell.in accordant:B.11h.other opoons par..e 4 tare asObt
All other slop.excavations shall be in accordance wrth the other options permitted rn$/926 652.1 SHEET NAME:
aaordance with the other optiOns redo..on.r§+Ma S.ifil
WW-6

Technical Data Sheet
PRTA ABS Tank Adapterssi
"�oPo,a"d
800-348-9843
Applications General
PRTA tank adapters are used to provide a structural,water- Orenco's PRTA tank adapters are molded plastic products and
tight method of installing a 24-in. (610 mm)or a 30-in.(762 mm) therefore have excellent part-quality and consistency. PRTA
access riser over a tank opening. tank adapters can be cast into a tank or fastened to the top
of the tank with a bolt-down kit.The bolt-down kit consists of
either six or twelve(depending on model)stainless steel con-
A crete anchors and a roll of butyl tape.
The 0.D. of the vertical flange matches the I.D.of Orenco's
ribbed risers,which provides a suitable joint to seal with
MA320,ADH100,SS115,or SS140 adhesive.
Standard Models
PRTA24 ast in Place Tank Adapters
Top view PRTA30 One for each end of Septic Tank.
x PRTA24
PRTA24BDKIT(6 anchors)
PRTA30BDKIT(12 anchors)
Nomenclature
C
PRTA �
B I Riser diameter
24 = 24"riser(Perma-Loc,Ultra-Rib,KOR FLO)
30 = 30"riser(Perma-Loc,Ultra-Rib)
ABS riser tank adapter
D Side view
Materials of Construction
Tank adapter ABS
Concrete anchors Stainless steel anchor bolts
Sealant Butyl tape
Specifications
Dimensions* PRTA24 PRTA30
A- Outside diameter 23.38 in.(594 mm) 29.25 in.(743 mm)
B-Flange diameter 26.75 in.(679 mm) 34.25 in.(870 mm)
C-Horizontal flange width 2.00 in.(51 mm) 2.50 in.(64 mm)
D-Vertical flange height 3.50 in.(89 mm) 3.25 in.(83 mm)
*The tank adapter has a nominal 0.25 inch(6 mm)thickness.
CO 2009 Orenco Systems"Inc. NTD-RLA-PRTA-1
Rev.1.0,©9/09
Page 1 of 1

Technical Data Sheet
Access Risers — Ultra-RibTM si
o° Yaem.
Incorporated
800.3,38-9843
Applications General
Orenco's Access Risers provide access to septic tank openings Orenco Ultra-Rib"Access Risers are constructed of ribbed PVC
and can be cast into the tops of concrete tanks,bonded in place, pipe and are available in 12",18",21",and 24"diameters.They can
or bolted down using a riser tank adaptor.They can also be used be ordered in 3-inch increments in lengths up to 13 ft for 12"and
as valve enclosures. 18'diameter risers,and up to 14 ft for 21"and 24"diameter risers.
Standard Models
RR12XX,RU18XX,RR21XX,RR24XX
RR24 XX-Adjust riser
Nomenclature height to allow for
minimum 6"above
ground.
-4-111"1116:__
+ Discharge grommet:
10=1"(25mm)
12=1-'A(32mm)
15=1-W'(38 mm)
20=2"(51 mm)
Splice box:
S =1"(25 mm)grommet installed'
L =1-1/1"(32 mm)grommet installed'
S1 =SB1 attached
S2=SB2 attached
S3=SB3 attached
S4=SB4 attached
• L5=SB5 attached
L6=SB6 attached
SX=Predrilled hole for external splice box'
XS=Explosion-proof splice box for simplex pumps°
XD=Explosion-proof splice box fa duplex pumps°
XT=Explosion-proof splice boxes for triplex pumps°
Riser height(specify in.or mm):
Riser diameter:
12=12"(305 mm)5
18=18"(457 mm)5
21 =21"(533 mm)
24=24"(610 mm)
Routing code:
U =Ultra-Rib1^^:18"(457 mm)
R =Ultra-Rib:12",21",24"(305,533,or 610 mm)
Riser
For Orenco SB1-SB4 splice boxes
'For Orenco SB5,SB6 splice boxes
'Minimum riser height 18"(457 mm)
'Used in Class I Division I environments
Not intended for use over pump vaults
Materials of Construction
Ultra-Rib'PVC Pipe: PVC
Specifications
Model RR12XX RU18XX RR21XX RR24XX
I.D. 11.74 in.(298 mm) 17.65 in.(448 mm) 20.50 in.(521 mm) 23.50 in.(597 mm)
Wall Thickness-excluding ribs 0.10 in.(3 mm) 0.19 in.(5 mm) 0.25 in.(6 mm) 0.25 in.(6 mm)
O.D.- including ribs 13.13 in.(334 mm) 19.44 in.(494 mm) 22.63 in.(575 mm) 25.63 in.(651 mm)
Weight in lbs per ft(kg per m) 5 lb(7.4 kg) 11 lb(16.4 kg) 15 lb(22.3 kg) 19 lb(28.3 kg)
©2009 Otenco Systems Inc. NTD-RLA-RR-2
23 Rey.12,©8/09
Pagel of 1

Access Risers and Tank Adapters CIO
Orenco tern:
Incorporated
800-348-9843
Installation Instructions
Access risers provide access to septic tank openings,simplifying inspection and maintenance procedures. It is important
that the riser be sized correctly and installed properly(i.e.,appropriate tank adapter,attachment method,etc.)to ensure a
watertight seal.Without a watertight seal,groundwater or surface water can leak into the tank,reducing the tank's perfor-
mance.When setting a riser,orient the grommets in the appropriate directions before bonding to the tank.
In this document,metric equivalents are omitted for nominal dimensions,such as riser and pipe diameters. If you are using
pipe other than IPS standard sizes,consult your Distributor for adapters you may need.
Riser Sizing
The installed riser should extend about 3 in. (76 mm)above the finished ground level (approximately 2 in. [51 mm]for tank
settlement and 1 in. [25 mm]to ensure drainage away from the riser). If the riser is too long,it may be cut to the appropri-
ate height using a circular saw or table saw.Always cut excess length from the bottom of the riser.To ensure a good fit and
watertight joint,a square cut is essential. If the riser is too short,a grade ring may be used as an extension.
Selecting a Riser and Tank Adapter Installation Method
To select an appropriate riser and tank adapter installation method,first determine the type of tank being used: concrete or
fiberglass.Then refer to the chart below,as you follow these steps:
Concrete Tanks
1. Determine desired riser diameter.
2. Determine if the riser tank adapter will be cast-in or bolted down.
3. Referring to the chart below,pick the appropriate tank adapter for your riser diameter and method of attachment.
If the bolt-down method is being used, make sure the adapter you selected will cover the tank's opening.
Orenco Fiberglass Tanks(contact your distributor or Orenco for other fiberglass tanks)
1. For 30-in. riser, choose the FRTA30-FRP tank adapter.
2. For 24-in. riser,no adapter is needed;24-in. riser fits tank directly.
Riser diameter Method of attachment Tank adapter Maximum tank opening
24 in. Bolted down or cast into concrete tank PRTA24 24 in. round/17 in.square* *NOTE For PRTA24
30 in. Bolted down or cast into concrete tank PRTA30 30 in. round/21 in.square* and PRTA 30 risers,
21 or 24 in. Bolted down to concrete tank or epoxied RRFTA 24 in. round/24 in. square the minimum tank
to top of non-Orenco FRP tank opening is 19in.,
30 in. Bolted down to concrete tank RRFTA30 30 in. round/30 in. square but 20 in.isrecom-
30 in. Glued onto Orenco FRP tank or PRTA24, FRTA30-FRP NA mended,so that the
allowing it to accept 30-in. riser. Biotube Pump Vault
12 in. Bolted down to concrete tank RUBDKIT 10 in.round/7 in.square (PVU)can rest
18 in. Bolted down to concrete tank RUBDKIT 16 in. round/11 in. square on the lip of the
Choosing Your Instruction Set opening.
Following are five different installation instruction sets for adapters,depending on your application,adapter,and method of
attachment. Refer to the chart below to determine which instruction set to use. Instructions for installing grommets in risers
are also provided.
Instruction set Adapter type used Page
1. Orenco FRP Tank Adapter FRTA30-FRP 3
2. Cast-In Adapters PRTA24,PRTA30 4
3. Round Bolt-Down Adapters PRTA24,PRTA30 5
4. Square Bolt-Down Adapters RRFTA,RRFTA30 6
5. No Adapters: Ultra-Rib Bolt-Down Kit None, Ultra-Rib pipe 7
Installing Grommets in Risers 8
2406 Orenco Systems'Inc. NIN-RLA-RR-1
Rev 2.7,10/06
Page 1 of 8

Installation Instructions (continued)
r, About Adhesives
1 -� ADH100 is a single-component adhesive/sealant for sealing pipe grom-
1 mets and joining PVC or fiberglass risers to ABS or fiberglass PRTA-
�.��, 1 1 style tank adapters(where the joint is in shear). Handling strength is
o j
,�; achieved within 12 hours,and full cure in 2to 3 days. It comes in a
iiii; ,
_ , ,
lila . 10.2-oz(300-mL)cartridge tube for application with a caulking gun.
ADH10(IPS810)adhesive is a white,two-component,self-leveling
e - methacrylate adhesive for bonding PVC,ABS,fiberglass,and concrete.
r ! ADH10 comes in pint(500 mL)and quart(1000 mL)kits, consisting of
A and B components(adhesive and activator),and requires hand mix-
ing. If a self-leveling adhesive is NOT required or if concrete is NOT
being bonded,SS115 or SS140 is preferred over ADH10.
ADH845 adhesive is a tan two-component methacrylate adhesive for
Clockwise from left:ADH10(IPS810)quart SS115, bonding PVC,ABS,fiberglass, and concrete.This is our only adhesive
ADH100,SS140 ADH845,ADH10(IPS810)pint and formulated to work in wet conditions or even under water,making it
MA320
ideal for field repairs. Repairs on leaking riser connections are pos-
sible,but any water pressure must be removed during the repair.
ADH845 has the consistency of molasses,comes in 400-mL cartridges,
and requires the manual dispensing gun ADH845-GUN.
MA320 is a white two-component methacrylate adhesive that bonds
PVC,ABS and fiberglass to themselves or each other, but does not
bond to concrete. It comes in a two-part 200-gram see-through plastic
pouch that must be kneaded to mix the two components,then cut open
and squeezed to apply adhesive.
SS140 adhesive is a gray two-component methacrylate adhesive for
bonding PVC and fiberglass to themselves or each other. It does not
bond to concrete. It has the consistency of toothpaste and will sag
slightly in warmer temperatures. Surface roughening is recommended
and provides the best bond strengths, but is not always necessary. Use
SS140 above 65° F(18°C) and SS115 below 50° F(10°C).Working life
of mixed adhesive is typically 20 to 30 minutes,and it usually hardens
in less than 2 hours, depending on temperature and adhesive thick-
ness. It comes in an 870-mL two-part cartridge and can be dispensed
from pneumatic gun SS-MK or,for occasional use,manual gun SS-MK-
MANUAL GUN.
SS115 adhesive is a white two-component methacrylate adhesive with
properties similar to those of SS140 and comes in the same two-part
cartridge, but has a much shorter open time for use in cooler tempera-
tures and jobs where quicker cure times are desired,or for applica-
tions where a white color is desired.Working life of mixed adhesive is
typically 10 to 15 minutes,and it usually hardens in less than 45 min-
utes,depending on temperature and adhesive thickness.
NIN-RLA-RR25 ©2006 Orenco Systems"Inc.
Rev 2.7,10/06
Page 2 of 8

Installation Instructions (continued)
1
�'"` Instruction Set 2: Cast-In Adapters
_-;:...- , . i Adapter type used: PRTA24 or PRTA30
Adhesive used: ADH100,MA320,SS115,or SS140
Bolt-down kit used: None
Step 2a:Apply Adhesive
Apply adhesive to the outside surface of the riser tank adapter.
Hint: If you plan to backfill the same day,the use of MA320,SS115 or
SS140 adhesive is recommended because of their quicker cure times.
Cast in PRTA30 tank adapter If you have multiple riser installations and do not have bulk adhesive
(SS115/SS140),consider using both MA320 and ADH100.Apply just
enough MA320 on the outside of the tank adapter for a quick structural I
joint(cure time is typically less than an hour).A single package of
MA320 can be used to provide a structural joint on two or three risers.
y Then apply ADH100 to the inside of the adapter and the riser joint,for a
watertight seal. I
•
\. ,� Step 2b: Place Riser
• t _ Orient the riser correctly and carefully slide it onto the adapter before
the adhesive cures.
Step 2c: Seal Adapter-to-Riser Joint
Apply adhesive to the inside of the adapter and riser joint. Use a putty
m „A -.�,� ., ' knife or similar tool to form a continuous fillet between the tank adapter
,_ '7 7' and the inside of the riser.
, eiet
Step 2d: Cure Adhesive
+ Allow adhesive to harden before backfilling. For ADH100,handling
strength is typically achieved within 12 hours. For MA320,cure time is I
I achieved within 30 minutes to 3 hours, depending on temperature.
0
I
.ct `
NIN-RLA-RR27 ©2006 Orenco Systems'Inc.
Rev 2.7,10/06
Page 4 of 8

,
Installation Instructions (continued)
0 I Grommet(at 12 o'clock) Installing Grommets
/
Splice box
/ Discharge Step 1: Mark the Riser
(---- assembly To install grommets in the field,first mark the riser for location of the
`_/ grommets.(For Perma-Loc risers,you should try to avoid
Grommet
411Ir cutting through ythe pipe seam the extra thick rib—unless it is
�.\'` 1' (at 3 o'clock)
unavoidable.)
Support pipes
Biotube pump vault Step 2: Notch the Ribs
Using a 4-in.(100-mm)grinder or other cutting tool, notch through the
0 - PVC ribs to the wall of the PVC riser.Remove an area of ribbing equal
to approximately 1 in. (25 mm) larger than the grommet diameter.
r�
Ode Step 3: Remove the Ribs
Using a hammer and chisel,break the notched ribs from the riser.Use a
D grinder to remove any remaining rib material so that you are left with a
1 smooth area, ensuring a watertight fit. (Hole saws with attached pocket
cutters are available from Orenco;they cut away the ribs as the hole is
T.. cut, eliminating the need to notch and break the ribs.)
k
, ,, .
k Step 4: Cut the Hole
Using the Grommet Hole Saw Sizing Chart below, select a hole saw
for the grommet installation and drill out the opening. (If you are using
pipe and grommets other than U.S. nominal sizes,ascertain the correct
I hole size for your grommet.)Use a deburring tool or knife to deburr the
edges of the opening, being careful not to enlarge the
rikii opening.
4 . `', Grommet Hole Saw Sizing Chart
1 gar
Grommet size(in.) Hole size(in.) NOTE:
. , 1/2 1 Grommet size=nominal
(IPS) size.For more
3/4 1-1/4 pipe
1 1-9/16 information about grommet
1-1/4 1-3/4 dimensions and actual pipe
1-1/2 2-1/8 O.D.,see Orenco's Grommet
2 2 3/4 Submittal(NSU-RLA-PG-1),
3 3 7/8 available from the Document
• 4 5 Library at www.orenco.com.
c
� _ • Step 5: Glue in the Grommet
4 e Install the grommet in the riser.Apply a bead of ADH100 adhesive to
the groove of the grommet before inserting it into the riser hole.This
t` will make the grommet more secure and will overcome any imperfec-
tions in the drilled hole.
Ili
NIN-RLA-RR31 G 2006 Orenco Systems"Inc.
Rev 2.7,10/06
Page 8 of

Technical Data Sheet ,
41:414S
Fiberglass Access Lids °w.
CI Systems
Incorporatetl
800-348-9843
Applications General
Orenco®Fiberglass Access Lids provide a secure covering Orenco Fiberglass Access Lids are molded using fiberglass
for risers,pump basins,and access ports. Lids fit Perma- reinforced polyester resin encapsulating a wood or structural
LocTM, Ultra-RibTM,Kor FloTM,and Ultra-CorrTM pipe.Orenco foam core,for added durability and longevity.The finish is
Fiberglass Access Lids are capable of supporting a 2500-lb green or brown and the top surface is textured to provide a
(1134-kg)wheel load;however,they are not designed or nonskid surface. Gasketed lids include a polyurethane or neo-
recommended for vehicular traffic. prene gasket. Lid comes with either two or four 5/®-inch stain-
less steel flathead socket cap screws and a hex key wrench.
AIIIII:::<::<:::>>:<:::::>::::;:::>:<:>::„ / Standard Models
FL18G-4B U G FL21 F L24G FL24 4B F L30G FL36G, FL48G
Nomenclature
FL24G-46 U
FL DO -I 1-❑
0
T Options:
Bottom Blank-green
- B =brown
W = warning label(24"and 30"only)
C = custom logo
ATX = AdvanTex logo(24"only)
Attachment method:
Blank = 2-bolt-hole lid(30"diameter only)
Cutaway view 4B = 4-bolt-hole lid(24",and 36"diameter only)
4BU = 4-bolt-hole lid Ultra-Rib(18"and 24"
diameter only)
8B = 8-bolt-hole lid(48"diameter only*)
Core Options:
Groove I.D. ► G = gasket
V = vent
Gasket CF = carbon filter:
4 Lid 0.D. r 12 = 2"insulation:
14 = 4"insulation:
Lid diameter: 18",21",24",30",36",48"
Fiberglass lid
*48"lids come without bolt holes unless FL48G-8B is ordered and hole
Materials of Construction locations are specified.For a 48"lid with no holes,to mount on a concrete
riser,specify FL48G.
Lid Fiberglass t For more information on this option,see the Carbon Filters Submittal Data
Sheet,NSU-RLA-CF-1.
Core Wood(structural foam in FL36) :Blue StyroJbam'"has an R-value of 10 per each 2-inch(51mm)increment.
Gasket Polyurethane or neoprene
Note:for basin bottoms without bolt holes,.specify FL 18,1,121,FL24,or FL30.
Specifications
Model FL18G-4BU FL21G FL24G-4BU F124G-4B FL3OG FL36G FL48G
Lid 0.D.in.(mm) 20.25(514) 22.5(572) 26.25(667) 25.5(648) 32.6(829) 39.63(1006) 53.88(1368)
Groove I.D.in.(mm) 17.5(445) 20.25(514) 22.75(578) 23.25(591) 28.75(730) 35(889) 47.5(1207)
Avg.thickness in.(mm) 0.75(19) 0.75(19) 0.75(19) 0.75(19) 1.0(25) 1.5(38) 1.5(38)
Weight lb(kg) 7.25(3.3) 9.75(4.4) 12.5(5.7) 12.5(5.7) 21.5(9.8) 41.0(18.6) 103.0(46.7)
Gasket type polyurethane polyurethane neoprene polyurethane polyurethane polyurethane polyurethane
Applications Ultra-Rib Ultra-Rib Ultra-Rib Perma-Loc Perma-Loc Kor Flo Call for more
Perma-Loc Kor Flo information
©2008 2nco Systems®Inc. NTD-RLA-FL-1
JL Rev.1.0,©9/08
Page 1 of 1

Mom .
Orenco° nrcaI
8 in. to 15-in . Dia.
Biotube Effluent Filters
Applications Standard Models
Orenco®8-inch to 15-inch Biotube®Effluent Filters are designed to FT0854-36,FT1254-36, FT1554-36,FT0822-14B,FT1254-36AR
remove solids from effluent leaving commercial septic tanks.They can
be used in new and existing tanks. Product Code Diagrams
General FT— - 36T
I Float switch bracket and slide rail options.
Orenco®8-inch to 15-inch Biotube®Effluent Filters'are used to improve Blank = no options selected
the quality of effluent exiting a commercial septic tank.The Biotube R = slide rail instalhaled insaled
cartridge fits snugly in the vault and is removable for maintenance,the Cartridge height,in.(mm):
handle assembly snaps into the notches in the top of the vault,and the 36=36(914),standard
tee handle can be extended for easy removal of the cartridge.A'base 48�in48(1219)n.(mm)
inlet'model(see p.2)is available for low-profile tanks.An optional slide so-son524
rail system,available on larger models,simplifies installation and pro- 66=66(1676-mm)
vides tank access for servicing. Fitter diameter,in.(mm). rTP 0848-36 NC
08= 08(200)
12= 12(300)
15= 15(375)
Handle assemblyFilter mesh option
Blank= N-in.(3-mm)filter mesh
I P = %u:-in.(1.6-mm)filter mesh
Biobibe"°effluent filter
r6 ��' 'Minimum liquid level(MLL)information:
/ ,' Alarm float assembly 48 in(1279 mm)housing for MLL of 37.46 in.(940 1168 mm)
12.
54-in.(1372-mm)housing for MLL of 47-63 in.(1194.1600 mm)
f . (ordered separately) 60-in.(1524-mm)housing for MLL of 64,84 in.(1626,2134 mm)
01 •
66 in(1676 mm)housing for MLL of 85.112 is(2159-2845 mm)
1 For 12-and 15-in.(300-and 375-mm)only;use slide rail option
when only one access is available for me filler chanter
FT� 22- 14B
..O'er_, — 1 —
oo�oo .- .-, T
o Pipe couplingI Float switch bracket and overflow plate options:
o 008,:r P Blank = no options selected
o— A = float switch elbow installed
r FSO = overflow plate installed
1
Base inlet model
Biotubes Cartridge height,in.(mm).
14= 14(356),standard
Filter housing height,in.(mm). '
Vault 22= 22(558),standard
Filter diameter,in(mm):
\ 08= 8(n,
12= 12(300)
Inlet holes - - O • 0 Filter mesh option
Blank= '-in.(3-mm)filter mesh
P = %u:-in.(1.6-mm)fitter mesh
Biotube"°effluent filter
Support coupling
Materials of Construction
Vault PVC
cSuplrtb
Pipe coupling PVC
racket Handle components PVC
Cutaway view Side view
Support coupling and bracket PVC
Biotube®cartridge Polypropylene and polyethylene
•Orencon Biotube"'Effluent Filters are covered under multiple US and international patents. Note:Support coupling and support bracket are available on 12-inch and 15-inch filters only.
Orenco Systems®Inc.,814 Airway Ave.,Sutherlin,OR 97479 USA•800-348-9843•541-459-4449•www.orenco.com NTD-FT-FT-2
' Rev.1.1,©09/14
Pagel of2

Of enc0` Technical Data Sheet
Air vents and discharge orifices
® _ Air vent O O
Discharge orifice(s) 00 O
8-in.base 8-in. 12-in.to 15-in.
inlet models models models
n •
• o bo bb .g0000 •
op:*0000 000 o QQ o°oog a op • •
00 oDo° pog o
°°o o°goo.No°o°goo.o°o°
00 0 0°o 0000-.0000 on o°°oo 0000
▪D 0-° ogee ogee
00-0 0000 o 00 goon 0000°i o
0°.20,o °•000 0000 0000
°°O�o °°0000°god Kg
ogog0 00° 0°0000 on _.
A boa a 3 ?fi. • •
t
�o�°0000 r± `r:
*°o o°d'00 o°ate `is r3 ;{i.
o 00000 40 . .
°.'is,,a A ai: : p• s:
000 0000 r: . D E
000 0000 d • •• •-
b oo a a C D E fi1: r: f:
L
°0 00 00°0 I I I �,.
°_°° °° °° °a�I 15 in. ♦ 1 i ,a_____ I 1.5-in.
Standard model Base inlet model
Specifications
Model FT0854-36 F10822-148 FT1254-36 FT1254-36AR FT1554-36
A- Cartridge height,in. 36 14 36 36 36
B-Nominal diameter,in. 8 8 12 12 15
C-Inlet hole height*,in. 22 n/at 22 22 22
D-Vault base to invert height,in. 38 13 38 38 38
E-Vault height 54 22 54 54 54
Number of inlet holes 8 n/a 8 8 8
Inlet hole diameter,in. 1.375 n/a 1.375 1.375 1.375
Number of discharge orifices 2 1 1 1 1
Discharge orifice diameter,in. 1.125 1.750 2 2 2
Pipe coupling diameter,in. 4 4 4 4 4
Number of air vents 1 1 1 1 1
Air vent diameter,in. 0.75 1.750 0.75 0.75 0.75
Filter surface area?,ft2 14.6 6.0 30.0 30.0 50.5
Flow area",ft2 4.4 1.8 9.0 9.0 15.2
•Inlet hole height can vary depending on the configuration of the tank.Optimum hole height is 65-75%of the minimum liquid level.
t No inlet holes required,because influent enters between the vault base and the bottom of the filter cartridge.
$Filter area is defined as the total surface area of all individual Biotubesv within the filter cartridge.
Flow area is defined as the total open area(area of the mesh openings)of all the individual Biotubes within the filter cartridge.
NTD-FT-FT-2 Orenco Systems°Inc.,814 Airway Ave.,Sutherlin,OR 97479 USA•800-348-9843•541-459-4449•www.orenco.com
Rev.1.1,©09/14
Page 2 of 2
1

!aitiecO
Biotube® Effluent Filters 61
90Lm
s
Incorporated
1-800-348-9843
Installation, Operation and Maintenance Instructions
FT08 Models and All Base Inlet Models
U.S. Patent Nos. 5294635 /4439323
Installation Instructions:
The Biotube Effluent Filter is suspended in the septic tank by the 4"outlet pipe.The filter is composed of a
vault body that will be fixed to the discharge pipe and a removable cartridge that consists of the Biotube
filter cartridge and the extendible handle.
1. Test-fit the effluent filter on the 4"out-
let
pipe without gluing. Make sure that
it fits plumb.
Any existing outlet tee will have to be
removed. 1
1
2. Ensure sufficient clearance for trouble-
free servicing of filter cartridge. Install
assembly near the tank wall to reduce
any stresses that may be caused by i
maintenance. II
Sufficient room between the access
port and filter should be provided for
easy removal of solids from the tank.
The cartridge will need to be removed
and cleaned while the tank's solids T
content is being pumped-out.
NIN-FT-FTM-1
Rev.1.3,©12/02
Page 1 of 4

Installation Instructions (continued)
3. Once the filter has been fitted properly,
apply primer and PVC cement to the
outside of the outlet pipe and the filter's .�
4" outlet. Use a multipurpose cement if
the outlet pipe is ABS. Do not use f,
primer on ABS. I _alb -'
J
Optional:Stainless steel set screws
may be used instead of glue.
,/
I
4. Slide the effluent filter onto the 4" pipe
and plumb vertically.
5. Hold the filter in position until the adhe-
sive has time to set(approximately 20
seconds). i i
\,
6. Extend the handle of the cartridge to an I v
elevation above the top of the tank for
easy access. Use 3/4" schedule 40 PVC 1)
for extension.
Either use the stainless steel set
screws or glue the extensions in place.
•
NIN-FT-ETM-1
Rev.1.3,©12/02
Page 2of4

Technical Data Sheet
External Splice Box csi
ord.,em,
800-348-9843
Applications Standard Models
The Orenco" External Splice Box attaches outside the access SBEX1-4,SBEX1-4-P
riser of an underground tank. It is engineered specifically for
water and wastewater treatment systems and is especially suited Nomenclature
for use in locations prone to high groundwater and other wet
conditions. Its separate conduit hubs,large volume,and optional SBEX1-4 -
dividers make it useful for maintaining isolation of high and low T
voltage wires where needed. It has four cord grips which accom- I Blank=no divider plates
modate power cords for floats and pumps of 0.170-0.470 inches P =divider plates
(4.3-11.9 mm)in diameter.Unused cord grips can be plugged
watertight with the supplied cord grip plugs.Each External Splice External splice box
Box is provided with a hole-cutting template to simplify installa-
tion on the riser.
General SBEX1-4, Use as Needed
To specify the Orenco External Splice Box for your installation,
require the following:
• Watertight for prolonged submergence per UL listing(Type 6P)
• Attachment external to access riser to allow inspection with no
need to open the riser lid
• Volume of 100 in?(1639 cm3)for easy wiring access and to
accommodate multiple wiring configurations
• Bottom entry,so conduit or direct-bury cable always remains
below minimum burial depth •
• Molded of UL(f1)rated plastic,resistant to cold and UV
exposure,suitable for external applications
• Optional divider plates available for isolating high and low vol-
tage wires from separate conduits or direct-bury cable
+J
The External Splice Box is molded of a UL
(f1)rated PVC alloy.It has a UL Type 6P list-
ing for prolonged submergence.
©2009 Orenco Systems'Inc. NTD-SBEX-1
Rev.1.0,©5/09
1 Page 1 of 2

External Splice Box (continued)
Physical Specifications Materials of Construction
Volume 100 in?(1639 cm3) Splice box PVC alloy
Cord grips 4 per SBEX Cord grips Nylon
Cord grip plugs 3 per SBEX Cord grip plugs EPDM rubber
Cord diameters 0.170-0.470 in.(4.3-11.9 mm) 0-rings Buna rubber
accommodated Conduit hub plug PVC per ASTM D-1784
Conduit hubs 2
Conduit hub plug 1
Conduit sizes 3 in.
accommodated 1 in.(with coupling)
12 in.(with fitting or bell end)
Diameter of hole 5 in.(127 mm)
into riser (hole-cutting template included)
4 5.24 in.(133 mm) io
Threaded �' '
cap Mit 8.25
in. 1 I33 mm)
1 7 ,
4.5 in.
(114 mm) ' a
iI / •
' I
Cord grip Cord grips Cord grip Optional 111 Conduit Optional
plugs(3) (4) plate divider hubs(2) divider
Conduit
hub plug (1)
NTD-SBEX-1 ©2009 Orenco Systems"Inc.
Rev.1.0,©5/09
Page2of2
I

r
Orenco° Technical Data Sheet
AdvanTex° AX-RI Treatment Systems
Applications General
Orenco's AdvanTex'AX-RT Treatment System is a single,complete, Following a septic tank equipped with a Biotube®effluent filter',the
self-contained module that treats septic tank effluent to better than AdvanTex AX-RT unit eliminates the need for separate recirc,treat-
secondary standards with nitrogen reduction before discharging it by ment,and discharge tanks by performing all functions within a single
means of pump or gravity. It is ideal for: module.It also reduces the number of risers and lids needed in the
• Repairs and retrofits treatment train.For sites requiring antibuoyancy measures,Orenco
offers antifloatation kits with turnbuckles.
• Small sites and poor soils
The heart of the system is the AdvanTex Recirculating Treatment Tank,
• Sites that require shallow bury a sturdy,watertight,corrosion-proof fiberglass tank that includes the
same dependable,textile treatment media found in all AdvanTex prod-
ucts.
IAX20RT- MODE3B
Standard Models
AX2ORT-MODE1 A,AX2ORT-MODE1 B/10,AX2ORT-MODE1 B/30
AX25RT-MODE1 A,AX25RT-M0DE1 B/10,AX25RT-MODE1 B/30
Product Code Diagram
Axl Ixr I II I-1 1-1 in 1- I HI I
r) - - T
( Float swln options
BOnk=mercury Coat mt000s
MVF F.non-mercury float swrt es
( Oat:Narge Pump.lage options
' 230k=130V
230 =230 V
:scnarge pump options
Bonk-no discharge pump
-.<. 10 =10 gpm N B L/,30 pump 20=20 gprn(I 3 Vse)pump
30 =30 gpm(1 9 L/sed pump 50=50 gam(3 2 User pump
Cold weraler options
Bank=standard lid
1 mode"=unre cola swatner patlege
(I/fl
i M0001nt M
MOCE1B=mode t,gaanty*allude MOGE3A=mode 3,pgraylyd�schage
M000tB=moat 1,pump as0Targe M00E30=mode 3,pump(Mane
IN disinfec0on ant opton(A%20-AT on 8
_ Bonk=no IN dllnlecoon and
UV =A7NV dw.ntecton unit
NSF approval option
Bank=standard Atvanies wstem
B =NNSF-tedirlea ArheNTel system
MST-serves treatment unit
Product image is for illustrative purposes only. Nomad treatment area
20=20 n,(1 8 m)
25=25 m(23 rrh
AtanTat Treatment System
AdvanTex®Treatment System AX-RTN Models meet the requirements of
NSF/ANSI Standard 40 for Class I Systems.
Orenco Systems®Inc.,814 Airway Ave.,Sutherlin,OR 97479 USA • 800-348-9843•541-459-4449•www.orenco.com NTO-ATX-AXRT-1
Rev.1.2,a 08/14
Page 1 of 2

: ¢ • Orenco
Components
1. Inlet `G_ � kill-010(
1 J U t "..1).-'YYYl{Ir 14 4 A-t YYLi'
2. Recirc/blend chamber Th3
3. Recirc transfer line I ' 10
4. Recirc
Epr.-
5. ec c um in t m I I IIP P 9 sYs e Q 1�L Manifold and spin nozzles --' Q
6. Treatment media , -
7. Tank baffle _ On7
8. Recirc return valve
0
9. Recirc/filtrate chamber — 0 0
10. Discharge pumping system(pump discharge only)
11. Outlet ",.,_.L,
12. Splice box AdvanTexAX-RT side view(AX20-RT pump discharge model shown)
13. Passive air vent
14. Biotube®effluent filter(in septic tank,not ,t shown) Cn-C-7F
15. Control panel(not shown) Iv l l J ` l
m
0 c
, 0,
Specifications .®,
Q •
Nominal Dimensions** # Q
Length,in.(mm) 102(2591) Q 0 I .i*i
Width,in.(mm) 62(1575) .
111Ir. f `!
Height,in.(mm) 72(1829) 4)t �� �� ~,., l-1„_A v4,—Jl,_\
Overall unit footprint,ft'(m2) 44(4.11)
AdvanTex AX-RT top view(AX20-RT pump discharge model shown)
Visible footprint after installation,ft'(m2) 20(1.86)
Lid insulation value R-6(RSI-1.1)
Dry Weight AX20-RT AX25-RT
Gravity discharge model,lb(kg) 883(400) 908(412)
Pump discharge model,lb(kg) 923(419) 948(430)
• Not to be sold individually in the state of Georgia.
" Nominal values provided.See AdvanTex®Treatment System drawings for exact dimensions.
Orenco Systems®Inc.,814 Airway Ave.,Sutherlin,OR 97479 USA • 800-348-9843•541-459-4449•www.orenco.com NTD-ATX-AXRT-1
Rev.1.2,°08/14
Page 2 of 2

- 1
Installation
Manual
AdvanTex®
AX-RT Treatment Systems
Residential Applications
Orenco
Orenco Systems,Ii1curportiled
1-800-348-9843
[phone]
www.orenco.com

Installation Manual:
O I'�11 t+O° T Treatment Systems
How To Use This Manual Page 2
Before You Begin Page 3
Septic Tanks Used in AX-RT Treatment Systems Page 3
Standard Unit Components And Functions Page 4
Installation Overview Page 5
Installation Steps
Step 1: Review or Sketch Site Plan Page 6
Step 2: Perform Excavation(s) Page 6
Step 3: Set Septic Tank(If Needed) Page 7
Step 4: Set AX-RT Unit Page 8
Step 5: Install Antibuoyancy Deadmen (If Needed) Page 8
Step 6: Partially Backfill Excavation(s) Page 9
Step 7: Install Adapters and Risers (If Needed) Page 10
Step 8: Test Tank and Adapter Seams for Watertightness Page 10
Step 9: Test AX-RT Midseam for Watertightness Page 11
Step 10: Install Effluent Filter Page 11
Step 11: Connect Tank-to-Unit Transport Line Page 11
Step 12: Connect Passive Air Vent Page 12
Step 13: Connect AX-RT Outlet to Transport Line Page 12
Step 14: Mount Control Panel and Perform Wiring Page 12
Step 15: Perform AX-RT Operational Test Page 13
Step 16: Complete Backfilling Page 15
How To Use This Manual
This manual contains an Installation Overview and a set of Installation Steps.
• Installation Overview—This is a simple overview of the installation steps.Its purpose is to help you quickly see the suggested order
of operations for installing an AX-RT unit. It is intended as a summary only—it does not provide complete instructions.
• Installation Steps This provides general instructions for each installation step along with references to detailed installation docu-
ments for specific components.Many Orenco products come with installation instructions and all of these instructions are also provided in
hard copy form in our Orenco Installer Binder. Contact your Dealer or Orenco for a copy of the binder, or find individual instructions online
in the Orenco Document Library at www.orenco.com.There are also steps in this manual covering operations performed before and after
the AX-RT unit is installed that are necessary to successfully complete the installation.
You will find IMPORTANT information, Key Points,and Notes in this manual, marked with easy-to-see visuals:
© IMPORTANT—These point out potential hazards to equipment or people during and after the installation.
AKey Points—These are critical for a quality installation and must be completed in order for your installation to be successful.
v " Notes These cover useful information and tips that can help make your installation simpler or easier.They may also
provide information on variations in components or methods.
NIM-ATX-AXRT-1 Orenco Systems-Inc.,814 Airway Ave.,Suthertin,OR 97479 USA • 800-348-9843•541-459-4449•www.orenco.com
Rev.3.0,©10/14
Page 2

Installation. . ,.n i. -"T"ratio Systems Orenco®
Before You Begin
At Orenco,we work hard to make your installation as easy and"hassle-free" as possible.This manual provides basic information for installing
AdvanTex AX-RT'"'treatment units. It is not intended to replace installer training or requirements and instructions detailed in your engineering
plans. If you discover any inconsistencies between your engineering plans and the instructions in this manual,contact your engineer or call
your AdvanTex Dealer. If you are not an Authorized AdvanTex Installer, contact your local AdvanTex Dealer for training and authorization before
installing this system.
The Dealer can provide technical support,training,and replacement components.To find the nearest Dealer,check the Distributor Locator
page at www.orenco.com. If there is no Dealer in your area,call Orenco Systems, Inc.at(800)348-9843 or+1 [phone].
Before you begin this installation,read this entire manual and any reference documents you may need to be familiar with to complete the
installation.Also,be sure that the instructions for these products are the most current ones available. Please note that you must perform
the installation according to the current manual or the AdvanTex® Treatment Systems Limited Warranty will be void.You
can make sure your instructions are current by checking our online Document Library at www.orenco.com.You'll save time and money on
installation day,and you'll get fewer call-backs.
Key Point:Inspect your order for completeness and inspect each component for shipping damage. Check to be sure
instructions and items supplied comply with your state and local regulations. Carefully read and follow all instructions. Improper
installation may void warranties.
* IMPORTANT: The backwash discharge from a salt-type water softener MUST NOT be plumbed into an AX-RT Treatment Unit
or the preceding septic tank. Failure to follow this instruction, or any other in this manual, will void the system's warranty.
Contact your AdvanTex Dealer if you have any questions about any household plumbing arrangements that may interfere with
the functioning of the system.
Note:All pipe diameters provided are U.S. nominal PVC pipe sizes. If you are using metric pipe,you may need adapters to
lac
connect to the U.S. fittings supplied with AdvanTex Treatment Systems,
Septic Tanks Used in AX-RT Treatment Systems
Be sure that any septic tank used in an AX-RT Treatment System meets the following conditions:
•The tank must conform to an approved and authorized tank design for AdvanTex Systems, and it must meet all applicable regula-
tory requirements (no pour-in-place tanks, no homemade tanks,etc.). Call your local Dealer for specifics.
•The tank must be structurally sound. '
•The tank must have at least 1000 gal. (3800 L) capacity for an AX20-RT, 1250 gal. (4730 L)for a 5-bedroom AX25-RT, and 1500
gal. (5680 L)for a 6-bedroom AX25-RT at the normal operating level (below the invert of the outlet).
•The tank must have an at-grade access with a watertight, securable and removable lid. If it doesn't, an at-grade access must be
installed onto the septic tank and be made watertight.
•The tank must be watertight and free of leaks.
•An Orenco effluent filter(model FTSO444-36V, FTW0444-36V, or FT0822-14B) must be installed in the septic tank.
AKey Point:For existing septic tanks—the tank's depth of burial must allow for a minimum fall of 1/8 inch per foot(10 mm
per meter or 1%)from the septic tank's invert of outlet to the AX-RT unit's invert of the inlet. If sufficient fall cannot be met,a
grade ring extension must be installed on the AX-RT or a pumping system will need to be installed in the septic tank to move
the filtered effluent to the AX-RT unit. (Contact your Dealer for assistance.)
Orenco Systems'Inc.,814 Airway Ave.,Sutherlin,OR 97479 USA • 800-348-9843•541-459-4449•www.orenco.com NIM-ATX-AXRT-1
Rev.3.0,°10/14
Page 3

w
Oren CO® Installation Ma
Standard Unit Components And Functions
Standard Components(AX2ORT-M0DE1 B shown):
0 Septic tank inlet tee 0 Recirc-pump system m Discharge pumping system
0 Biotube®effluent filter 0 Manifold and spin males ®AX-RT outlet
0 AX-RT inlet and tee 0 Textile media ® Passive air vent
O Treatment tank(recirc/blend chamber) 0 Tank baffle m Splice box
O Recirc-transfer line 0 Treatment tank(recirc/filtrate chamber) ® Control panel,not shown
. ...� IIliri
m
��,A■ I l�l I 0
JIIIIIIIR: jf
rr )) 0 - `-
1 ,_ , \-.
1
I .0
0
+ I • �
o ® I
'-•
r
0 ;
, 4,.]
Side view septic tank Side view AX-RT unit
'Fill®�IW IWIIII/I1 IWIWIWIlIl/I1I ,�1,l
/ I NNE m ollimmillimm . KO
1111 01111!!!!!"!0 11111111111110.11111111111!a' IT 11.. Ill
=IIII (# I: it
•
iiiiiiiiiiriririviiniiiiii
Top view,septic tank Top view AX-RT unit
Raw sewage enters the septic tank through its inlet tee. In the septic tank, the raw sewage separates into a scum layer, a sludge layer,
and a clear zone. Effluent from the clear zone passes through a Biotube®Effluent Filter and is discharged to the recirc/blend chamber
of the AX-RT unit.The effluent flows through the recirc transfer line to the recirc pumping system, which pumps filtered effluent to the
distribution manifold in the top of the unit. Effluent percolates down through the textile media and is divided—by means of a tank baffle
—between the recirc/blend chamber and the recirc/filtrate chamber inside of the unit.
The recirc pumping system's operation is controlled by a timer in the control panel. It allows the pump to dose the textile media for short
periods(usually 40-60 seconds),typically 72 times a day.These frequent"micro-doses,"which optimize the treatment process,occur
throughout the day to maintain the proper biological environment.
NIM-ATX-AXRT-1 Orenco Systems®Inc.,814 Airway Ave.,Suthertin,OR 97479 USA • 800-348-9843•541-459-4449•www.orenco.com
Rev.3.0,©10/14
Page 4

Installation Manual:AX-RT,Treat S s r s Ore n Co®
Installation Overview
Step 1: Review the site plan. If there is no site plan,draw up a plan including locations and distances.
Step 2: Perform the excavations for the AX-RT unit and (if needed)the septic tank.
Step 3: If the septic tank has not been set, set it according to the manufacturer's instructions.
Step 4: Set the AX-RT unit.
Step 5: Install antibuoyancy deadmen on the AX-RT unit(if needed).
Step 6: Partially backfill the AX-RT unit and(if needed)the septic tank.
Step 7: If the tank adapters and risers have not been installed on the septic tank,install them according to the manufacturer's instructions.
Step 8: If no watertightness test has been performed on the tank and the tank-to-riser connections, perform a watertightness test.
AKey Point:The tank and tank-to-riser connections must pass this test before the AX-RT is connected to the tank.
Step 9: Perform a watertightness test of the AX-RT unit's midseam.
Step 10: If the effluent filter has not been installed in the septic tank, install it according to the manufacturer's instructions.
Step 11: Connect the transport line from the septic tank outlet to the AX-RT unit.
Step 12: Connect the passive air vent to the AX-RT unit.
StepConnectthe discharge 13: line to the AX-RT outlet.
Step 14: Install and test the control panel and wiring for the AX-RT unit.
Step 15: Perform an operational test of the AX-RT float switches and pump(s).
Step 16: Complete the backfilling of the AX-RT unit and (if needed)the septic tank.
Orenco Systems'Inc.,814 Airway Ave.,Sutherlin,0R 97479 USA • 800-348-9843•541-459-4449•www.orenco.com NIM-ATX-AXRT-1
Rev.3.0,°10/14
Page 5

Orenco® Installation Manual:AX-RT Treatment Systems
Installation Steps
_® Discharge to Step 1:Review or Sketch Site Plans
drainfield
I
Check the site plan for the specifics of your installation.
Key Point If you're installing the AX-RT unit more than 20 ft(6 m)
Splice
A
Passive AX-RT unit 1 boxes from the septic tank,contact your Dealer for assistance.
t_ I
i
o Step la: Detailed Site Plan Provided
IMake sure that the plan accurately reflects conditions at the site. If it Fi
—� 12ft Aeft >I doesn't,contact the Designer before scheduling the installation.
® v 1/8
4-ft inn.. Step 1 b: Plan Of Limited Detail Or No Site Plan Provided
el' _\ panel Control (minimum distance) fall y If you are installing the AX-RT unit with a plan of limited detail or with no plan,
,6
• • 'r contact your local Dealer for assistance and then sketch a site plan that is
Lleanout Outlet
• ,I, consistent with the Designer's specifications:
riser 0
O O Septic tank V A Key Points:
•
\� Sft —�••. •
•Sketch the exact positions of the system components, pipes, electrical
conduits,etc.Account for current and likely future landscape features
I \< 14ft > in the sketch. (See Panel Installation, EIN-CP-GEN-1,for recommenda-
tions for installing control panels.)
•A minimum fall of 1i8 inch per foot(10 mm per meter or 1%)is required
This is a sample sketch of an AX-RT unit installed parallel from the septic tank's invert of outlet to the AX-RT unit's invert of the inlet.
to the septic tank,with no antibuoyancy measures installed.
Distances and estimated fall from the septic tank's invert of •The invert of the inlet on the AX-RT is 46 in. (1168 mm) up from the
the outlet to the AX-RT unit's invert of the inlet are included. base of the unit.The outlet is 24 in. (610 mm)down from the top of the
unit for pump dispersal or 41.5 in. (1054 mm) down for gravity dispersal.
•The bottom of the AX-RT lid must sit 2 inches(50 mm)above finished
grade when set and level. Standard unit height is 72 inches(1830 mm);
grade rings increase height by 6 or 12 inches (152 or 305 mm).
• If the AX-RT unit is installed in its own excavation, the unit requires
• 18-24 inches(457-610 mm) of space on all four sides.
T ,^ T . • If the AX-RT unit is installed in tandem with the septic tank,a minimum of
2 ft(610 mm)separation distance is required between the unit and tank.
• If the AX-RT unit is being installed parallel to the septic tank, offset the
unit from the tank by 6 ft(1.8 m) if antibuoyancy measures are neces-
sary or 4 ft(1.2 m) if antibuoyancy measures are not necessary.
t Step 2:Perform Excavation(s)
4 ' '' Step 2a: Before excavating, consider the necessary elevations, offsets,and
grade requirements for the AX-RT unit and(if needed)the septic tank.
Step 2b: Perform the excavation(s).
F A Key Points:
• Follow the manufacturer's recommendations for excavating the tank area.
\-......,_ 1 3
•A minimum fall of 1/8 inch per foot(10 mm per meter or 1%) is
required from the septic tank's invert of outlet to the AX-RT unit's invert
of the inlet.
AX-RT units require 18-24 inches(457-610 mm)space on
all four sides when installed in their own excavation.
NIM-ATX-AXRT-1 Orenco Systems®Inc.,814 Airway Ave.,Sutherlin,OR 97479 USA • 800-348-9843•541-459-4449•www.orenco.com
Rev.3.0,c 10/14
Page 6

, . Orenco°
Installation Steps
Step 2:Perform Excavation(s), cont. `l 'h '#76. 11
Step 2c: Make sure the bottom of the excavation is suitable for setting the Q
��>
AX-RT unit and (if needed) the tank: stable, smooth, level, and free of debris, ' i .
, . "�
rocks, and other sharp objects. i,.
A Key Points: y !i
•
• Follow the manufacturer's instructions for bedding the tank. ...-- t
• If the bottom of the excavation is uneven or rocky, lay a 4-in. (100-mm) �., , �� R, ' i"
bed of sand or pea gravel and compact the material to create an even, • Mg . . r- C
smooth surface.
Step 2d: If the bottom of the excavation is unstable, stabilize the bottom of ... :
the excavation before continuing. - ' # !' '" 1
• For unstable base soil(peat,quicksand, muck,soft or highly expansive clay, " "~- L
etc.),you may need to over-excavate the site depth and set a firm,6-in. j
(152-mm)compacted base of s%z-to s 3/4-in.(13-to 19-mm)aggregate Make sure the excavation is stable,smooth,level,and free
or pea gravel. from debris,rocks,and sharp objects.
• For extremely unstable soil,you may need to pour a concrete layer to
stabilize the bottom of the excavation.
• If you have doubt about the soil's stability, consult a local civil or struc-
tural engineer.
Step 3:Set Septic Tank(If Needed)
Set the septic tank according to the manufacturer's instructions.
• Use Fiberglass Tank Burial instructions(NIN-TNK-1)to install Orenco's
500-gallon through 2000-gallon(2000-L through 7570-L)Fiberglass Tanks.
© IMPORTANT Take care to keep everyone clear of the excavation
when placing the tank.
AKey Points:
•The tank has to be set at the correct depth to connect to the sewage inlet.
•A minimum fall of 1/8 inch per foot(10 mm per meter or 1%)is required
from the septic tank's invert of outlet to the AX-RT unit's invert of the inlet.
Orenco Systems'Inc.,814 Airway Ave.,Sutherlin,OR 97479 USA • 800-348-9843•541-459-4449•www.orenco.com NIM-ATX-AXRT-1
Rev.3.0,c'10/14
Page 7

Orenco®
Installation Steps
—- w Step 4:Set AX-RT Unit
, ,• : Step 4a:Attach proper lifting equipment to the lifting points on the AX-RT unit.
Step 4b:Carefully lift the unit and lower it into the correct position.
. / - ' Step 4c: Remove the equipment when the unit is set and level in position.
IMPORTANT.' Take care to keep everyone clear of the excavation
' ` when placing the unit. Use a lifting device that will not damage
the unit or the unit's lid.
C. A Key Points:
A 4 • A minimum fall of 1/8 inch per foot(10 mm per meter or 1%)is required
from the septic tank's invert of outlet to the AX-RT unit's invert of the inlet.
•The bottom of the AX-RT lid must sit 2 inches (50 mm) above finished
Lower the AX-RT unit into position. grade when set and level.
• If the AX-RT unit is installed in its own excavation, the unit requires
18-24 inches (457-610 mm) of space on all four sides.
• If the AX-RT unit is installed in tandem with the septic tank, a minimum of
2 ft(610 mm)separation distance is required between the unit and tank.
• If the AX-RT unit is being installed parallel to the septic tank, offset the
unit from the tank by 6 ft(1.8 m) if antibuoyancy measures are neces-
sary or 4 ft(1.2 m) if antibuoyancy measures are not necessary.
—® Step 5:Install Antibuoyancy Deadmen(If Needed)
ii ii liliiiii li Determine if antibuoyancy deadmen are necessary for the installation.
j1-111i—i1� Orenco offers antibuoyancy hardware kits that can be used with Orenco
III—�—ili=- Y Y
iii�il�iirf fiberglass deadmen or concrete deadmen.
glII �1T
1T • Deadmen are recommended for all installations.
arrlY
!—' • Deadmen are required if there is a potential for groundwater to be pres-
18-24 in. ent in the excavation at any time,or if surface runoff can fill the excava-
(460-600 mm) tion at any time, resulting in a"bathtub"effect.
0 h' up' Note: This effect occurs in dense soils when water fills an excavation
1 during surface water runoff—usually during a heavy rain event—
before the disturbed soil in the excavation has had time to settle.
• If you are unsure whether to install antibuoyancy deadmen or not, con-
sult the system Designer or an engineer.
Step 5a: Installing Orenco Fiberglass Deadmen
1 ii Step 5a (i): Build up a 3- to 4-inch (75-to 100-mm) lift of soil on each
11
ii side of the unit for the deadmen to rest upon.
[...--..{ Step 5a (ii): Secure the deadmen along the length of the unit,on both
12 in.(300 mm)
sides, with the antibuoyancy kit hardware.Then lower the unit into the hole.
When using Orenco fiberglass deadmen,be sure to place them Step 5a (iii): Place the deadmen at least 12 inches(300 mm)from the
on a small lift of soil 12 inches(300 mm)from the bottom of bottom of the unit,and make sure they are level.
the AX-RT.
NIM-ATX-AXRT-1 Orenco Systems'Inc.,814 Airway Ave.,Sutherlin,0R 97479 USA • 800-348-9843•541-459-4449•www.orenco.com
Rev.3.0,'10/14
Page 8

S Orenco°
Installation Steps
Step 5:Install Antibuoyancy Deadmen (If Needed), cont
Step 5b: Installing Concrete Deadmen
USNotes:
• We recommend preparing concrete deadmen off site before installation.
•PVC forms for concrete deadmen can be made from 12-in. dia. x 4-ft
long(300-mm x 1200-mm long)PVC half-pipe or chamber material.
• Wooden forms for concrete deadmen can be built 12-in. wide x 6 in.
tall x 4 ft long(300-mm x 150-mm x 1200-mm).
Step 5b (i): Fill two forms halfway with concrete.
Step 5b (ii): Place two#4 reinforcing bars in each of the forms.
Step 5b (iii): Finish filling the forms.
Step 5b (iv): Sink eyebolts from the antibuoyancy hardware kit into the
concrete for attaching the deadmen later.
Step 5b (v): Let the concrete set completely before moving the deadmen.
Step 5b (vi): Use appropriate lifting gear to set the deadmen in place.
Step 5b (vii): Secure the deadmen along the length of the unit, on both
sides, with the antibuoyancy hardware kit and make sure they are level.
Step 6:Partially Backfill Excavation(s)
i 111III-1 I
Partially backfill around the AX-RT unit and(if needed)the tank. Follow the -ii1--iti=frr=11, f
71-iTF=11i=1 i
manufacturer's instructions for backfilling around the tank. Follow the steps r=1f3=11;
= --III_,
below to backfill around the AX-RT unit. LIi
T
© IMPORTANT:Bolt down the AX-RT lid before backfilling!Bolting
down the lid increases rigidity and helps prevent deformation.
Step 6a:Fill the AX-RT with 16 in.(410 mm)of water on both sides of the baffle.
( 1
Step 6b: Backfill around the unit with a 16-inch (410-mm) layer of material.
AKey Points: 4l
• Do not use native material to backfill if it is primarily sand; very soft or •
•
highly expansive clay; or if it contains debris, large (> 3A-in. or 19-mm)
rocks, sharp rocks, peat, or muck. In these cases, use s 3/ inch (s 19
mm) rounded gravel, crushed stone,or pea gravel as fill material.This • •
material should be washed,free-flowing, and free of debris. •
• Do not backfill with sand.
Step 6c: Compact the fill thoroughly with a mechanical compactor.
Step 6d: Fill the AX-RT with water to just above the midseam flange on both IMPORTANT:
sides of the baffle, Do not backfill around the unit
Step 6e:Add another 16-inch (410-mm) layer of backfill. unless the lid is bolted down!
Step 6f:Compact the fill to 2-3 inches (50-75 mm)below the midseam flange.
Orenco Systems®Inc.,814 Airway Ave.,Sutheriin,0R 97479 USA • 800-348-9843•541-459-4449•www.orenco.com NIM-ATX-AXRT-1
Rev.3.0,°10/14
Page 9

Orenco t
Installation Steps
•
Step 7:Install Adapters and Risers (If Needed)
Step 7a: Install tank adapters if needed. Follow the manufacturer's instructions.
..� • Use PRTA24 and PRTA30 Tank Adapter Installation(NIN-TA-PRTA-2)
i instructions for installing Orenco PRTA24 or PRTA30 Tank Adapters.
• Use RRFTA and RRFTA30 Tank Adapter Installation(NIN-TA-RRFTA-1)
instructions for installing Orenco RRFTA or RRFTA30 Tank Adapters.
4 • Use FRTA30-FRP Tank Adapter Installation (NIN-TA-FRTA-1) instructions for
See Orenco's PVC Access Riser Installation(NIN-RLA-RR-1) installing Orenco FRTA30-FRP Tank Adapters.
instructions for installing access risers on Orenco Tank Adapters. • Use Tank Adapter Installation for Roth Tanks(NIN-TA-RR-2)instructions
for installing Orenco FRTA24-R or Orenco PRTA30 Tank Adapters on Roth
Fralo tanks.
Step 7b: Install the access risers and any necessary grommets.
4-1 • Use PVC Access Riser Installation(NIN-RLA-RR-1)instructions for installing
(`, • access risers on Orenco Tank Adapters and grommets in access risers.
"., , . - Key Points:
•The seam between the tank and the tank adapter has to be watertight.
Watertight seams are critical for proper performance. •Watertight seams and penetrations are critical for proper performance.
• Before installing the riser,make sure the riser is the correct height—the
recommended riser height is 2-3 inches(50-75 mm)above final grade.
• Before installing the riser,make sure that the riser penetrations are made
at the correct height to make connections.
• Before installing the riser,make sure the penetrations are aligned correctly.
•After installing the riser, make sure all adhesive seams are free of voids,with
smooth,continuous fillets.
•After installing the riser, make sure the adhesive is set before continuing.
Step 8: Test Tank and Adapter Seams For Watertightness
Step 8a: Test the tank for watertightness if it has not been tested already.
Note:Follow the manufacturer's recommendations for watertight-
ness testing.Some manufacturers require the tank be fully backilled
before testing watertightness.
Step 8b:Test the tank-to-riser adapter seams for watertightness.
• Use PVC Access Riser Installation(NIN-RLA-RR-1)instructions to test the
seams between the access riser,tank adapter,and tank for watertightness.
Key Points:
• Watertight seams are critical for proper system performance—the seams
between the access riser,tank adapter,and tank must all pass the water-
tightness test before you continue.
• Follow all applicable regulations and manufacturer's instructions for water-
tightness testing.
NIM-ATX-AXRT-1 Orenco Systems' Inc.,814 Airway Ave.,Sutherlin,OR 97479 USA • 800-348-9843•541-459-4449•www.orenco.com
Rev.3.0,°10/14
Page 10

Orenco°
Installation Steps
Step 9: Test AX-RT Midseam for Watertightness
Step 9 : Make sure the AX-RT unit is filled with water to 1-2 inches (25- I •in ••••-�-••n•••••.,: +w�wg►x.='
50 mm) above the midseam flange on both sides of the tank baffle. I 11 . rg;�
1 ' I III
Step 9b:Wait 15 minutes and then inspect the midseam flange for leaks. 111
There should be no drop in liquid level and no visible leakage from the seam. ! ! _ w 1_ _
Step 9c: If there is any leakage, contact your Dealer for information on
repairing the AX-RT unit. -_-, , . _
Step 10:Install Effluent Filter
Alit"
Install the effluent filter after the tank has been water tested. Fill AX-RT unit with water to 1-2 inches(25-50-mm)above
Step 10a: Verify the model of the effluent filter. the midseam flange on both sides of the baffle.
• Orenco's FTSO444 36V, FTW0444 36V, and FT0822 14B filters are .,. .
the only models allowed for use with the AX-RT Treatment Unit.
Step 10b: Dry test-fit the effluent filter on the septic tank's outlet pipe. --
AKey Points: I
• Make sure the filter is plumb.
• Make sure the filter is snug to the tank wall with enough clearance for
easy removal of the filter cartridge.
Step 1Oc:Secure the filter to the outlet pipe with one of the following methods:
• Glue the filter onto the tank outlet pipe with primer and glue, or I
• Secure the filter with a stainless steel set screw.
Step 1Od: If necessary for ease of access, extend the cartridge handle
with a longer length of 3/4-inch nominal (20-mm DN) Schedule 40 PVC pipe.
Step 11: Connect Transport Line from Tank to AX-RT
Step 11 a: Dry fit the 4-inch (100-mm)transport line and any fittings Effluent filter installed on the septic tank outlet.
between the outlet of the septic tank and the inlet of the AX-RT unit.
Key Point Confirm there is a minimum fall of 1i8 inch per ft(10
mm per m or 1%) from the septic tank's invert of outlet to the _
AX-RT unit's invert of the inlet.
Step 11 b: Glue all of the transport line pieces in place.
© IMPORTANT Do not use primer on ABS parts. 1/8 inch minimum fall
•
Confirm a minimum fall of 1/8 inch per foot(10 mm per
meter or 1%)from the septic tank's invert of outlet to
the AX-RT unit's invert of the inlet.
Orenco Systemse Inc.,814 Airway Ave.,Sutherlin,0R 97479 USA • 800-348-9843•541-459-4449•www.orenco.com NIM-ATX-AXRT-1
Rev.3.0,c'10/14
Page 11

Orenco®
Installation Steps
® Step 12: Connect Passive Air Vent
Use 2-inch (50 mm) PVC pipe to plumb the passive air vent to the 2-inch
Passive air vent (50 mm)vent fitting that protrudes from the outlet side of the AX-RT unit.
, t 1 Key Points:
• Install the vent within 20 ft (6 m) of the AX-RT unit, preferably near a
r. wall or other location that will protect it from damage.
• Make sure the vent line is sloped back a minimum of inch per foot
(20 mm per meter)so that it can drain back into the unit.
• Make sure there are no"bellies" in the line that can collect water.
• Make sure the vent's top is a minimum of 3 in. (75 mm)above final grade.
Install the vent within 20 ft(6 m)of the AX-RT unit. •
3 Notes:
• The air vent can easily be hidden by shrubbery or landscaping.
• The air vent can be painted to better blend in with landscaping.
Step 13: Connect AX-RT Outlet to Transport Line
Glue the AX-RT discharge plumbing line to the transport line for final discharge.
® - e, Step 14:Mount Control Panel and Perform Wiring
AKey Points:
•This step should be performed by a licensed or qualified electrician.
• Installation instructions,schematics,and wiring diagrams specific to the
panel and float switch configuration are included with each panel. If any of
these is missing,contact your Dealer or Orenco for a replacement.
Step 14a:Install the splice box(es)on the AX-RT using the instructions that
came with it.
r
Step 14b: Mount the panel using the instructions that came with it.
© IMPORTANT:DO NOT mount the control panel on an exterior wall
other than a garage or shop wall The motor contactor makes a sound
•
while engaging and disengaging that can be disruptive to residents.
>\ A Key Points:
Wire control panel. • Follow all applicable regulations for placement of the control panel.
• Mount the panel within sight of the tank in a service-friendly location.
NIM-ATX-AXRT-1 Orenco Systems''Inc.,814 Airway Ave.,Suthedin,OR 97479 USA • 800-348-9843•541-459-4449•www.orenco.com
Rev.3.0,°10/14
Page 12

Installation Manual:AX-RT Treatment Systems Orenco®
Installation Steps
Step 14:Mount Control Panel and Perform Wiring, cont.
Step 14c: Route wires and connect the panel,pump,float switches,and other
equipment shown in the instructions and schematics into the control panel.
© IMPORTANT Follow all applicable regulations and electric codes.
AKey Points:
• Use watertight wire connectors to avoid electrical shorts and other issues.
• Be sure to seal the conduit at the control panel and at the splice box
with UL-listed sealing foam, putty,or silicone sealant.
la( Note: To help identify wiring runs for individual pumps and float
switches, use different-colored wires for each electrical component.
Step 15:Perform AX-RT Operational Test ® ,. r ft. ''
© IMPORTANT Before using a generator to operate a pump, contact
your Dealer or Orenco to make sure it can supply sufficient starting il t.
amperage to the pump.
Step 15a: Rotate the manifold so that the spin nozzles face upward. R
Step 15b: Remove the cap at the end of the manifold. A.
Step 15c:Toggle the recirc pump"AUTO/OFF/MAN"switch to"MAN"for Rotate the manifold so spin nozzles face upward.
10-20 seconds to flush any debris out of the manifold. �®
* IMPORTANT Always make sure there is enough water in the
AX-RT's recirc/blend chamber to safely run the pump.
Step 15d: Rotate the manifold so that the spin nozzle faces down and
reinstall the cap on the end of the manifold.
Step 15e: Install the pressure gauge on the manifold. Remove the cap at the end of the manifold.
Step 15f:Toggle the recirc pump"AUTO/OFF/MAN"switch to"MAN"and adjust _®
the gate valve fora pressure gauge reading of 3.0-3.5 psi(20.7-24.1 kPa).
Note:If the manifold won't pressurize to 3.0-3.5 psi(20.7-24.1 kPa), „
check for debris,line breaks, or broken valves,and verify that the pump has
sufficient power. Contact your Dealer for additional assistance. jil �,t
Key Point:Check for complete spray coverage of the textile media and alk, Adjust
Install1116 gate valve _
adjust the pressure as needed for complete coverage. �\
pressure
Step 15g:Toggle the recirc pump"AUTO/OFF/MAN"switch to"OFF." II
gauge —► 1 IDr
Step 15h: Remove the pressure gauge. LJ
r
Step 15i: Return the recirc pump "AUTO/OFF/MAN"switch to"AUTO."
Orenco Systems°Inc.,814 Airway Ave.,Sutherlin,OR 97479 USA • 800-348-9843•541-459-4449•www.orenco.com NIM-ATX-AXRT-1
Rev.3.0,°10/14
Page 13

Ore n Co® Installation Manual:AX-RT Treatment System
Installation Steps
Step 15:Perform AX-RT Operational Test, cont.
Step 15j: If the system uses a VCOM— control panel, use the instructions that
came with it to place the control panel in "Test Mode."If the system uses an
MVP control panel,go on to the next step.
Step 15k: Check the operation of the recirc chamber's float switches by
raising and lowering the low-level, mid-level, and high-level float in turn and
verifying that each performs its intended function.
• If the AX-RT unit has a discharge pump, continue to step 151.
• If the AX-RT unit has an MVP panel and gravity discharge,go to step 150.
• If the AX-RT has a VCOM panel and gravity discharge,take the panel
out of"Test Mode" and go to step 15o.
© IMPORTANT Always make sure there is enough water in the
AX-RT's discharge chamber to safely run the pump.
Step 151:Toggle the discharge pump's"AUTO/OFF/MAN"switch to"MAN"
and verify the pump runs.
Step 15m:Toggle the discharge pump's"AUTO/OFF/MAN"switch to"AUTO."
Step 15n: Check the operation of the discharge chamber's float switches by
raising and lowering the low-level, mid-level, and high-level float in turn and
verifying that each performs its intended function.
• For units with a VCOM control panel, take the control panel out of"Test
Mode."
Step 15o: Make sure the recirc pump and (if equipped)discharge pump's
"AUTO/OFF/MAN"switches are toggled to"AUTO."
Step 15p: Close and bolt down the lid on the AX-RT unit.
NIM-ATX-AXRT-1 Orenco Systems®Inc.,814 Airway Ave.,Sutherlin,OR 97479 USA • 800-348-9843•541-459-4449•www.orenco.com
Reu.3.0,= 10/14
Page 14

Orenco°
Installation Steps
Step16: Complete Backfillin
P 9 +
2 in.(50 mm)
AKey Points: ��'yy above final grade
• When backfilling, be careful not to alter the slope of pipes. Brace the �III_�I III_
9PP I ILL 11—
pipes or place the pipes on a compacted bed and carefully fill around IIII=ITI11—
them. I�ffl I� I— _I I
—II—I
• Before backfilling, make sure the AX-RT unit's lid and all riser lids are Il� 1
ll lll
bolted down. ITlll_T�Ti=
Step 16a: Backfill the septic tank excavation if it has not yet been done. ••
Follow the tank manufacturer's guidelines for backfilling. I' —II— ----
-TI I
Step16b: Backfill and compact around the AX-RT unit in maximum 12-inch �1 -I Maintain minimum 1/8 in.
II �i-T�I�I
e
(305-mm) lifts. IIIIll (10 mm or'.1%)slope
aKey Points: 11-1I1111I I
• Do not use native material to backfill if it is primarily sand; very soft or Backfill the AX-RT in 12-inch(300 mm)lifts
highly expansive clay; or if it contains debris, large (> 3/4-in. or 19-mm)
rocks, sharp rocks, peat, or muck. In these cases, uses 3/4-in. (s 19
mm) rounded gravel, crushed stone, or pea gravel as fill material.This
material should be washed,free-flowing, and free of debris.
• For installations in non-cohesive soils*with high seasonal water tables,
use 3/4-inch crushed rock as the backfill material.
• Do not backfill with sand.
Step 16c: Compact the fill thoroughly with a mechanical compactor.
Key Points:
•The bottom of the AX-RT lid should sit 2 inches (50 mm)above final
grade.
•After backfilling, call the system's Service Provider to arrange for the
official System Start-up.
Step 16d: Be sure the AX-RT unit's lid is closed and secured.
Step 16e: Be sure the septic tank's access lids are secured.
*As described in OSHA Standards(29 CFR,Part 1926,Subpart P,Appendix A),noncohesive soils
or granular soils include gravel,sand,or silt with little or no clay content.Granular soil cannot be
molded when moist and crumbles easily when dry.Cohesive soils include clayey silt,sandy clay,
silty clay,clay,and organic clay.Cohesive sod does not crumble,can be excavated with vertical
sideslopes,is hard to break up when dry,and when moist,can be rolled into threads without
crumbling.For example,if at least a 2-inch(51-mm)length of 1/8-inch(3-mm)thread can be
held on one end without tearing,the soil is cohesive.
Orenco Systems®Inc.,814 Airway Ave.,Sutherlin,OR 97479 USA • 800-348-9843•541-459-4449•www.orenco.com NIM-ATX-AXRT-1
Rev.3.0,©10/14
Page 15

: te
Installation
Manual
AdvanTex®
AX-RT Treatment Systems
Residential Applications
,
QAideanTex Treatment System A -RTN
Models meet the requirements of NSF/ANSI
Standard 40 for Class I Systems.
C®US
LISTED A
Auslra an
SIa,o3'd
Orenco
Orenco Systems,Ir,c:L,rporaled
1-800-348-9843
NIM-ATX-AXRT 1
[phone] Rev.3.0,©10/14
www.orenco.com Orenco Systems'',Inc.

Orenco Technical Data Sheet
W A T E R
Orenco® PF-Series 60Hz 1 -Phase Pumps
Applications General
Orenco's 60Hz,1-phase,4in(100mm)Submersible Effluent Pumps To specify this pump for your installation,require the following:
are designed to transport screened effluent(with low TSS counts)from • Minimum 24-hour run-dry capability(liquid end)with no deteriora-
septic or dosing tanks.These pumps are engineered using lightweight, tion in pump life or performance*
corrosion-resistant stainless steel and polymers,and are field ser-
viceable and repairable with common tools.They're also CSA and UL •
1/8in(3mm)bypass orifice to ensure flow recirculation for motor
certified to US and Canadian safety standards for effluent pumps. cooling and to prevent air binding
• 1/8in(3mm)mesh intake screen to limit solids
PF Series pumps are used in a variety of applications,including • Liquid-end repair kit availability for better long-term cost to own
pressurized drainfields,packed-bed filters,mounds,aerobic units,
effluent irrigation,liquid only(effluent)sewers,wetlands,lagoons,and • TRI-SEAL floating impeller design on 10,20,and 30gpm(0.6,1.3,
more.These pumps are designed to be used with a Biotube®pump and 1.9Usec)models;floating stack design on 50 and 75gpm(3.2
vault or after a secondary treatment system. and 4.7Usec)models
• Franklin Electric Super Stainless motors are rated for continuous
Discharge use and frequent cycling,with surge arrestors,hermetically sealed
connection motor housing for moisture-free windings,and Kingsbury-type
thrust bearing for thrust absorption
• Thermal overload protection trips at 203-221°F(95-105C)for
1-phase motors through 1.5hp(1.12kW)
• Type SOOW 600V motor cable(model PF751512 uses 14 AWG,
SJOOW,300V cord)
•Not applicable for 5hp(3.73kI41 models
Franklin liquid
end Standard Models
See Specifications on page 2 for a list of standard pumps.For a
complete list of available pumps,call Orenco.
Suction connection Product Code Diagram
PF _ - -
TLK=ClickTight°M compatible
Cord length,ft(m):'
Blank = 10(3) 20 =20(6)
Discharge Pump 30 = 30(9) 50 = 50(15)
Franklin P F 1005 1 1-30 Check valve:
Suer Stainless Blank = no internal check valve
p CV = internal check valve'
motor
Recirculation Pump Voltage,nameplate:
PF3005 1 1-30 1 = 115* 2 = 230
Frequency:
1 = 1-phase,60Hz
Horsepower(kW):
05 =1/2hp(0.37) 07= 3/4hp(0.56)
10 =1 hp(0.75) 15= 1 1/2hp(1.12)
20 =2hp(1.50) 30= 3hp(2.24)
Powered by 50 =5hp(3.73)
a , ; Franklin Electric Nominal flow,gpm(Usec):
C US 10=10(0.6) 20=20(1.3)
30=30(1.9) 50=50(3.2)
LR80980 75=75(4.7)
LR2O53896
Pump,PF-Series
1/2hp(0.37kW)only
Available for 10gpm(0.6Usec),1/2hp(0.37kW)
Note.2IIIt cords are available only for pumps through 1 1/2hp
�renco Orenco Systems"•800-348-9843•[phone]•www.orenco.com NTD-PU PF-1
All product and performance assertions are based on proper design,installation,operation,and Rev.12©03/23
W A TER maintenance according to Orenco's current published documentation. Page 1 of 4

Orenco Orenco® PF-Series 60Hz, 1-Phase Pumps =
W A
Technical Data Sheet
A TFR
Specifications
N-
C. O N a 0 9 d
rn� al.o� rn my r E Eh E QE L.or C.' >
`�� o t R o i o E '�c m °'� o 0)
Pump Model 0�- x a z > a > c Ca 2 c co .a._ ._ 3_ cc a
PF100511' 10(0.6) 0.50(0.37) 1 115 120 12.7 12.7 114in GFP 23.0(584) 16(406) 26(12) 300
PF100511CV' 10(0.6) 0.50(0.37) 1 115 120 12.7 12.7 1'/nin GFP 23.0(584) 16(406) 26(12) 300
PF1005129 10(0.6) 0.50(0.37) 1 230 240 6.3 6.3 1 Ynin GFP 23.0(584) 16(406) 26(12) 300
PF100712 4" 10(0.6) 0.75(0.56) 1 230 240 8.3 8.3 1'/ain GFP 25.9(658) 17(432) 30(14) 300
PF101012 9" 10(0.6) 1.00(0.75) 1 230 240 9.6 9.6 1%nin GFP 27.9(709) 18(457) 33(15) 100
PF200511' 20(1.3) 0.50(0.37) 1 115 120 12.3 12.5 1 Yain GFP 22.3(566) 18(457) 25(11) 300
PF200512' 20(1.3) 0.50(0.37) 1 230 240 6.4 6.5 1'/ain GFP 22.5(572) 18(457) 26(12) 300
PF201012'S' 20(1.3) 1.00(0.75) 1 230 240 10.5 10.5 1'/nin GFP 28.4(721) 20(508) 33(15) 100
PF2015124
.6 20(1.3) 1.50(1.12) 1 230 240 12.4 12.6 1'/ain GFP 34.0(864) 24(610) 41(19) 100
PF300511' 30(1.9) 0.50(0.37) 1 115 120 11.8 11.8 1141n GFP 21.3(541) 20(508) 28(13) 300
PF3005129 30(1.9) 0.50(0.37) 1 230 240 6.2 6.2 1'/ain GFP 21.3(541) 20(508) 25(11) 300
PF300712' 30(1.9) 0.75(0.56) 1 230 240 8.5 8.5 1'/ain GFP 24.8(630) 21(533) 29(13) 300
PF301012" 30(1.9) 1.00(0.75) 1 230 240 10.4 10.4 l%ain GFP 27.0(686) 22(559) 32(15) 100
PF301512'6 30(1.9) 1.50(1.12) 1 230 240 12.6 12.6 11/a1n GFP 32.8(833) 24(610) 40(18) 100
PF302012 691 30(1.9) 2.00(1.49) 1 230 240 11.0 11.0 1%ain SS 35.5(902) 26(660) 44(20) 100
PF303012 6 6'8 30(1.9) 3.00(2.23) 1 230 240 16.8 16.8 11/ain SS 44.5(1130) 33(838) 54(24) 100
PF305012 6'67° 30(1.9) 5.00(3.73) 1 230 240 25.6 25.8 1'/ain SS 66.5(1689) 53(1346) 82(37) 100
PF500511' 50(3.2) 0.50(0.37) 1 115 120 12.1 12.1 2in SS 20.3(516) 24(610) 27(12) 300
PF5005129 50(3.2) 0.50(0.37) 1 230 240 6.2 6.2 2in SS 20.3(516) 24(610) 27(12) 300
PF500712' 50(3.2) 0.75(0.56) 1 230 240 8.5 8.5 2in SS 23.7(602) 25(635) 31(14) 300
PF5010129 50(3.2) 1.00(0.75) 1 230 240 10.1 10.1 2in SS 27.0(686) 26(660) 35(16) 100
PF501512' 50(3.2) 1.50(1.12) 1 230 240 12.5 12.6 2in SS 32.5(826) 30(762) 41(19) 100
PF503012'6" 50(3.2) 3.00(2.23) 1 230 240 17.7 17.7 2in SS 52.0(1321) 37(940) 55(25) 100
PF505012 6 6{6 50(3.2) 5.00(3.73) 1 230 240 26.2 26.4 2in SS 77.0(1956) 55(1397) 64(29) 100
PF751012' 75(4.7) 1.00(0.75) 1 230 240 9.9 10.0 2in SS 27.0(686) 27(686) 34(15) 100
PF751512 75(4.7) 1.50(1.12) 1 230 240 12.1 12.3 2in SS 33.4(848) 30(762) 44(20) 100 1
1.GFP=glass-filled polypropylene;SS=stainless steel.The 1 1/4in NPT GFP discharge is 2 7/8in octagonal across flats;the 1 1/4in NPT SS discharge is 2 1/8in octagonal across flats;and the 2in NPT SS
discharge is 2 7/8in hexagonal across flats.Discharge is NPT threaded receptacle-style port,US nominal size,to accommodate Orenco discharge hose and valve assemblies.Consult your Orenco distributor
about fittings to connect hose and valve assemblies to mehic-sized piping.
2.Minimum liquid level is for single pumps when installed in an Orenco Biotube Pump Vault or Universal Flow Inducer.In other applications,minimum liquid level should be top of pump.Consult Orenco for more
information.
3.Weight includes carton and 10ft(3m)cord.
4.High-pressure discharge assembly required.
5.Do not use cam-lock option(0)on discharge assembly
6.Custom discharge assembly required for these pumps.Contact Orenco.
7.Capacitor pack(sold separately or installed in a custom control panel)required for this pump.Contact Orenco.
8.Torque locks are available for all pumps,and they are supplied with 3hp and 5hp pumps.
9.Click liight"compatible.
NTD-PU-PF-1 Orenco Systems' •800-348-9843• [phone]•www.orenco.com
Rev.12©03/23
Page 2 of 4

Orenco PF-Series 60Hz, 1-Phase Pumps - Orenco
Technical Data Sheet W ATER
Materials of Construction
Discharge Glass-filled polypropylene or stainless steel
Discharge bearing Engineered thermoplastic(PEEK)
Diffusers Glass-filled PPO(SABIC's NORYL"GFN3 resin)
Impellers Celanese's Celcon®acetal copolymer on 10,20,and 30gpm models; 50gpm impellers are NORYL GFN3 resin
Intake screen Polypropylene
Suction connection Stainless steel
Drive shaft 7/16in hexagonal stainless steel,300 series
Coupling Sintered stainless steel,300 series
Shell Stainless steel,300 series
Motor Franklin Electric motor filled with deionized water and propylene glycol for constant lubrication.Stainless steel shell.
Using a Pump Curve
A pump curve helps you determine the best pump for your system.Pump curves show the relationship between flow(gpm or L/sec)and pressure
(total dynamic head or TDH),providing a graphical representation of a pump's optimal performance range.Pumps perform best at their nominal flow
rate—the value,measured in gpm,expressed by the first two numerals in an Orenco pump nomenclature.These graphs use solid lines to show the
optimal pump operation range.Dashed lines indicate flow rates outside of the optimal range for each pump.For the most accurate pump specifica-
tions,use Orenco's PumpSelect'software.
Pump Curves
450 1 1 i 1 1 1 i 1 1 1 400 1 1 1 1 1 1 1 1 L--
PF10 Series,60Hz,0.5-1.0hp - - PF20 Series,60Hz,0.5-1.5hp -
400 350 pF2015
a 71PF1010 a — - _ _
a? 350
_ ,m 300 - - -
0• 1 JPF2010
300 I fF1 i071••••,.• 250 ..
.7
coo 250 d.PF1008 a .. \\'\I
a� t....,... . au 200
200
'''''' '''''''' N E 150 PF2o05
as ca
'=off 150 a ti.
76
100 100
t°
50- - 50
0 0 j
0 2 4 6 8 10 12 14 16 18 0 5 10 15 20 25 30 35 40
Flow in gallons per minute(gpm) Flow in gallons per minute(gpm)
Orenco Systems • 800-348-9843• [phone]•www.orenco.com NTD-PU-PF-1
Rev.12©03/23
Page 3 of 4

Orenco Orenco° PF-Series 60Hz, 1-Phase Pumps —
WATER Technical Data Sheet
1 Pump Curves, cont.
900 i , 1 1 1 1 1 1 I I I I 450- I I I I 1 1 I I I I
-PF3050 PF30 Series,60Hz,0.5-5.0hp PF5050 PF50 Series,60Hz,0.5 5.0hp
800 400 -
' 700 w 350
•c - c
600 • T 300
cz
Z. 1 PF30301 OI--• PF5030
500 ............... ..
..
a 250
400-PF3020 I C4 200
I 1k.
--------.. .N:**...,
300 ct PT 01.........-. m 150 PF5015
PF3010 jPF5010
1PF5007(......- .
1 00 1 pF30051 ........ ..... 50....''''" .. .....--
jPF5005 ..00 5 10 15 20 25 30 35 40 45 00 10 20 30 40 50 60 70 80 90
Flow in gallons per minute(gpm) Flow in gallons per minute(gpm)
100 1 1 1 1 1 1 1 1 1 1 1
90 j PF7515I'••••.., PF75 Series,60Hz,1.0-1.5hp —
eu 80
•S
70
C PF7510 ••
Z. 60
1
ca
•M 50
.v
E 40
ca
4 30
Tei
20
10
00 10 20 30 40 50 60 70 80 90 100
Flow in gallons per minute(gpm)
NTD-PU-PF-1 Orenco Systems' •800-348-9843 • [phone]•www.orenco.com
Rev.12©03/23
Page 4 of 4
L

Veri Comm ® VeriComm AXB1 SA UV IB
AXB_ Control PanelsTechnical
Data Sheet
For AdvanTex" Treatment Systems Communication and Alarm Management
• Remote telemetry capabilities coupled with a Web-based
Applications monitoring application(see VeriComm Monitoring System,
ATD-WEB-VCOM-1)for communication and alarm manage-
VeriComm" AXB1 and AXB2 remote telemetry control panels are ment. Updating of point values(including timer settings)and
used with two-pump operations—recirculation and discharge receipt of queued changes during each communication ses-
(on-demand or timed)—for AdvanTex'Treatment Systems. sion with host. Communication sessions that occur monthly,at
Interlocked controls prevent the recirculation pump from running a minimum,and more frequently during alarm conditions.
if there is a high level alarm on the discharge side. Coupled with • Multiple methods of communication,as follows:
the VeriComm Web-based Monitoring System,these affordable
control panels give water/wastewater system operators and Call-In to VeriComm®Host
maintenance organizations the ability to monitor and control — Automatic notification to host of"Alarms,"which signal
each individual system's operation remotely,with real-time effi- fault conditions that need to be addressed immediately
ciency,while remaining invisible to the homeowner.VeriComm (e.g.,pump failure).
AXB panels allow remote operators to change system param-
eters,including timer settings,from the Web interface. — Automatic notification to host of"Alerts,"which signal
less critical fault conditions and which trigger the panel's
troubleshooting logic and alternative operating mode
• (e.g.,stuck float switch).
— Automatic notification to host of"Updates,"which include
i ,- N.
alarm updates or all clear notifications following Alarms/
i , Alerts,as well as normally scheduled monthly panel reports.
o® I — Manual,forced communication from panel to host to effect
�� 1 --_ !! an updating of point values and receipt of queued changes.
l '• Real-Time Direct Connection to Panel
:. - Inc_ • _ — Manual,direct connection at the site via RS-232 serial port,
to allow a local operator real-time access to detailed logged
Typical AXB_ VeriComnrs Control Panel data and the ability to change point values from a laptop.
Standard Models:VCOM AX81, VCOM AX82 — Manual,forced communication by local operator/
To Specify... homeowner at the site to initiate an auto-answer mode,
allowing a remote operator real-time access to detailed
To specify this panel for your installation,require the following: logged data and the ability to change point values.
Basic Control Logic: Three Operating Modes During real-time,manual connections,software with open
• A"Start-up Mode"for the initial 30 days,during which the architecture(and password security)is used;no proprietary
system collects trend data to establish operating standards for software is required.VT100 protocol allows access and control
future reference. from any computer modem(Mac or PC)with a simple com-
munication program(e.g.,Windows HyperTerminal);multilevel
• A"Normal Mode"that manages day-to-day functions. password protection in panel ensures that only qualified per-
• A"Test Mode"that suspends data collection and alarm report- sonnel can access the panel's data.
ing during installation and service. Additional Features
Data Collection and Utilization '
• Status light indicators on the board, #"..\,.'7. ---.,0
• Data logs of system conditions and events,such as pump run including... °NW.
times,pump cycles,and alarm conditions. — Flashing green LED for normal ♦ a
Troubleshooting and Diagnostic Logic operation ♦
— Yellow LEDs for status of digital inputs Orenco Systems'
• Troubleshooting capabilities that can report suspected failed g p Incorporated
1 components,which then trigger Alarms. - Red LEDs for status of digital outputs Changing the Waythe
and modem activity World Does Waaauanr'
Advanced Control Logic 800-348-9843
• UL-recognized and FCC-approved www.orenco.com
• Advanced control logic that activates during float malfunctions For more information,tryonline demo
to diagnose the situation and keep the system operating nor our atATD2.5© OM•1
www.vericomm.net(no password required). Rev.2.5©6/06
mally until servicing. Pagel of 2

Technical
VeriComm® AXB Control Panels Data Sheet
1. VeriComml Remote Telemetry Board EIMP
2. Motor-Start Contactors W onn I 2
3. Toggle Switches 11
■ _° n
_ ..
4. Control Circuit Breaker
5. Pump Circuit Breakers
6. Fuse 3
7. Transformer OfgangiM� 4
8. Audio Alarm Off
9. Visual Alarm
5
10. Panel Enclosure '
o\- I armor. io
10 9 8 7 6
Standard Components
Feature Specifications
1. VeriComm^Remote Telemetry Unit* ATRTU-100:36/18 VAC(center tap transformer),8 digital inputs,4 analog inputs,4 digital
outputs,0 analog outputs,on-board modem (2400 baud),LED input and output indicators,
1-year battery backup of data and program settings.
2. Motor-Start Contactors 120 VAC:16 FLA, 1 hp,60 Hz;2.5 million cycles at FLA(10 million at 50%of FLA).
240 VAC:16 FLA,3 hp,60 Hz;2.5 million cycles at FLA(10 million at 50%of FLA).
3. Toggle Switches Single-pole switch,automatic On,with spring-loaded,momentary,manual On.20 A,1 hp.
4. Control Circuit Breaker 10 A,OFF/ON switch.Single-pole 120 VAC,double-pole 240 VAC. DIN rail mounting
with thermal magnetic tripping characteristics.
5. Pump Circuit Breakers 20 A,OFF/ON switch.Single-pole 120 VAC,double-pole 240 VAC. DIN rail mounting
with thermal magnetic tripping characteristics.
6. Fuse 120 VAC Primary,36 VCT®0.85 A Secondary.
7. Transformer 250 VAC,1 A.
8. Audio Alarm 95 dB at 24 in.(610 mm),warble-tone sound.
9. Visual Alarm 7/8 in.(22 mm)diameter red lens,"Push-to-silence." NEMA 4,1 W bulb,120 VAC.
10. Panel Enclosure Measures 15.5 in.high x 13.3 in.wide x 6.7 in.deep(384 mm x 338 mm x 170 mm►.
NEMA 4X rated.Constructed of UV-resistant fiberglass;hinges and latch are stainless steel.
Conduit couplings provided.
VCOM-AXB1 120 VAC,3/4 hp,14 A,single-phase,60 Hz.
VCOM-AXB2 240 VAC,2 hp,14 A,single-phase,60 Hz.
Optional Components
Feature Specifications Product Code Adder
Pump Run Light 7/8 in.(22 mm)diameter green lens.NEMA 4,1 W bulb,120 VAC. PRL
Anticondensation Heater Self-adjusting:radiates additional wattage as temperature drops. HT
Programmable Timer Discharge side timed dosing. PT
UV Disinfection Compatibility UV grounded power circuit and alarm contacts. Pump disable upon UV failure. UV
*See VeriComm Remote Telemetry Unit(ATD-CP-VCOM-1)and VeriComm*Monitoring System(ATD-WEB-VCOM-1)for more detail.
ATD-CP-VCOM-7
Rev.2.5©6/06
Page 2 of 2

Float Switch Assemblies °ei
Orenco Systems'
Incorporated
1-800-348-9843
Installation, Operation and Maintenance Instructions
Model MF
Installation Instructions
The float switch assembly is typically mounted in the screened pump vault or effluent screen inside of a septic or dosing tank.
The assembly is detachable without removal of the screened pump vault or effluent screen.A typical float switch assembly is
shown below.
Stop 1:
Each float cable is provided with a color marker.This marker indicates the O I�
function of the float. Make sure that your float cable color markers corre-
spond with the wiring diagram provided. If the wiring diagram does not Float function
match your float cable marker colors,contact Orenco Systems® Inc.or `+, color marker
your local dealer for assistance. I
_ Float stem
Adjustable float
collar
�q' a� Stainless steel
Al i set screw
Farp
�.�4 Float
•
Step 2
To check for proper float switch operation,move each switch up and down
and check for interference. Remove the assembly from its holding bracket
by snapping it out of the holding bracket.
CO •
2003 Orenco Systems'Inc. NIN-MF-MF-1
Rev.2.0,CO 11/04
Page 1 of 4

Installation Instructions (continued)
© Step 3:
If any float interferes with another,the float may be adjusted by loosening
J
the stainless steel set screw provided in the float collar.Using a phillips
�' screwdriver,slowly back the screw out of the collar to a point at which the
collar may be adjusted. Be careful not to back the screw completely out of
1.)
the collar. Carefully rotate the collar on the stem until the float switches can
move freely past one another.Tighten the stainless steel set screw and
recheck.
Warning: Be careful not to alter the the tether lengths of any of the floats.
/�, `� (N. v Alteration of the tether length may affect proper operation of the float
li • r„,
switch assembly.
AlTigli
c11
am, 4.. ).
V
0
Step 4:
Check the float settings with the project plans and specifications. If the set-
tings need to be adjusted,loosen the set screw as described in step 3.
Adjust the float switches to the desired level and tighten the set screw.
Make sure float level settings do not violate any state or local regulations.
Note: The float stem provided is the maximum length possible without
interfering with the pump minimum liquid level or screened pump vault
4 �J intake ports. Never lengthen the float stem without prior approval from
�' _„....,_
'� � Orenco. Lengthening of the float stem will void the warranty.
als,
. --4ts)
f�
0
Step 5:
© 11,- Rep1
lac the float switch assembly in the holding bracket.Make sure the
assemblye snaps fully into the bracket.
Step 6:
allow for easy removal of a float switch assembly,a 1" diameter handle
may be added to the top of the float switch assembly. Measure the distance
ITo
from the top of the float switch assembly up to about one foot from grade
level. Cut a 1" diameter PVC pipe to the measured length and glue it into the
handle.
. ___________
NIN-MF-MF-1 ©2003 Orenco Systems`Inc.
Rev.2.0,©11/04
Page 2 of 4
1

Installation Instructions (continued)
Step 7:
When used with an Orenco electrical splice box:
Push the level control wires through the watertight cord grips into the
electrical splice box. Leave an adequate length of electrical cable coiled
inside the riser to allow for easy removal of the pump and float switch
assembly. Do not remove the colored markers or the paper tags from the ( 31
float cables,and do not try to thread the markers and tag through the ® m
cord grip.lighten the cord grips by hand,not by tool,then test the tight-
ness of the cord grips by tugging on each cable.A cable is secure when
the cord grip is tight enough to prevent slippage.Adequate lengths of
cable should be left within the splice box to allow easy removal for future
disconnecting and resplicing.
Note: See the splice box instructions(EIN-SB-SB-1)and
corresponding splice box diagram for connection instructions.
©2003 Orenco Systems'Inc. NIN-MF-MF-1
Rev.2.0,©11/04
Page 3 of 4

Maintenance Instructions °EN
Orone('Systems'
Incorporated
1-800-348-9843
During the annual inspection,follow the testing procedures provided to ensure that the system is operating properly. If a float is
found to be faulty,either during the annual inspection or during troubleshooting after an alarm condition,see the section below
titled Removing and Replacing Inoperative Floats.
Removing and Replacing Inoperative Floats
Important: Before doing any work either on the wiring to the level control floats and pump in the vault or in the pump control
panel,switch the circuit breakers in the panel to their"OFF"positions;then switch off the power to the system at the service
entrance panel.
1. Remove the float assembly from the vault.
2. Using a Phillips screwdriver, remove the stainless steel screws from the splice box lid,being careful not to drop the screws
into the tank. If the splice box was submerged,or if there is a crack in the conduit,there may be water in the splice box. If
this is the case, remove water from the splice box with a syringe,sponge,or other appropriate method. Loosen the cord grip
at the splice box and verify the appropriate splice for the float. Unscrew the wire nuts and remove the float.
3. Remove the inoperative float and replace it with a new one. Push the float cable through the watertight cord grip into the
electrical splice box. Leave an adequate length of electrical cord coiled inside the riser to allow for easy removal of the float
assembly. Do not remove the colored markers or the paper tags from the float cords,and do not try to thread the markers and
tag through the cord grip.Tighten the cord grip by hand,not by tool,then test the tightness of the cord grip by tugging on the
cord.A cord is secure when the cord grip is tight enough to prevent slippage.An adequate length of cord should be left
within the splice box to allow for easy removal for future disconnecting and resplicing.
4. Refer to document EIN-SB-SB-1 for instructions to splice the float wire to the wire from the control panel.Attach the float
wires using the waterproof wire nuts. It is necessary to replace this wire nut with a new watertight wire nut.Always use
watertight wire nuts or heat shrink splice kits for all connections!
5. Replace the float and collar and return the assembly to the pump vault.
6. Reconnect power and test the unit.
NIN-MF-MF-1 ©2003 Orenco Systems'Inc.
Rev.2.0,,,c)11/04
Page 4 of 4

Technical Data Sheet
UV Disinfection Unit O091renco Systems
800-348-9843
Applications General
The Orenco` UV Disinfection Unit can be used after secondary In a pump or gravity discharge basin or tank,treated effluent is
treatment(10 mg/L CBOD5/TSS)in applications requiring disinfec- disinfected as it flows through the housing and around the UV
tion before dispersal. lamp.The unit uses no chemicals and has no moving parts. It
In NSF Standard 40 testing for fecal coliform reduction using typi- annual cleaning and lamp replacement.
cal residential flows of 500 gpd(1890 Uday),the UV Disinfection
Unit reduced fecal coliform by 99.9 percent(3 logs).Specifically, Features/Specifications
it yielded an overall geometric mean of 1.71 cfu/100 mL.The bulb
used in testing was rated at 125 pW/cmz intensity. To specify this component for your secondary treatment system,
require the following:
This test used effluent treated by an AdvanTex®AX20 Treatment
System,which produced effluent of 4 mg/L CBOD5,6 mg/L TSS, For all secondary treatment systems:
and 1.2 NTU,with a geometric mean of 1.35 x 104 cfu/100mL. • Require a secondary treatment system that produces
Similar reductions in fecal coliform can be expected from other 10 mg/L CBOD5 and TSS in the field.
secondary treatment systems that produce 10 mg/L CBOD5 and • Require a power ballast and lamp current sensor housed in a
TSS in the field. control panel(not a tank or riser)to minimize corrosion and
For information on commercial or high-flow applications,contact failure due to environmental exposure.
Orenco's Engineered Systems department. • Require a quartz sheath to minimize buildup and service
intervals
1;1 Power cord Require a quick disconnect fitting for easy inspection and
Cord grip
• cleaning.
For Orenco's AdvanTex Treatment Systems:
Lamp handle •• Require suitability with Orenco MVP Panels or the VeriComm"
Monitoring System.When coupled with an AdvanTex
Treatment System,the MVP panel or VeriComm Monitoring
System prevents discharge of non-disinfected effluent due to
Inlet lamp failure.A current sensor monitors lamp function and,in
Outlet the event of lamp failure,the AdvanTex discharge pump is
1—ms,
automatically disabled.With MVP panels,an audible and
visible alarm is activated.With VeriComm-equipped systems
Housinga text alert is sent to the Service Provider.
Standard Model
UV-125/31-P
Quartz sheath Nomenclature
and lamp
UV - 125 / 31 -TP
I Housing material:
P = Sch 40 ABS
Lamp length:
Flow-through 31 =31 in.(787 mm)
spacer Lamp output:
125=125 µw/cm'
UV disinfection unit
Orenco' UV Disinfection Unit,cutaway view
©2010 Orenco Systems`Inc. NTD-UV-OSI-1
Rev.1.0,©1/10
Page 1 of 2

UV Disinfection Unit (continued)
A
Flow path + `
B p F
Flow path
Orenco UV Disinfection Unit,top view
t Materials of Construction
C Cord grip Nylon
Housing 3-in.(80-mm)diameter Sch 40 black ABS
Inlet tee 3-in.(80-mm)Sch 40 black ABS
Other housing fittings Black ABS
Quick-disconnect Black ABS
coupling
1W IPS outlet Black ABS
Lamp assembly seal EPDM rubber
Lamp sleeve 20.5-mm quartz sleeve
Specifications
Dimensions,in.(mm)
A 42.26(1073)
B 36.00(914)
C 30.87(784)
D 0.50(13)
E 4.00(100)
F 7.60(193)
G 1.50 IPS(40 DN)
Performance
L E s Lamp 31"(787 mm),120V,AC,50 or 60 Hz,425 mA,
v 38 W;radiant intensity is 125 µw/cm'at 254 nm
Ballast 120V,AC,50 or 60 Hz,located in UL listed
Orenco control panel
Power cord 600V,18/2 UL Type TC,25 ft(7.62 m)standard
length
Cord plug UL listed four-pin connector,lampholder,
Orenco UV Disinfection Unit,side cutaway view electric discharge,1000 V or less
NTO-UV-OSI-1 ©2010 Orenco Systems'Inc.
Rev.1.0,©1/10
Page 2 of 2

5TF-N18, 24 & 30
FEATURES
Install in any riser without an inner lid.
Use as a security measure to keep
persons, especially children, from
accidental entry while systems are
being serviced or any other instance
where a cover is removed
Available to fit 18", 24", and 30"
diameter risers
4. Open areas in web are large enough
to allow tanks to be pumped without
having to remove the security net
Lam. Installs easily in our segmented riser
and others
f
Order part No.STF-N18
STF-N24
STF-N30
- x ♦ _ .
tor I
CAD detail drawing available in DXF format
acne
RELATED PRODUCTS
STF-CI24 page 5
41.110.
ST FAD,.9SEGME.,IED915E11- 5TF-APC24G page 6
STF-APC24B page 6
STF-R824B page 9
STF-AR24 page 9
STF-APC24GI-075 page 14
STF-APC24BI-075 page 14
STF-APC24GI-100 page 14
STF-APC24BI-100 page 14
STF-APL24G page 14
U S.Patent Pending STF-APL24B page 14
PAGE
Toll Free 888-999-3290 Office 231-582-1020 Fax [phone] Email [e-mail] Web www.gag-simtech.com 1 0

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Engineers and Soil Scientists
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501 N.Salem Street,Suite 203
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919-859-0669
www.agnwaste.corn
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Engineers and Soil Scientists
Agri-Waste Technology,Inc.
501 N.Salem Street,Suite 203
Apex,North Carolina 27502
919-859-0669
www.agrtwaste.com
0�
,.� Jacobs Residence
e Surface Discharge
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N58°03'40"E o Douglas Jacobs
1401 W Academy Si.
2 Fuquoy—Varina,NC 27526
612-1532
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1401 W Academy St
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Trenching and Excavation Safety (c) Requirements
The employer must comply with the trenching and excavation requirements of 29 CFR 1926.651 and 1926.652 "Soil classification system"means,for the purpose of this subpart,a method of categorizing soil and rock A/T
or comparable OSHA-approved state plan requirements. deposes in a hierarchy of Stable Rock,Type A,Type B.and Type C,in decreasing order of stability.The (1) Classification of soil and rock deposits.Each soil and rock deposit shall be classified a competent personAWl
categories are determined based on an analysis of the properties and performance characteristics of the B,or Po by P (b) (2) Manual tests.Manual analysis of soil samples isi conducted to determine quantitative as well as qualitative
deposits and the characteristics of the deposits and the environmental conditions of exposure. as Stable Rock,Type A,Type Type C in accordance with the definitions set forth in paragraph of properties of soil and to provide more information in order to classify soil properly. Engineers and Soil Scientists
Inspection of Excavations "Stable rock"means natural solid mineral matter that can be excavated with vertical sides and remain intact this appendix.
OSHA standards require that a competent person inspect trenches daily and as conditions change before while exposed. (2) Basis of classification.The classification of the deposes shall be made based on the results of at least one (i) Plasticity.Mold a moist or wet sample of soil into a ball and attempt to roll it into threads as thin as Agri-Waste Technology,Inc.
visual and at least one manual analysis.Such analyses shall be conducted by a competent person using 1/8-inch in diameter.Cohesive material can be successfully rolled into threads without crumbling.For 501 N.Salem Street,Suite 203
worker entry to ensure elimination of excavation hazards.A competent person is an individual who is capable of "Submerged soil"means soil which is underwater or is free seeping.
identifying existing and predictable hazards or working conditions that are hazardous,unsanitary,or dangerous tests described in paragraph(d)below,or in other recognized methods of soil classification and testing such example,if at least a two inch(50 mm)length of 1/8-inch thread can be held on one end without Apex,North Carolina 27502
to workers,soil types and protective systems required,and who is authorized to take prompt corrective "Type A"means cohesive soils with an unconfined,compressive strength of 1.5 ton per square foot Os()(144 as those adopted by the American Society for Testing Materials,or the U.S.Department of Agriculture tearing,the soil is cohesive. 919-859.0669
measures to eliminate these hazards and conditions. kPa)or greater.Examples of cohesive soils are:day,silty day,sandy day,clay loam and,in some cases, Visual
classification system. (ii) Dry strength.If the soil is dry and crumbles on its own or with moderate pressure into individual grains www.agriwaste.com
silty clay loam and sandy clay loam.Cemented soils such as callohe and hardpan are also considered Type (3) and manual analyses.The visual and manual analyses,such as those noted as being acceptable in or fine powder,it is granular(any combination of gravel,sand,or silt).If the soil is dry and falls into
Access and Egress A paragraph(d)of this appendix,shall be designed and conducted to provide sufficient quantitative and dumps which break up into smaller clumps,but the smaller dumps can only be broken up with
OSHA standards require safe access and egress to all excavations,including ladders,steps,ramps,or However,no soil is Type A if: qualitative information as may be necessary to identify property the properties,factors,and conditions difficulty,it maybe clay in any combination with gravel,sand or silt.If the dry soil breaks into dumps
other safe means of exit for employees working in trench excavations 4 feet(1.22 meters)or deeper. () The soil is fissured;or affecting the classification of the deposits. which do not break up into small clumps and which can only be broken with difficulty,and there is no Jacobs Residence
These devices must be located within 25 feet(7.6 meters)of all workers. (i) The soil is subject to vibration from heavy traffic,pile driving,or similar effects;or (4) Layered systems.In a layered system,the system shall be classified in accordance with its weakest layer. visual indication the soil is fissured,the soil may be considered unfissured.
Off The soil has been previously disturbed;or However,each layer may be classified individually where a more stable layer lies under a less stable layer. (iii) Thumb penetration.The thumb penetration test can be used to estimate the unconfined compressive Surface Discharge
• Recommendations (Hi)The soil is part of a sloped,layered system where the layers dip into the excavation on a slope of four (5) Reclassification.If,after classifying a deposit,the properties,factors,or conditions affecting its classification strength of cohesive soils.(This test is based on the thumb penetration test described in American Treatment System
Heavy equipment and trucks should stay as far as possible from the edge of any trench. horizontal to one vertical(4H:1 V)or greater;or change in any way,the changes shall be evaluated by a competent person.The deposit shall be Society for Testing and Materials(ASTM)Standard designation D2488-"Standard Recommended Wastewater
Always usepadsen under stabilizers to minimizegroundreclassified as necessary to reflect the changed circumstances. Practice for Description of Soils(Visual-Manual Procedure).")Type A soils with an unconfined
Y pressures that could lead to failures. (v) The material is subject to other factors that would require it to be classified as a less stable material. compressive strength of 1.5 tsf can be readily indented by the thumb;however,they can be penetrated
(b) Definitions "Type B"means: (d) Acceptable visual and manual tests by the thumb only with very great effort Type C soils with an unconfined compressive strength of 0.5 Owner Information:
tsf can be easily penetrated several inches by the thumb,and can be molded by light finger pressure. Douglas Jacobs
• () Cohesive soil with an unconfined compressive strength greater than 0.5 tsf(48 kPa)but less than 1.5 This test should be conducted on an undisturbed soil sample,such as a large clump of spoil,as soon 1401 W Academy St.
tsf(144 kPa);or (1) Visual tests.Visual analysis is conducted to determine qualitative information regarding the excavation site
"Cemented soil"means a soil in which the particles are held together by a chemical agent,such as calciumaspracticable after excavation to keepto a minimum the effects of exposure to drying mfluences.lf the
carbonate,such that a hand-size sample cannot be crushed into powder or individual soil particles byfinger (i) Granular cohesionless soils including:angular gravel(similar to crushed rock),silt,silt loam,sandy in general,the soil adjacent to the excavation,the soil forming the sides of the open excavation,and the soil o ry 9 Fugtxry—Varino,NC 27526
p 9 loam and,in some cases,sift clayloam and sandyclayloam. excavation is later exposed to wetting influences(rain,flooding),the classification of the soil must be
Y taken as samples from excavated material. ON)612-1532
pressure. changed accordingly. dog A'cobsteamrealestate.com
"Cohesive soil"means clay(fine grained soil),or soil with a high clay content,which has cohesive strength. (iii)Previously disturbed soils except those which would otherwise be classed as Type C soil.
rig Iv Soil that meets the unconfined compressive strength or cementation requirements for T (iv)Other strength tests.Estimates of unconfined compressive strength of soils can also be obtained by 9 to
Cohesive soil does not crumble,can be excavated with vertical sideslopes,and is plastic when moist.Cohesive ( ) p Type A,but is (i) Observe samples of soil that are amounts and soil in the sides of the excavation.Estimate the range
soil is hard to break up when dry,and exhibits significant cohesion when submerged.Cohesive soils include fissured or subject to vibration;or of particle sizes and the relative of the particle sizes.Soil that is primarily composed of use of a pocket penetrometer or by using a hand-operated shearvane.
clayey silt,sandy clay,silt clay,clayand organic clay. (v) Dry rock that is not stable;or fine-grained material material is cohesive material.Soil composed primarily of coarse-grained sand or (v) Drying test.The basic purpose of the drying test is to differentiate between cohesive material with Property Information:
Y Y Y Yr8 Y fissures,unfissured cohesive material,and granular material.The procedure for the drying test involves Douglas Jacobs
"Dry (v)Material that is part of a sloped,layered system where the layers dip into the excavation on a slope less gravel is granular material. drying a sample of soil that is approximately one inch thick(2.54 cm)and six inches(15.24 cm)in 1401 W Academy St.
soil"means soil that does not exhibit visible signs of moisture content. steep than four horizontal to one vertical(4H:1V),but only if the material would otherwise be classified (ii) Observe soil as h is excavated.Soil that remains in clumps when excavated is cohesive.Soil that"Fissured"means a soil material that has a tendency to break along definite planes of fracture with littlediameter until it is thoroughly dry: Fu u _Varina,NC 27526
resistance,or a material that exhibits open cracks,such as tension cracks,in an exposed surface. as Type B. breaks up easily and does not slay in clumps is granular. (A) If the sample develops cracks as it dries,significant fissures are indicated. PIN 0646834697
"Granular soil"means gravel,sand,or silt(coarse grained soil)with little or no clay content.Granular soil has (iii) Observe the side of the opened excavation and the surface area adjacent to the excavation.Crack-like (B) Samples that dry without cracking are to be broken by hand.If considerable force is necessary to
'Type C"means: openings such as tension cracks could indicate fissured material.If chunks of soils all off a vertical
no cohesive strength.Some moist granular soils exhibit apparent cohesion.Granular soil cannot be molded iP break a sample,the soil has significant cohesive material content The soil can be classified as an
when moist and crumbles easily when dry. () Cohesive soil with an unconfined compressive strength of 0.5 tsf(48 kPa)or less;or side,the soil could be fissured.Small spells are evidence of moving ground and are indications of unfissured cohesive material and the unconfined compressive strength should be determined.
"Layered system"means two or more distinctly different soil or rock types arranged in layers.Micaceous (ii) Granular soils including gravel,sand,and loamy sand;or potentially hazardous situations. 9
9 Ye NO Submerged soil or soil from which water is freelyseeping;or (C)If a sample breaks easily by hand,it is either a fissured cohesive material or a granular material.
seams or weakenedplanes in rock or shale are considered layered. () r8 V 9: (iv)Observe the area adjacent to the excavation and the excavation itself for evidence of existing utility and ng pulverizedumps of the sample by hand or by stepping
Y (iv)Submerged rock that is not stable,orTo distinguish between the two, the dried
"Moist soil"means a condition in which a soil looks and feels damp.Moist cohesive soil can easily be shaped other underground structures,and to identity previously disturbed soil. on them.If the clumpsdo notpulverize easily,the material is cohesive with fissures.If theyPROFESSIONAL ENGINEER SEAL
v Material in a sloped, Y.
into a ball and rolled into small diameter threads before crumbling.Moistgranular soil that contains some () pad,layered system where the layers dip into the excavation or a slope of four (v) Observe the opened side of the excavation to identify layered systems.Examine layered systems to
horizontal to one vertical 4H:1 or steeper. pulverize easily into very small fragments,the material is granular.
cohesive material will exhibit signs of cohesion between particles. ( identify if layers slope toward the excavation.Estimate of degree of slope of the layers.
"Plastic"means a property of a soil which allows the soil to be deformed or molded without cracking,or "Unconfined compressive strength"means the load (vi)Observe the area adjacent to the excavation and the sides of the opened excavation for evidence of
appreciable volume change. P 9l per unit area at which a soil will fail in compression.It surface water,water seeping from the sides of the excavation,or the location of the level of the water
"Saturated soil"means a soil in which the voids are filled with water.Saturation does not require Box. can be determined by laboratory testing,or estimated in the field using a pocket penetrometer,by thumb table.
penetration tests,and other methods. (vii)Observe the area adjacent to the excavation and the area within the excavation for sources of vibration
Saturation,or near saturation,is necessary for the proper use of instruments such as a pocket penetrometer or •Wet soil"means soil that contains significantly more moisture than moist soil,but in such a range of values that may affect the stability of the excavation face.
sheer vane. that cohesive material will slump or begin to flow when vibrated.Granular material that would exhibit cohesive
properties when moist will lose those cohesive properties when wet.
EXCAVATIONS IN TYPE A SOILS EXCAVATIONS IN TYPE B SOILS EXCAVATIONS IN TYPE C SOILS EXCAVATIONS IN LAYERED SOILS k1nA rr'rrryry
All simple slope excavations 20 feet or less in depth shall have a maximum allowable slope of 331:1. All simple slope excavations 20 feet or less in depth shall have a maximum allowable slope of 1:1. All simple slope excavations 20 feet or less in depth shall have a maximum allowable slope of 6§:t. All excavations 20 feet or less in depth made in layered soils shall have a maximum allowable =4 a;-vpt b4'•:I
slope for each layer as set forth below. = { SEAL ...- 1 rlµ
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20'Max. r 20'Max. , B 1— tffeelEtli.'47 Si
3'^ , 20'Max. S,51 a ysk
Exception:Simple slope excavations which are
A 1
open 24 hours or less(short term)and which
are 12 feet or less in depth shall have a 14
maximum allowable slope of y-§:1 SIMPLE SLOPE SIMPLE SLOPE B OVER A
All benched excavations 20 feet or less in depth shall have a maximum
allowable slope of 1:1 and maxium bench dimensions as follows: 1
1 All excavations 20 feet or less in depth which have vertically sided lower portions that are C
20'Max. 20'Ma 1 supported or shielded shall have a maximum allowable slope of 1)z:1.The support or shield 1X
3/
6 system must extend at least 18 inches above the topof the vertical side.
5'Max 3/4This bench allowed in Y
cohesive soil only. A 1 FINAL DESIGN
4'Max. 'Max. 20'Max. , snit NOT RELEASED FOR CONSTRUCTION
'
SIMP E BENCH MUL IPLE BENCH C OVER A REV. ISSUED DATE DESCBPDON
4'Max
All benched excavations 20 feet or less in depth shall have a maximum allowable slope of 33 1
and maxium bench dimensions as follows: SINGLE BENCH 1 C 1
1X US
20'Max.
8'Max. 1 This bench allowed in B 1
3/420'Max. cohesive soil only. 18"Min. 1
3.5'Max. 12'Max. 1 1
1 4'Max. 1 C OVER B
4'Max.
3.5'Max.
All excavations 8 feet or less in depth MULTIPLE BENCH A •
which have unsupported vertically sided
lower portions shall have a maximum VERTICALLY SIDED LOWER PORTION
All excavations more than 8 feet but not more B
vertical side of 3Y with unsupported feet. than 12 feet in depth pponed vertically
sided lower portions shall have a maximum All other sloped excavations shall be in accordance with the other options permitted in§1926.652(b). 1
allowable slope of 1:1 and a maximum vertical All excavations 20 feet or less in depth which have vertically sided lower portions that are
side of 3Y feet. supported or shielded shall have a maximum allowable slope of 1:1.The support or shield system A OVER B
must extend at least 18 inches above the top of the vertical side.
All excavations 20 feet or less in depth which have vertically sided lower portions that are supported or
shielded shall have a maximum allowable slope of 3'a:1.The support or shield system must extend at A 1
least 18 inches above the lop of the vertical side. 1g
c SHEET TITLE
,
Ix
,
, 20'Max. A OVER C
,, Excavation Safety
20'Max. 16"Min.
18"Min. B 1r—
DRAWN BY: CREATED ON:
N. Corronzo 04/19/2024
c REVISED BY: REVISED ON:
VERTICALLY SIDED LOWER PORTION 115
B OVER C RELEASED BY: RELEASED ON:
All other simple slope,compound slope,and vertically sided lower portion excavations shall be in All other sloped excavations shall be in accordance with the other options permitted in§1926.652(b).
accordance with the other options permitted under§1926.652(b). All other sloped excavations shall be in accordance with the other options permitted in§1926.652(b). SHEET NAME:
WW-6

I
4X6 TREATED POST AI A/T
Engineers and Soil Scientists
� MOUNT PANEL DIRECTLY Agri-Waste Technology,Inc.
CiiiTIERiOi' SAp x,North Carolina 2750201 N.Salem Street,Suite 3
TO POSTS OR TO
9T a nwaste 9
ALUMINUM PLATE www.agdwaste.com
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--
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r.e•Support Pa„ (no splices) Wastewater Treatment System
24'GaeMeted Fiberglass Safety Net eV, Safety het enn 4 B•'6}Su min'n
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6 aeae graa Sisal Doffs(a' 1Qir w NM Vacherie IV at SO. Owner Information:
„.„. ae f 97 ea,a.a, CONDUIT WITH 4-3"DECK SCREWS
Ball Yoh," Rke.,daae f`�°°° SUPPORT Douglas Jacobs
---- Rew• ------ �--------- -�a�!�� PER POST 1401 W Academy St.
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•
Douglas Jacobs
i n 1401 W Academy St.
j j r 1 I J / r - L\�(L , �L \L \�L\L Fuquay-Varina,NC 27526
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----
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TO RT UNIT
TO POWER SOURCE I ' t TO HEADWORKS
t5 or r57 Grave. Realraulafan
RecirculationTransfer Line ALL CONDUIT
Undisturbed Earth Undisturbed Earth Return Rohe
INSTALL TO BE 3/4"(min)
MULTIPLE
CONDUITS AS
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NEEDED 3' BURIAL DEPTH ;.v‘ctsNCARpf.40N
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°11-12/
Specifications
Septic Tank TS 1250 STB AdvanTex RT Pod AX,20 RT
FINAL DESIGN
1.
min 3'
Length 125.50 In. Length 102.00 In. NOT RELEASED FOR CONSTRUCTION
10.46 ft. 8.50 ft.
Width 65.50 in. Width 64.25 in. REV. ISSUED DATE DESCRIPTION
5.46 ft. 5.35 ft.
Support External Height 61.50 in. External Height 72.00 in.
Concrete Support Strap 5.13 ft. 6.00 It.
Pad 1 8"x 1 8"x4" ---\\ Bottom of 4'Inlet 11.50 In. Bottom d4'Inlet 28.00 In.
'from Top of Tank 0.96 It. "from Top of RT 2.33 It.
Bottom of 4 Outlet 13.50 In. Bottom d 4'Outlet 37.00 In.
e�►, from Top of Tank 1.13 It. 'from Top o1 RT 3.08 It.
F
Elevations
Stubout(Assumed) 402.12 ft.
/ MIN?COVER Septic Tank AdvanTex RT Pod AX-20 RT
Geotextile Gravel
Fabric gain Ho e1 DL Pipe Length to ST Inlet 40.00 It DL Pipe Length to RTInlet 12.00 ft. SHEET TITLE
Supply Line Ground Surface at Low Side of ST 401.62 ft Ground Surface at High Side of RT 401.25 ft
,... ._ ''.t Cover over Low Side of ST 3 00 In Exposed Height of RT 6.00 In. System Detail 2
0.25 ft. 0.50 ft y
Galvanized Exterior Top of Tank 401.37 ft. Exterior Top of RT 401.75 it.
4"x4" Treated Post Elbow Inlet Invert 400.41 ft. Inlet Invert 399.42 ft.
48" burial (min) Slope of DL Pipe 4.2796 Slope of DL Pipe 6.90%
'minimum 2%slope `minimum I%slope DRAWN BY: CREATED ON:
Outlet Invert 400.25 It. Outlet Invert 398.67 ft. N. Carronza 04/19/2024
Bottom of Excavation 395.75 ft. Bottom of Excavation 395.25 It.
'beneath 6'gravel base `beneath 6'gravel base REVISED BY: REVISED ON:
RELEASED BY: RELEASED ON:
t to scale
DRAWING NUMBER
tr�+
Elevation Determinations V� - -5
I
nd Hydrant(if required)- _ _ Ors �qE^� f �/

NOTES
1. Topographic data from GIS. AW 1•
2. Septic Tank to hove approved Orenco Effluent
Filter model FTP-0848-36 NC. Engineers and Soil Scientists
s;-sm., Agri-Waste Technology,Inc.
AX2ORTUV Treatment System-UV with Pump Discharge q
3. Treatment system to be 15' from residence, 501 N.Salem Street,Suite 203
"NOTE-ORENCO zr 'ZB- sHOAFPREDAsrsEPrK;INc. MODEL:TS 1250 STB 1' I ••'^^• property A ex,North Carolina 27502
ROUND 40TEDRISER CAST-IN 40' fromlines, 15' from onsite P
9 Z LEXINGTON NC 95 NON TRAFFIC • •
■■ ■ ;.p" "` _,..,... ....,-, buildings. 100' from neighboring residences, 91s asaste c
PHONE DM)78258M MIL, w S,t I t I t,1,t !■./l www.agflWBste.com
. I r••� _'--••'•••^-••--� and 100' from any Well. Verification of these
1250 Gallon Septic Tank ,„,-,,,,��,,,,�-�,
r' - FAX I � ~,~e-' setbacks to beperformed bycontractor.
_2K•_ ' - _, .;;N ,�; / '"�'�I Jacobs Residence
WWW.SHOAFPRECAST.COM /LILT S L_1l►; L■e�'; ' III 4. Contractor shall backfill around all access Surface Discharge
SHOAF.12513 SEPTIC TAN( '-•yes I': - --':�••• Ir •..T ..--.•- Ii'`,, " (�
D] o p t v"� I !�,�1 ; ®p»« mono,
areas such that storm Water is shed away Wastewater Treatment System
\ LWUIDCAPACITY�12S]OALLONSIIeuinspAce '- - ,_ ,,, from potential entry points.
�1n• `J a'IIlETd
OURET TANK HEIGMl1}' r i i i i ` t `�' •a r
B,».e Lb""" BOOTS ewe...., ,.I'.,.,.I,.I'.I,.,.V I i7i
TOP viEw BOTTOM OF TANK TO CENTER OF iwET-R' J .
•' 5. Invert elevations of all components to be Opner Douglas InformaJacobs• BOTTOM OF TAN(TO CENTER OF OVTOCT.lw
"'TOP VIEW MEASUREMENTS ARE LENGTH TO VADTH RATIO-2 TO 1 a verified in field by contractor to ensure proper 1401 W Academy St.
• TO W DESTDEENSIONS SIZE OF INLET a OUTLET,PIPE 1000 gal.Primary Tank-Top View AX20Recirc.Tank-Top View o ' operation. Fuquay-Varino,NC 27526
TYPE OF INLET a OUTLET-STATE APPROVED RUBBER BOOT .W7177 [phone]
CONCRETE PSI4030:TAN(N'EI°M-11.0g0 L85,
6. All system piping to be SCH40 PVC except dougOjacobsteamrealestate.com
REINFORCEMENT PER STATE CODE Where noted.
-
an,:..,md1u
SCALE•NT .S. ,uaea,o....,mo,m _ ,«a.u.0 ono '-' ,,,,..„,,„- Propertyy Information:
CAST IN RACE ORENCO RISER ADAPTERS - -- --.- Do
uglas os Jacobs
`tt•I� ,,� M l,� 7. All gravity elbows to be long radius or 14D1 ly Academy St.
s STATE r=r.0 ar�al►� II
- _ long sweeping type elbows. Fuqua-VarinaN027526
allI_ 1.�� _Z7 �_-��II-a '• I t ... ., N�
aR,-dM�M •
S B 3eg - "a 11 lhll I I - I I� I ^'I ,,, 8. Actual installation and placement of PI 0646834697
INLET • ET
79'RSaE 0,..
,a. at m ' "" 1ltreatment system to be overseen by
Ili I.III I� ,s-'rio_:r. �aTE �__O " IiiI Lid' _ ., ' I'll h I ',,�I PROFESSIONAL ENGINEER SEAL
TOBO^0"' I' � I all 9. Use Class a6' erosion control stone for
OF OURET
BOTTtp°M FLgy B �. �• 615' S55" �- ` ___��Ii,1 ' ,...,. �'iin lima i i 1 structural base for outlet stabilization structure.
THROUGH `Oa l ,,,_ ",...•., Use #5 or #57 stone for sediment control.
INLET °�
LO.L.... ...,
E�� 1000 gal.Primary Tank-Side View AX20 Recirc.Tank-Side View �""`�
T5• 35• 5s• Discharge Chamber-End View 10. Discharge line must be covered to a
16 17. minimum depth of 18". Discharge pipe outlet
122.
to have grate.
11. Flow from the receiving ditch back into the s+o�4��s'sy`!�y-�
system shall be prevented. - -t t"... 1 ri.aAEL
! SEAL *E,-05T 4
12. Engineer Inspection required duringsystem
i L' Q2� s
Not to scale Not to scale installation and at final completio . y hL\.to4„eQP',
13. Contractor to seed and/or mulch y rs1y°is1;
_ Septic Tank(or equivalent)O AX20-RT UV AdvanTex Treatment System -FOR ILLUSTRATION ONLY disturbed areas to coincide with existing"• eaA E AAA R 0"r' landscape. Area shall not be left With
uncovered soil.
*Note: 14. Upon system completion, Contractor to supply
Ensure lid is bolted shut prior to backfilling Engineer with documentation of
installation and a signed letter indicating
Treatment Pod. system was installed per approved design
Add water to Treatment Pod duringBackfill or noting any deviation from approved
design. FINAL DESIGN
Install Safety Net in Each Access (Match water level to backfill level). NOT RELEASED FOR CONSTRUCTION
Riser that does not conjoin an w Ns7NIAttW W"Ra`"""E 1 5. Contractor to install phone line to VCOM
RqR p•nnd a RM
Inner Lid 11. a ee bowing euHaaw a,
�^ai°^•"•"^ control panel. REV. ISSUED DATE DESCRIPTION
IMtlI Sande Nd Be.2nd leer R„ 12 Use a Wan dote sb maw er
dad.al to dam the tending
-- -- e1rl°''e1 a Wader am rl" 16. AdvanTex-RT Unit to be placed on gravel bed
Clean,Tamped Backfil RWIsx R�„1y�r r�l" Ea': a m
4"SCH 40 PVC 12 "•",. and backfilled with gravel.
g:„aI are L« sales e sy.eroMldF
Class B Rip Ra "" "" 21 o F°"ein o, :.
w/Grate o.T aaA. d 17. Mount Control Panel a minimum of 24" above
U / / t 1 Gall •aJ•2 Eye 24T de rTwM Ipkd b and
O 0 0 O O • A''• grade. Power to panel to be installed by
/ / �= - '=.�.�� .�.�fs -- ��^ a1`H .a m.eV, licensed electrician per code.
L .i.. � z a
• �11 1 .Aidy MP - + - agm1.7,:r u Xn�tI.`..u�. Nil
r lilit
EtIW)� _ 'I•e�'-t",m •^_.(• 11111
E . 18. Leak test required on septic tank and pod.11l •�:��L�.�:��::0 . �.;a" ..,(...,-).gad 1111111111 ,ate.fedba-mm a'forth` '-s�' .e>�..rn. T,"1 m.dr ew aw NHnfiberglass��l;7110‘-"- / •Leyte, ••°1 R m 1° nberglo 19. Water spigot to be located on exterior of
eede a ema= a'°d,-I°e ",:'"ZIA residence Within 50' of tanks.
amass now-adapter kint
-lI _ aant„ue.Hee `,•a emew•^, 20. Pour concrete collar around flange of
�. L treatment unit or install anti-buoyancy beams
Filter Fabric �#57 Gravel � � W.aa.-.._= APdy^�°-n-'11o�
outer deer gal end top al tan,
e Env,defy oat.m Inner a ad h
IrIMIIEy e BAR Pba.ow sew. per manufacturer's recommendations.
Clean, Tamped Backfill Undisturbed Earth % awea-. a.° SHEET TITLE
.A11 e•_yse 21. Existing septic tanks to be properly abandoned.
.I. Contractor shall provide documentation from Durham County. System Detail #1
i. 11
22. All wastewater from the SFR, including
IgTE:0,161l 4 Reg Cbmpe II ♦ y
s ca lorga,)'ra I,loon • tank ter, is to be conveyed to the septic
11 1Eli
24 (hP) I tankTu,n DRAWN BY: CREATED ON:
RucLle0111111111 23. Separate circuits for pump and alarm/control N. Carranza 04/19/2024
panel ore required (2-120V, 20 amp; 1-120V,
kimb. 15 amp). Separate conduits required for phone REVISED BY: REVISED ON:
J or Internet line. RELEASED BY: RELEASED ON:
t to scale Not to scale Not to scale z.min 24 Recirculation Timer Settings:
TIME ON/OFF: 0.8/14.2 minutes DRAWING NUMBER
I,=!=
char a Ri ra Detail 14 gpm to Pod / 5 gpm to Septic Tank. �`� _4
9 Rip rap Safety Net(install in Septic Tank Risers) p Anti-Buo an Installation1 ;Ir/ \V��'/
e,,,NTS sc..o.�,.."..

, _
AWIr ,
I
1ff '
1 / Line Legend Engineers and Soil Scientists
Agri-Waste Technology,Inc.
\\ / I Line Name Size Type 5Apex,N rthem CarolinaSuite203
YP Apex,North 27502
/ Tree Protection 919-859-0669
/ C DL Drain Line 4.0" SCH 40 PVC www.agriwaste.com
.... ----
J EDL Effluent Discharge Line 1.25" SCH 40 PVC
_ Jacobs Residence
ca ERL Effluent Return Line 1.0" SCH 40 PVC Surface Discharge
lS •L Wastewater Treatment System
- lS S' U
0 '�- DL a) COMPONENT LEGEND Owner Information:
Douglas Jacobs
r... .......) 1401 W Academy St.
v a) ST Septic Tank CP Control Panel Fuquay-Varina, NC 27526
2-1532
(n • cv ca RT Recirculation Tank UV UV Disinfection (919 6
dougOjacobsteamrealestate.com
E
E A AdvanTex Pod P Pump
co Lu
Property Information:
xo CO Cleanout EF Effluent Filter Douglas
Jacobs Si.
c Q
IT Inlet Tee BV Ball Valve Fuquay Varino,NC 27526
\'‘‘° 65 c5'
1"'— O Q SB Splice Box PINI 0646834697
tii
.
\ -
57 PROFESSIONAL ENGINEER SEAL
V J LL
ea
1 Ct
SBL 1SB co
„nrm,,,,,
��m0.�N'A Rp��tiy
ra Fnwr
50' Property Line Setback ` ° =°-0sy
ERL
y7
I-A
_, (('.15 \
DESIGNo
a3 FINAL
v
�\ NOT RELEASED FOR CONSTRUCTION
al
REV. ISSUED DATE DESCRIPTION
(I
a)
t I
��*),, 1
a) ��� \
o °soo \
0
b o�od, \\ c-) Connect to Existing
�, 4 ° Building Sewer
DL (Field Verify Location)
4 \ SHEET TITLE
64 Vi \N System Layout
8 Approximate Electrical Line
Existing ST
o 5 ,q (to be abandoned) — DRAWN BY:a CREATED2 0O2N:
�� Feet REVISED BY: REVISED ON:
RELEASED BY: RELEASED ON:
DRAWING NUMBER
.,ALED FOR 11"X17"SHEET System Layout ,\�V W -J2

Pond : : : • .
1 AW'r
Engineers and Soil Scientists
• ' Agri-Waste Technology,Inc.
501 N.Salem Street,Suite 203
Apex,North Carolina 27502
— — — — •— — — — — — — — —
— — — — — — 919-859-0669
``/i- www.agnwaste.corn
tc Jacobs Residence
N Cb
h• Surface Discharge
v ,� o Wastewater Treatment System
N58°03'40"E ,o Owner Information:
I0 - 296.50' , Douglas Jacobs
1401 111 Academy t.
- MMt 44,
Fuquay-Va i a, NCS27526
CD - V- °D ' . •.
!^. �� �. doug®ocobsteamrealestate.com
- r V— �•40
f___ r"' Q •',� ^ ` '.' .------
Property Information:
0'.
p -408 ° M _— — — _ SO°01'44"E 0 . • .: / Douglas Jacobs
(`� D,• 1401 W AcademySt.
M_ — — M — — — — — — — i�— — — 9.66' — �O ,, Fuquay-Varina, C 27526
�y M t— // — ✓ d — / PIN/0646834697
CO 406 / \
z ' I' 7
V\ % / PROFESSIONAL ENGINEER SEAL
404 /
/ I -" 50'Property Line Setback / `
/
I
\ '/ I / / '1 �mmmuy1y/ \ \ � 6ABOz y/
j� \ VA i cc.yslor
1_ / \ ", s o•r
V/11
n .
o Unknown Tributary 1
to Kenneth Creek ��/
Cr)CO � = a1 cm/ \ I
z IN cn I ��/
7y us I 15'Foundation Setback `')J `r,J 1
o h o I ]� ED
Q'y , - \ t FINAL DESIGN
CO o I Shed /�. J / \ ' ' D. * I NOT RELEASED FOR CONSTRUCTION
CO• I / I / ` o I REV. ISSUED DATE DESCRIPTION
Z I \� ) /
t
\\\�\t ` I \\ // Ni
to • /4 pi. I Existing 4—BDR Dwelling / \
\ \
.....A0 .4.,. ...:.•- .• ..*...• !t • • '•-• a , 'L. .' . • 4/08
Shed ;;D SHEET TITLE
:• \_D 406, \ / Property Layout
85.01 I
I 160.24
S58°23'28"W S58°23'28"W\ s58°23Zs°w '4
- 3 / %III DRAWN BY: CREATED ON:
\ OTE : Topoc raph is Data from G S . - --
0 25 so$ N. Carranza 04/19/2024
REVISED BY: REVISED ON:
..-. ._""- ��
rr_ _ Feet
t nim
Shed RELEASED BY: RELEASED ON:
DRAWING NUMBERNUY
.;ACED FOR 11"X17"SHEET Property LayoutW W`�J
-2

ANT
a c o b 5 Res ° dece Sroce Engineers and Soil Scientists
Agri-Waste Technology,Inc.
501 N.Salem Street,Suite 203
Apex,North Carolina 27502
919-859-0669
www.agriwaste.corn
project Locction : 1 /101 W Accdemy St .
Jacobs Residence
F u c u c y V c r i n c \ C 27526 Surface Discharge
WosteWater Treatment System
W a K e County SITE Owner Do JacobsInformation:
�' Douglas Ja
1401 A Academy St.
D \ # 06 / 683/ 697 (919)612-15, NC27526
919 12-1532
doug®jac obsteo mrea lestate.com
Ss Property Information:
�¢<PS Douglas Jacobs
_r; �P� 1401 W Academy St.
Project Owner: DougIcs Jccons © a:� Fuguay_46834NG27526
(� � PIN+ 0646834697
1 /101 W A c c c e m y t . PROFESSIONAL ENGINEER SEAL
Fucucy Vcrinc , \ C 2 / 526 E. - : oo
I=
■ o
(919 ) 61 21 532 • oY�� pQ.p<.
coug@jccobstec nnrec estcte . com
0 �ry
"\�r111111Mp
N.T.S. 2°•o�tsslaq,.�,P�i
VICINITY MAP - -�1 �Ir
= rt -0s1
Project Consu tents : Kevin Drcvicson , P . "} ' `0.�°5�=__
Kdavicson@ccriwaste . com
AgriWcste Technology , Inc .
501 \ . Sc em Street, Ste 203 FINAL DESIGN
NOT RELEASED FOR CONSTRUCTION
Apex , \ C 2 / 5 0 2 REV. ISSUED DATE DESCRIPTION
( 919 ) 8590669 Sneet Incex
' 919 ; 233 1970 Fcx
Sneet 1 : Cover Sneet
System Overview : Sing e Fc mi y Resicence Sneet 2 : Property Lcyout
Four ( / ) Bec roo nn , / 80 CDC Sneet 3 : System Lcyout
Design Stcnccrc Dischcrce Sneet / : System Detc1 # 1
SHEET TITLE
Acvc nTex AX - 20 RT Poc Sneet 5 : System Detc # 2
Cover Sheet
witn Sinc e Bu c V Disinfection Sneet 6 : T xccvction Safety DRAWN BY: CREATED ON:
N. Carranza 04/19/2024
REVISED BY: REVISED ON:
�NOrth'Q7� RELEASED BY: RELEASED ON:
t n a �i SHEET NAME:
www.ncett.ory'
WW-1

i a`r`.t STATE� ',,,
Attorney-Client Privilege; Confidential `�"
ROY COOPER i r t
Governor •,, , �'
ELIZABETH S.BISER ate-
•s
Secretary ,aAl+vx ,.
RICHARD E.ROGERS,JR. NORTH CAROLINA
Director Environmental Quality
May 20, 2024
Mr. Mark Phillips
Phillips Plating Company, Inc.
P.O. Box 336
Bridgeton, NC 28519
Subject: Permit Renewal Materials
Permit NC0001881 /EPA ID NCD041466806
Phillips Plating Company Inc
Discharge: 0.1 MGD;Neuse River SC, Sw,NSW
Craven County (WRO)
Dear Mr. Phillips,
Pursuant to your request please find enclosed the following documents related to Phillips Plating
Company, Inc. permit renewal. Be sure to complete these forms completely and pay attention to
the directions provided on each. Federal and State regulations require that permit renewal
applications be submitted at least 180 days prior to the expiration of the current permit (apx.
8/31/24). The following information shall be required for the permit renewal.
1. Form 1 General Information pursuant to 40 CFR 122.21 (f),Attachment IA.
2. Form 2C Existing manufacturing discharges pursuant to 40 CFR 122.21 (g),Attachment
I B.
3. Form 2F: Major industrial facilities with stormwater outfalls MUST fill this out for each
stormwater outfall covered by an NPDES permit, if stormwater outfalls exist on site,
(Attachment 1 C)
4. Chemical Addendum: Pursuant to Session Law 2018-5, Senate Bill 99, Section 13.1(r),
every applicant shall now submit documentation of any additional pollutants for which
there are certified methods with the permit application if their discharge is anticipated. The 1
list of pollutants may be found in 40 CFR Part 136. If there are additional pollutants with
certified methods to be reported,please complete,and submit the Chemical Addendum and
be sure to list the selected certified analytical method used. If there are no additional
pollutants to report, this form is not required to be included with your application. Please
refer to Attachment ID herein I
D_E North Carolina Depar r ent of Environmental Quality I Division of Water Resources
512 North Salisbury Street 11611 Mail Service Center I Raleigh,North Carolina 27699-1611
NORTH CAROLINA 919 707 9000
Uep.Ponent of EnNrmernntel 0ulllr

r
5. PFAS Questionnaire: For sites that use, generate and/or potentially discharge PFAS
compounds, please complete and submit the attached questionnaire (Attachment 1E).
6. Mercury Data: A statewide mercury TMDL was developed to estimate the proportions of
mercury contributions to water and fish from wastewater discharges, and to calculate
appropriate reductions needed. For more information on mercury in North Carolina go to:
https://www.deq.nc.gov/about/divisions/water-resources/water-planning/modeling-
assessment/special-studies/mercury-tmdl. Be sure to include in your application all data
related to mercury. For additional details see condition A. (9) Effluent Mercury analysis in
the existing permit.
Note Completion of Forms
a. Print or type in the specified areas only. If you do not have enough space on the form
to answer a question, you may continue additional sheets, as necessary, using a format
consistent with the form. If applicable, please denote on the form"See Attachment"with
the Attachment number for ease of reference.
b. Do not leave any response areas blank unless the form directs you to skip them. If
the form directs you to respond to an item that does not apply to your facility or activity,
enter"N" for"not applicable"to show that you considered the item and determined a
response was not necessary for your facility.
If you should have any questions and/or require further explanation,please contact me at 919-707-
3605 or email at [e-mail].
Sincerel
Doug as Dowden
Environmental Program Supervisor II
Division of Water Resources/Permitting
Attachments: 1 A- Form 1 General Information; 1 B - Form 2C Existing manufacturing; 1C -
Form 2F Major industrial facilities with stormwater outfalls; 1D - Chemical Addendum; and 1 E -
PFAS Questionnaire
Hardcopy: Via Mail
Ecopy: Central Files
D_E North Carolina De yp Street 11611 Mail Service Center I Raleigh,North Carolina 27699-1611
NORTH cARoLINA 919.707.9000
Department of rnrlmnmptll quality

Attachment 1A
Form 1 General Information
DE�� North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 11611 Mail Service Center I Raleigh,North Carolina 27699-1611
NORTH c^r�ol-I"^ 919.707.9000
MpMmem of Environmental Quay

United States Office of Water OMB No.2040-0004
Environmental Protection Agency Washington, D.C. Expires 07/31/2026
Water Permits Division
EPA Application Form 1
General Information
i i n Pro
NPDES Permitting Program
g
Note: All applicants to the National Pollutant Discharge Elimination System(NPDES)permits
program, with the exception of publicly owned treatment works and other treatment works treating
domestic sewage, must complete Form 1. Additionally, all applicants must complete one or more of the
following forms: 2B, 2C, 2D, 2E, or 2F. To determine the specific forms you must complete, consult the
"General Instructions" for this form.

Paperwork Reduction Act Notice
This collection of information is approved by OMB under the Paperwork Reduction Act, 44
U.S.C. 3501 et seq. (OMB Control No. 2040-0004). Responses to this collection of information
are mandatory (40 CFR 122.21). An agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it displays a currently valid OMB
control number. The public reporting and recordkeeping burden for this collection of information
is estimated to be 2.7 hours per response. Send comments on the Agency's need for this
information, the accuracy of the provided burden estimates and any suggested methods for
minimizing respondent burden to the Regulatory Support Division Director, U.S. Environmental
Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the
OMB control number in any correspondence. Do not send the completed form to this address.

DESCRIPTION OF NPDES PERMIT APPLICATION FORMS CONTENTS OF FORM 1 PACKAGE
The application forms for individual National Pollutant Discharge Form 1—General Instructions
Elimination System(NPDES)permits include the following: Form 1—Line-by-Line Instructions
Form 1—General Information (included in this package). Form 1—Activities That Do Not Require Permits
Form 2—Forms Based on Facility or Activity Type (not included in Form 1—Glossary
this package): Form 1—Application
2A. New and Existing Publicly Owned Treatment Works
2B. Concentrated Animal Feeding Operations and Concentrated
Aquatic Animal Production Facilities
2C. Existing Manufacturing,Commercial, Mining,and Silvicultural
Operations
2D. New Manufacturing, Commercial, Mining,and Silvicultural
Operations That Have Not Yet Commenced Discharge of
Process Wastewater
2E. Manufacturing,Commercial, Mining, and Silvicultural Facilities
Which Discharge Only Nonprocess Wastewater
2F. Stormwater Discharges Associated with Industrial Activity
2S. New and Existing Treatment Works Treating Domestic Sewage
1-3

FORM 1—INSTRUCTIONS
General Instructions with industrial activity—excluding discharges from
Who Must Apply for an NPDES Permit? construction activity under 122.26(b)(14)(x)or(b)(15)—you
must also complete Form 2F. If the discharge is composed
With the exceptions described in"Form 1—Activities That Do of stormwater and non-stormwater,you must complete
Not Require Permits,"the federal Clean Water Act(33 U.S.C. Form 2F and you must also complete Forms 2C,2D,
1251 et seq.)prohibits any person from discharging pollutants and/or 2E,as appropriate.See Form 2F's instructions for
into waters of the United States without first having been
further details.
issued a permit under the NPDES program. Ifyour facilityis a new or existingtreatment works
•
Who Must Complete Form 1? treating domestic sewage,you must also complete Form
All applicants,other than publicly owned treatment works 2S.
(POTWs)and sludge-only facilities,must submit Form 1. If you If your facility is a federally owned or privately owned
operate one of the following facilities,you must submit Form 1: treatment works,contact your permitting authority to determine
concentrated animal feeding operations and aquatic animal the appropriate form(s)to submit(see 64 FR 42436).
production facilities;manufacturing,commercial,mining,and
silvicultural operations;or other industrial facilities.
At the state level,either the U.S. Environmental Protection Where to File Your Completed Form
Agency(EPA)or an approved state agency administers the • If you are in a jurisdiction with an approved state NPDES
NPDES permit program. If you are located in a jurisdiction in permit program,file according to the instructions on the
which an EPA regional office administers the NPDES permit state forms.
program,you should use Form 1 and all other applicable forms • If you are in a jurisdiction where EPA is the NPDES
described in these instructions. If you are located in a permitting authority(i.e.,the state is not an NPDES-
jurisdiction where a state administers the NPDES permit authorized state),mail the completed application forms to
program,contact the state to determine the forms you should the EPA regional office that covers the state in which your
complete.States often develop their own application forms facility is located(see Exhibit 1-1).
rather than use the federal forms.See
http://www.epa.gov/npdes/npdes-state-program-information for When to File Your Completed Form
a list of states that have approved NPDES permit programs Because of statutory and regulatory requirements,the deadlines
and those that do not. for filing applications vary according to your facility or activity
Exhibit 1-1 (see end of this section)provides contact type and the type of permit you need.The various permit
information for each of EPA's 10 regional offices.Since the application deadlines are listed in Exhibit 1-2 at the end of this
exhibit's content is subject to change,consult EPA's website for section.
the latest information:http://www.epa.gov/aboutepa#regional.
Upon your request,and based on information supplied by you, Fees
EPA or the authorized NPDES state will determine whether you EPA does not require applicants to pay a fee for applying for
are required to obtain a permit for a particular facility or activity. NPDES permits.However,states that administer the NPDES
Be sure to contact EPA or your state if you have a question. permit program may charge fees.Consult with state officials for
Form 1 collects general information only.You must also further information.
complete a more detailed application based on your proposed Public Availability of Submitted Information
discharge activity,as follows:
If your facility is a concentrated animal feeding EPA will make information from NPDES permit application forms
• operation or a concentrated aquatic animal production available to the public for inspection and copying upon request.
facility,you must also complete Form 2B. You may not claim any information on Form 1 (or related
attachments)as confidential.
• If your facility is an existing manufacturing,commercial,
mining,or silvicultural facility that currently discharges You may make a claim of confidentiality for any information that
process wastewater,you must also complete Form 2C. you submit to EPA that goes beyond the information required by
Form 1. If you do not assert a claim of confidentiality at the time
• If your facility is a new manufacturing,commercial,mining, you submit your information to the NPDES permitting authority,
or silvicultural facility that has yet to commence discharge EPA may make the information available to the public without
of process wastewater,you must also complete Form 2D. further notice to you. EPA will handle claims of confidentiality in
• If your facility is a new or existing facility(including accordance with its business confidentiality regulations at Part 2
manufacturing,commercial,mining,and silvicultural of Title 4 of the Code of Federal Regulations(CFR).
facilities)that discharges only nonprocess wastewater, Completion of Forms
you must also complete Form 2E.
• If your facility is a new or existing facility whose Print or type in the specified areas only. If you do not have
discharge is composed entirely of stormwater associated enough space on the form to answer a question,you may
1-4

FORM 1—INSTRUCTIONS(CONTINUED)
continue on additional sheets,as necessary,using a format applicable"to show that you considered the item and
consistent with the form. determined a response was not necessary for your facility.
The NPDES permitting authority could consider your application The NPDES permitting authority will consider your application
incomplete if you do not provide an answer(or indicate"NA"for complete when it and any supplementary material are received
"not applicable")for all questions on Form 1 and the applicable and completed according to the authority's satisfaction.The
Form 2. NPDES permitting authority will judge the completeness of any
Do not leave any response areas blank unless the form directs application independently of the status of any other permit
you to skip them. If the form directs you to respond to an item application or permit for the same facility or activity.
that does not apply to your facility or activity,enter"NA"for"not
1-5

FORM 1—INSTRUCTIONS(CONTINUED)
Exhibit 1-1.Addresses of EPA Regional Contacts and Covered States
REGION 1 REGION 6
U.S.Environmental Protection Agency,Region 1 U.S.Environmental Protection Agency,Region 6
5 Post Office Square,Suite 100,Boston,MA 02109-3912 1445 Ross Avenue,Suite 1200,Dallas,TX 75202-2733
Phone:[phone];toll free:[phone] Phone:[phone];toll free:[phone]
Fax:[phone] Fax:[phone]
Website:http://www.epa.gov/aboutepalepa-region-1-new-england Website:http://www.epa.govlaboutepa/epa-reqion-6-south-central
Covered states:Connecticut,Maine,Massachusetts,New Hampshire,Rhode Covered states:Arkansas,Louisiana,New Mexico,Oklahoma,and Texas
Island,and Vermont
REGION 2 REGION 7
U.S.Environmental Protection Agency,Region 2 U.S.Environmental Protection Agency,Region 7
290 Broadway,New York,NY 10007-1866 11201 Renner Boulevard,Lenexa,KS 66219
Phone:[phone];toll free:[phone] Phone:[phone];toll free:[phone]
Fax:[phone] Website:http://www.epa.00v/aboutepa/epa-region-7-midwest
Website:http://www.epa.gov/aboutepa/epa-region-2 Covered states:Iowa,Kansas,Missouri,and Nebraska
Covered states:New Jersey,New York,Virgin Islands,and Puerto Rico
REGION 3 REGION 8
U.S.Environmental Protection Agency,Region 3 U.S.Environmental Protection Agency,Region 8
1650 Arch Street,Philadelphia,PA 19103-2029 1595 Wynkoop Street,Denver,CO 80202-1129
Phone:[phone];toll free:[phone] Phone:[phone];toll free:[phone]
Fax:[phone] Fax:[phone]
Website:http://www.epa.gov/aboutepa/epa-region-3-mid-atlantic Website:http://www.epa.00v/aboutepa/epa-region-8-mountains-and-plains
Covered states:Delaware,District of Columbia,Maryland,Pennsylvania,Virginia, Covered states:Colorado,Montana,North Dakota,South Dakota,Utah,and
and West Virginia Wyoming
REGION 4 REGION 9
U.S.Environmental Protection Agency,Region 4 U.S.Environmental Protection Agency,Region 9
Sam Nunn Atlanta Federal Center 75 Hawthorne Street,San Francisco,CA 94105
61 Forsyth Street,SW,Atlanta,GA 30303-8960 Phone:[phone];toll free:(866)EPA-WEST
Phone:[phone];toll free:[phone] Fax:[phone]
Fax:[phone] Website:http://www.epa.gov/aboutepa/epa-region-9-pacific-southwest
Website:http://www.epa.qov/aboutepa/about-epa-region-4-southeast Covered states:Arizona,California,Hawaii,Nevada,Guam,American Samoa,
Covered states:Alabama,Florida,Georgia,Kentucky,Mississippi,North Carolina, and Trust Territories
South Carolina,and Tennessee
REGION 5 REGION 10
U.S.Environmental Protection Agency,Region 5 U.S.Environmental Protection Agency,Region 10
77 West Jackson Boulevard,Chicago,IL 60604-3507 1200 Sixth Avenue,Suite 900,Seattle,WA 98101
Phone:[phone];toll free:[phone] Phone:[phone];toll free:[phone]
Fax:[phone] Fax:[phone]
Website:http://www.epa.gov/aboutepa/epa-region-5 Website:http://www,epa.gov/aboutepa/epa-reqion-10-pacific-northwest
Covered states:Illinois,Indiana,Michigan,Minnesota,Ohio,and Wisconsin Covered states:Alaska,Idaho,Oregon,and Washington
Exhibit 1-2.Filing Dates for NPDES Permit Applications
Permit Application When to File
180 days before your present NPDES permit expires or,if you are a
2A new discharger,180 days before the date on which the discharge is
to commence unless the NPDES permitting authority has granted
permission for a later date.
26 180 days before your present NPDES permit expires or 180 days
prior to startup if you are a new facility.
2C 180 days before your present NPDES permit expires.
2D 180 days prior to startup.
2E 180 days before your present NPDES permit expires,or 180 days
prior to startup if you are a new facility.
Construction:90 days prior to date construction is to commence.
2F Nonconstruction:180 days before your present NPDES permit
expires or 180 days prior to startup if you are a new facility.
2S 180 days before your present NPDES permit expires or 180 days
prior to startup if you are a new facility.
1-6

FORM 1—LINE-BY-LINE INSTRUCTIONS
EPA Identification Number,NPDES Permit Number,and Item 2.5.Give the address or location of the facility identified
Facility Name under Item 2.1. If the facility lacks a street name or route
Provide your EPA Identification Number from the Facility number,give the most accurate,alternative geographic
Registry Service, NPDES permit number,and facility name at information(e.g.,section number or quarter section number
the top of each page of Form 1 and any attachments. If your from county records or"at intersection of Routes 425 and 22").
facility is new(i.e.,not yet constructed),write or type"New Also provide the county name,county code(if known),city or
Facility"in the space provided for the EPA Identification Number town,state,and zip code.
and NPDES number. If you do not know your EPA Identification For concentrated aquatic animal production facilities,provide
Number,contact your NPDES permitting authority.See Exhibit the address or location of the production area(i.e.,the location
1-1 for contact information. where the animals are contained,grown,or held).
Section 1.Activities Requiring an NPDES Permit Section 3.SIC and NAICS Codes
Item 1.1.Review the questions in Item 1.1 to determine if you Items 3.1 and 3.2.List,in descending order of significance, up
are required to submit Form 1. Be sure to check"Form 1— to four 4-digit standard industrial classification(SIC)codes and
Glossary"below for the legal definitions of any key terms. North American Industrial Classification System(NAICS)codes
If the facility is a new or existing POTW or your permitting that best describe your facility in terms of the principal products
authority has directed you to submit Form 2A,then you do not or services it produces or provides. If the SIC or NAICS codes
need to complete Form 1,but you must submit Form 2A.If the do not adequately describe your facility's products or services,
facility is also a treatment works treating domestic sewage,you you have the option to provide additional descriptive information.
must also complete Form 2S. You can find SIC code numbers and descriptions in the
If the facility is a sludge-only facility that is not otherwise 1987 Standard Industrial Classification Manual, prepared by the
required to obtain an NPDES permit,then you do not need to Executive Office of the President,Office of Management and
complete Form 1,but you must submit Form 2S. Budget.This document is available from the Government
Printing Office,Washington,D.C.An online version of the
Item 1.2.Respond to the questions in Items 1.2.1 to 1.2.6. If you manual is also available courtesy of the Occupational Safety
answer"Yes"to any question in Items 1.2.1 to 1.2.5,you must and Health Administration at
complete Form 1 and the Form 2 application specified. If you http://www.osha.gov/plslimislsic manual.html.
also answer"Yes"to Item 1.2.6,you must also submit Form 2S.
See Exhibit 1-2 for filing deadlines. You can find NAICS code numbers and descriptions in the
North American Industrial Classification System Manual
If you answer"No"to every question in Items 1.1 and 1.2,then prepared by the Executive Office of the President,Office of
you do not need an NPDES permit,and you do not need to Management and Budget.This document is available from the
complete and return any of the NPDES application forms. National Technical Information Service(NTIS)in Alexandria,
Contact your NPDES permitting authority if you have questions Virginia. It is also available online at
about the need to submit an NPDES permit application or the http://www.census.qov/eoslwww/naics/.
applicable forms that you need to submit.
Use the latest edition of the manuals. If you have any questions
Section 2.Name,Mailing Address,and Location about the appropriate SIC or NAICS codes for your facility,
Item 2.1.Enter the facility's official or legal name. Do not use a contact your NPDES permitting authority.
colloquial name.
Section 4.Operator Information
Item 2.2.Provide your EPA Identification Number from the Item 4.1.Give the legal name of the person,firm,public
Facility Registry Service if you have an existing facility. If you do organization,or other entity that operates the facility described
not know your EPA Identification Number,contact your NPDES in this application.This may or may not be the same as the
permitting authority. If your facility is new(i.e., not yet facility's name.The operator of the facility is the legal entity that
constructed),write or type"New Facility." controls the facility's operation rather than the plant or site
Item 2.3.Give the name(first and last),title,work telephone manager.Do not use a colloquial name.
number,and email address of the person who is thoroughly Item 4.2.Indicate whether the entity listed in response to Item
familiar with the operation of the facility and with the facts 4.1 also owns the facility by marking the appropriate box.
reported in this application.The NPDES permitting authority will
contact the person listed if they have questions on the material Item 4.3.Indicate the ownership status of the operator of the
submitted. facility by marking the appropriate box.If the facility is a federal
facility(i.e.,owned by the U.S.government),check the box for
Item 2.4.Give the complete mailing address of the office to "Public—federal."If the facility is owned by a state government,
which the NPDES permitting authority should send check the box for"Public—state."If the facility is owned by a
correspondence.This often is not the address used to designate county government,municipal(e.g.,city or town)government,
the location of the facility or activity. tribal government,school district,water district,or other local
1-7

FORM 1—LINE-BY-LINE INSTRUCTIONS(CONTINUED)
government entity,check the box for"Other public"and specify • All hazardous waste management,storage,and disposal
the type of government entity. If the facility is owned by a facilities.
corporation or other private entity,check the box for"Private."If Each well where you inject fluids underground.
the facility has mixed ownership(e.g.,public/private)or is not •
owned by an entity of the types previously listed,check the box • All wells,springs,surface water bodies,and drinking water
for"Other"and specify the type of entity. wells that are in the public record or otherwise known to
you and that are located in the map area.
Items 4.4 to 4.6.Enter the telephone number,address,and
email address of the operator identified in Item 4.1. If the facility has associated water intakes,discharge structures,
hazardous waste disposal sites,or injection wells and these
Section 5.Indian Land items are located more than one mile from the facility,include
Item 5.1.Indicate whether the facility is located on Indian Land. them on the map if possible. If you cannot,attach additional
Section 6.Existing Environmental Permits sheets describing the location of the structures,disposal site(s),
or well(s)and identify the U.S.Geological Survey(USGS)or
Item 6.1.Check the appropriate boxes and provide the permit other map corresponding to the location(s).
numbers for all relevant federal,state,and local environmental
permits or construction approvals received or applied for under On each map,include the map scale,a meridian arrow showing
any of the programs listed below. If you have more than one north,and latitude and longitude to the nearest second or
currently effective permit under a particular permit program for equivalent decimal degrees(e.g.,38.893829,-77.029289).
your facility, list the additional permit numbers on the Latitude and longitude coordinates may be obtained in a variety
application form or on a separate sheet of paper. of ways,including use of hand held devices(e.g.,a GPS
enabled smartphone),internet mapping tools,geographic
• Hazardous waste management program under the information systems(e.g.,ArcView),or paper maps from trusted
Resource Conservation and Recovery Act(RCRA). sources(e.g., USGS).
• Underground Injection Control(UIC)program under the On all maps of rivers,show the direction of the current. In tidal
Safe Drinking Water Act(SDWA). waters,show the directions of ebb and flow tides.
• NPDES program under the Clean Water Act(CWA). You may develop your map by going to USGS's National Map
• Prevention of Significant Deterioration(PSD)program website at http://nationalmap.gov/.(For a map from this site,use
under the Clean Air Act(CM). the traditional 7.5-minute quadrangle format. If none is available,
• Nonattainment program under the CAA. use a USGS 15-minute series map.)You may also use a plat or
National Emission Standards for Hazardous Pollutants other appropriate map.Briefly describe land uses in the map
• (NESHAPs)preconstruction approval under the CAA. area
• Ocean dumping permits under the Marine Protection (e.g.,residential,commercial).An example of an acceptable
Research and Sanctuaries Act(MPRSA). location map is shown as Exhibit 1-3 at the end of these
Dredge or fill permits under Section 404 of the CWA. instructions.Note: Exhibit 1-3 is provided for illustration only;it
• does not show an actual facility.
• Other federal,state,or local environmental permits.
If the facility is a concentrated animal feeding operation,you are
Section 7.Map not required to provide the topographic map required by this
Unless the facility is a concentrated animal feeding operation, section of Form 1.Instead,you are required to provide a
provide a topographic map(s)of the area extending at least topographic map as specified in Section 4 of Form 2B.
one mile beyond the property boundaries of the facility that Item 7.1.Note that you have completed your topographic map
clearly shows the following: and attached it to the application.
• The legal boundaries of the facility. Section 8.Nature of Business
• The location and serial number of each of your existing and Briefly describe the nature of your business(e.g.,products
proposed intake and discharge structures. produced or services provided).See Examples 1 and 2.
Example 1
Facilities Subject to 40 CFR 426,Subparts F and G
Industry A is an auto tempered and auto laminated glass manufacturing facility subject to effluent limitation guidelines(ELGs)for the
"Automotive Glass Tempering"and"Automotive Glass Laminating"subcategories of the"Glass Manufacturing"point source category at
40 CFR 426,subparts F and G.At the facility,glass is cut and then passed through a series of processes that grind and polish the
edges,bend the glass,and then temper the glass to produce side and back windows for automobiles.Tempering involves heating the
glass near the melting point,then rapidly cooling it to increase its mechanical and thermal endurance.The facility also produces
automobile windshields and undertakes processes that laminate a plastic sheet between two layers of glass and that prepare the glass
for lamination(e.g.,cutting, bending,and washing).
1-8

FORM 1—LINE-BY-LINE INSTRUCTIONS(CONTINUED)
Example 2
Facility Not Subject to ELGs
Industry B undertakes batch-type resin manufacturing operations. It has aboveground storage tanks for raw materials and finished
goods,resin loading operations,and warehouses for 55-gallon drums of finished product. Industry B manufactures alkyd,saturated and
unsaturated polyester resins in batches using reactor vessels and mix tanks.Most of the feedstock liquids are pumped from storage
tanks to the kettles and mixers via a closed piping system.Additional feedstocks are added manually as solids from bags and sacks via
manways,which are located on top of the kettles.The resin is then chemically reacted in the kettles.After the reaction step finishes,the
resin is transferred from the kettles to the mix tanks,where solvents are added to thin it.The primary byproduct of the reaction is water
vapor containing condensed soluble organics.The byproduct flows to an isolation tank where the vapors are directed to an onsite
thermal oxidizer.The finished resin is then pumped through one of three types of filtration systems into finished goods storage tanks,
55-gallon drums,350-gallon intermediate bulk container totes,or directly into tanker trucks.A typical batch takes about 30 hours to
complete.
Section 9.Cooling Water Intake Structures any application, ...shall upon conviction,be punished by a fine
of no more than$10,000 or by imprisonment for not more than
Item 9.1.Indicate whether the facility uses cooling water. If six months,or both."
yes,continue to Item 9.2. If no,skip to Item 10.1.
Item 9.2.Identify the source of the cooling water.For example, FEDERAL REGULATIONS AT 40 CFR 122.22 REQUIRE THIS
APPLICATION TO BE SIGNED AS FOLLOWS:
indicate whether the cooling water is from a surface water,
groundwater well,public water system,or treated effluent that A. For a corporation,by a responsible corporate officer.For
would otherwise be discharged to a water of the U.S. the purpose of this section,a responsible corporate officer
If the facility uses a cooling water intake structure as described means:(1)a president,secretary,treasurer,or vice-
in 40 CFR 125,Subparts I and J,the facility may have additional president of the corporation in charge of a principal
application requirements under 40 CFR 122.21(r). Note that the business function,or any other person who performs
information required by 40 CFR 122.21(r)is not requested as similar policy-or decision-making functions for the
part of Form 1.Contact your NPDES permitting authority to corporation,or(2)the manager of one or more
determine the specifics of what you should provide and when. manufacturing,production,or operating facilities,provided
the manager is authorized to make management decisions
Section 10.Variance Requests which govern the operation of the regulated facility
An applicant(other than a POTW)may request a variance from including having the explicit or implicit duty of making major
otherwise applicable effluent limitations under certain capital investment recommendations,and initiating and
conditions described at 40 CFR 122.21(m). directing other comprehensive measures to assure long
term environmental compliance with environmental laws
Item 10.1.If known at the time of application,check all of the and regulations;the manager can ensure that the
authorized variances that you plan to request or renew.Note necessary systems are established or actions taken to
that you are not being asked to submit any other information at gather complete and accurate information for permit
this time.Contact your NPDES permitting authority to application requirements;and where authority to sign
determine the specifics of what you should provide and when. documents has been assigned or delegated to the
The ability to request a variance is not limited to the time of manager in accordance with corporate procedures.
application,and an applicant may request a variance B. For a partnership or sole proprietorship,by a general
consistent with statutory and regulatory requirements. partner or the proprietor,respectively.
Section 11.Checklist and Certification C. For a municipality,state,federal,or other public facility,by
Item 11.1.Review the checklist provided.In Column 1,mark either a principal executive officer or ranking elected
the sections of Form 1 that you have completed and are official.For purposes of this section,a principal executive
submitting with your application. In Column 2,indicate for each officer of a federal agency includes:(1)the chief executive
section whether you are submitting attachments. officer of the agency or(2)a senior executive officer having
Item 11.2.The Clean Water Act provides for severe penalties responsibility for the overall operations of a principal
for submitting false information on this application form.CWA Administrators
nistra unit of theP agency(e.g., Regional
Section 309(c)(2)provides that,"Any person who knowingly Administrators of EPA).
makes any false statement,representation,or certification in
1-9

FORM 1—LINE-BY-LINE INSTRUCTIONS(CONTINUED)
Exhibit 1-3.Example Topographic Map
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1-10

FORM 1—ACTIVITIES THAT DO NOT REQUIRE PERMITS
You are not required to obtain an NPDES permit if your discharge is in one of the following categories,as provided by the CWA and
NPDES regulations at 40 CFR 122 to 125.(However,under CWA Sections 510 and 312,some discharges exempted from the federal
NPDES requirements may still be regulated by a state permitting authority.)
• Any discharge of sewage from vessels and any effluent from properly functioning marine engines,laundry,shower,and galley sink
wastes,or any other discharge incidental to the normal operation of a vessel,including vessels of the Armed Forces within the
meaning of Section 312 of the CWA and recreational vessels within the meaning of Section 502(25)of the CWA.None of these
exclusions apply to rubbish,trash,garbage,or other such materials discharged overboard; nor to other discharges when the vessel is
operating in a capacity other than as a means of transportation such as when used as an energy or mining facility,a storage facility or
a seafood processing facility,or when secured to a storage facility or a seafood processing facility,or when secured to the bed of the
ocean,contiguous zone or waters of the United States for the purpose of mineral or oil exploration or development.
• Discharges of dredged or fill material into waters of the United States that are regulated under CWA Section 404.
• The introduction of sewage,industrial wastes,or other pollutants into publicly owned treatment works by indirect dischargers.Plans or
agreements to switch to this method of disposal in the future do not relieve dischargers of the obligation to have and comply with
permits until all discharges of pollutants to waters of the United States are eliminated.(See also 40 CFR 122.47(b).)This exclusion
does not apply to the introduction of pollutants to privately owned treatment works or to other discharges through pipes,sewers,or
other conveyances owned by a state,municipality,or other party not leading to treatment works.
• Any discharge in compliance with the instructions of an On-Scene Coordinator pursuant to 40 CFR 300(The National Oil and
Hazardous Substances Pollution Contingency Plan)or 33 CFR 153.10(e)(Pollution by Oil and Hazardous Substances).
• Any introduction of pollutants from nonpoint source agricultural and silvicultural activities, including stormwater runoff from orchards,
cultivated crops,pastures,range lands,and forest lands, but not discharges from concentrated animal feeding operations as defined
in 40 CFR 122.23,discharges from concentrated aquatic animal production facilities as defined in 40 CFR 122.23,discharges from
concentrated aquatic animal production facilities as defined in 40 CFR 122.24,discharges to aquaculture projects as defined in 40
CFR 122.25,and discharges from silvicultural point sources as defined in 40 CFR 122.27.Note: Per 40 CFR 122.26(b)(14)(ii),
facilities classified within SIC 24, Industry Group 241,that are rock crushing,gravel washing,log sorting,or log storage facilities
operated in connection with silvicultural activities defined in 40 CFR 122.27(b)(2)—(3)and Industry Groups 242 through 249;26
(except 265 and 267),28(except 283),29,311,32(except 323),33,3441,and 373(not included are all other types of silviculture
facilities)are considered stormwater discharges associated with industrial activity,and are required to obtain an NPDES permit.
• Return flows from irrigated agriculture.
• Discharges into a privately owned treatment works,except as the NPDES permitting authority may otherwise require under 40 CFR
122.44(m).
• Discharges from a water transfer."Water transfer'means an activity that conveys or connects waters of the United States without
subjecting the transferred water to intervening industrial, municipal,or commercial use.This exclusion does not apply to pollutants
introduced by the water transfer activity itself to the water being transferred.
1-11

FORM 1—GLOSSARY
Note:This glossary includes terms used in the various NPDES application forms,including Form 1.The definitions are from the NPDES
regulations at 40 CFR 122.2 unless otherwise specified. If you have any questions concerning the meaning of any of these terms,contact
your NPDES permitting authority.
ANIMAL FEEDING OPERATION(defined at§ 122.23)means a lot or facility(other than an aquatic animal production facility)where the
following conditions are met;
• Animals(other than aquatic animals)have been,are,or will be stabled or confined and fed or maintained for a total of 45 days or
more in any 12-month period;and
• Crops,vegetation,forage growth,or post-harvest residues are not sustained in the normal growing season over any portion of the lot
or facility.
APPLICATION means the EPA standard national forms for applying for a permit,including any additions,revisions,or modifications to the
forms;or forms approved by EPA for use in approved states, including any approved modifications or revisions.
APPROVED PROGRAM or APPROVED STATE means a State or interstate program which has been approved or authorized by EPA
under part 123.
AQUACULTURE PROJECT(defined at§ 122.25)means a defined managed water area which uses discharges of pollutants into that
designated area for the maintenance or production of harvestable freshwater,estuarine,or marine plants or animals.DESIGNATED
PROJECT AREA means the portions of the waters of the United States within which the permittee or permit applicant plans to confine the
cultivated species,using a method or plan or operation(including,but not limited to,physical confinement)which,on the basis of reliable
scientific evidence,is expected to ensure that specific individual organisms comprising an aquaculture crop will enjoy increased growth
attributable to the discharge of pollutants,and be harvested within a defined geographic area.
AVERAGE MONTHLY DISCHARGE LIMITATION means the highest allowable average of daily discharges over a calendar month,
calculated as the sum of all daily discharges measured during that month divided by the number of daily discharges measured during that
month.
AVERAGE WEEKLY DISCHARGE LIMITATION means the highest allowable average of daily discharges over a calendar week,
calculated as the sum of all daily discharges measured during a calendar week divided by the number of daily discharges measured during
that week.
BEST MANAGEMENT PRACTICES(BMPs)means schedules of activities,prohibitions of practices,maintenance procedures,and other
management practices to prevent or reduce the pollution of waters of the United States.BMPs include treatment requirements,operation
procedures,and practices to control plant site runoff,spillage or leaks,sludge or waste disposal,or drainage from raw material storage.
BIOSOLIDS(see sewage sludge).
BYPASS(defined at§122.41(m))means the intentional diversion of waste streams from any portion of a treatment facility.
COMBINED SEWER OVERFLOW(CSO)means a discharge from a combined sewer system(CSS)at a point prior to the Publicly Owned
Treatment Works(POTW)Treatment Plant(defined at§403.3(r)).
COMBINED SEWER SYSTEM(CSS)means a wastewater collection system owned by a State or municipality(as defined by Section
502(4)of the CWA)which conveys sanitary wastewaters(domestic,commercial and industrial wastewaters)and storm water through a
single-pipe system to a Publicly Owned Treatment Works(POTW)Treatment Plant(as defined at§403.3(r)).
CONCENTRATED ANIMAL FEEDING OPERATION(defined at§ 122.23)means an animal feeding operation that is defined as a Large
CAFO or as a Medium CAFO by the terms of(A)or(B)below,or that is designated as a CAFO in accordance with 40 CFR 122.23(c).Two
or more AFOs under common ownership are considered to be a single AFO for the purposes of determining the number of animals at an
operation, if they adjoin each other or if they use a common area or system for the disposal of wastes.
A. LARGE CONCENTRATED ANIMAL FEEDING OPERATION(LARGE CAFO)means an AFO that stables or confines as many as or
more than the numbers of animals specified in any of the following categories:
1. 700 mature dairy cows,whether milked or dry;
2. 1,000 veal calves;
3. 1,000 cattle other than mature dairy cows or veal calves.Cattle includes but is not limited to heifers,steers,bulls and cow/calf
pairs;
4. 2,500 swine each weighing 55 pounds or more;
5. 10,000 swine each weighing less than 55 pounds;
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FORM 1—GLOSSARY(CONTINUED)
6. 500 horses;
7. 10,000 sheep or lambs;
8. 55,000 turkeys;
9. 30,000 laying hens or broilers, if the AFO uses a liquid manure handling system;
10. 125,000 chickens(other than laying hens),if the AFO uses other than a liquid manure handling system;
11. 82,000 laying hens,if the AFO uses other than a liquid manure handling system;
12. 30,000 ducks(if the AFO uses other than a liquid manure handling system);or
13. 5,000 ducks(if the AFO uses a liquid manure handling system).
B. MEDIUM CONCENTRATED ANIMAL FEEDING OPERATION(MEDIUM CAFO)means any AFO with the type and number of
animals that fall within any of the ranges listed below and which has been defined or designated as a CAFO.An AFO is defined as a
Medium CAFO if:
1. The type and number of animals that it stables and confines falls within any of the following ranges:
a. 200 to 699 mature dairy cows,whether milked or dry;
b. 300 to 999 veal calves;
c. 300 to 999 cattle other than mature dairy cows or veal calves.Cattle includes but is not limited to heifers,steers,bulls and
cow/calf pairs;
d. 750 to 2,499 swine each weighing 55 pounds or more;
e. 3,000 to 9,999 swine each weighing less than 55 pounds;
f. 150 to 499 horses;
g. 3,000 to 9,999 sheep or lambs;
h. 16,500 to 54,999 turkeys;
i. 9,000 to 29,999 laying hens or broilers,if the AFO uses a liquid manure handling system;
j. 37,500 to 124,999 chickens(other than laying hens),if the AFO uses other than a liquid manure handling system;
k. 25,000 to 81,999 laying hens,if the AFO uses other than a liquid manure handling system;
I. 10,000 to 29,999 ducks(if the AFO uses other than a liquid manure handling system);or
m. 1,500 to 4,999 ducks(if the AFO uses a liquid manure handling system);and
2. Either one of the following conditions are met:
a. Pollutants are discharged into waters of the United States through a man-made ditch,flushing system,or other similar man-
made device;or
b. Pollutants are discharged directly into waters of the United States which originate outside of and pass over,across,or
through the facility or otherwise come into direct contact with animals confined in the operation.
CONCENTRATED AQUATIC ANIMAL PRODUCTION FACILITY(defined at§122.24)means a hatchery,fish farm,or other facility which
contains,grows,or holds aquatic animals in either of the following categories,or which the Director designates as such on a case-by-case
basis:
A. Cold water fish species or other cold water aquatic animals including,but not limited to,the Salmonidae family of fish(e.g.,trout and
salmon)in ponds, raceways,or other similar structures which discharge at least 30 days per year but does not include:
1. Facilities which produce less than 9,090 harvest weight kilograms(approximately 20,000 pounds)of aquatic animals per year;
and
2. Facilities which feed less than 2,272 kilograms(approximately 5,000 pounds)of food during the calendar month of maximum
feeding.
B. Warm water fish species or other warm water aquatic animals including,but not limited to,the Ameiuridae, Cetrarchiclae,and
Cyprinidae families of fish(e.g.,respectively,catfish,sunfish,and minnows)in ponds,raceways,or other similar structures which
discharge at least 30 days per year,but does not include;
1. Closed ponds which discharge only during periods of excess runoff;or
2. Facilities which produce less than 45,454 harvest weight kilograms(approximately 100,000 pounds)of aquatic animals per year.
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FORM 1—GLOSSARY(CONTINUED)
CWA means the Clean Water Act(formerly referred to as the Federal Water Pollution Control Act or Federal Water Pollution Control Act
Amendments of 1972)Public Law 92-500,as amended by Public Law 95-217, Public Law 95-576, Public Law 96-483 and Public Law
97-117,33 U.S.C. 1251 et seq.
CWA AND REGULATIONS means the Clean Water Act(CWA)and applicable regulations promulgated thereunder. In the case of an
approved State program, it includes State program requirements.
DAILY DISCHARGE means the"discharge of a pollutant"measured during a calendar day or any 24-hour period that reasonably
represents the calendar day for purposes of sampling.For pollutants with limitations expressed in units of mass,the'daily discharge"is
calculated as the total mass of the pollutant discharged over the day. For pollutants with limitations expressed in other units of
measurement,the"daily discharge"is calculated as the average measurement of the pollutant over the day.
DIRECT DISCHARGE means the"discharge of a pollutant."
DIRECTOR means the Regional Administrator or the State Director,as the context requires,or an authorized representative.When there
is no"approved State program,"and there is an EPA administered program,"Director"means the Regional Administrator.When there is
an approved State program,"Director"normally means the State Director. In some circumstances,however, EPA retains the authority to
take certain actions even when there is an approved State program.(For example,when EPA has issued an NPDES permit prior to the
approval of a State program, EPA may retain jurisdiction over that permit after program approval,see§123.1.)In such cases,the term
"Director"means the Regional Administrator and not the State Director.
DISCHARGE(OF A POLLUTANT)means:
• Any addition of any pollutant or combination of pollutants to waters of the United States from any point source;or
• Any addition of any pollutant or combination of pollutants to the waters of the contiguous zone or the ocean from any point source
other than a vessel or other floating craft which is being used as a means of transportation.
This definition includes discharges into waters of the United States from:surface runoff which is collected or channelled by man;
discharges through pipes,sewers,or other conveyances owned by a State, municipality,or other person which do not lead to a treatment
works;and discharges through pipes,sewers,or other conveyances,leading into privately owned treatment works.This term does not
include an addition of pollutants by any"indirect discharger."
DISCHARGE MONITORING REPORT means the EPA uniform national form, including any subsequent additions,revisions,or
modifications for the reporting of self-monitoring results by permittees.DMRs must be used by"approved States"as well as by EPA.EPA
will supply DMRs to any approved State upon request.The EPA national forms may be modified to substitute the state agency name,
address,logo,and other similar information,as appropriate,in place of EPA's.
DRAFT PERMIT means a document prepared under§124.6 indicating the Director's tentative decision to issue or deny,modify,revoke
and reissue,terminate,or reissue a"permit."A notice of intent to terminate a permit,and a notice of intent to deny a permit,as discussed
in§ 124.5,are types of"draft permits."A denial of a request for modification,revocation and reissuance,or termination,as discussed in§
124.5, is not a"draft permit."A"proposed permit"is not a"draft permit."
EFFLUENT LIMITATION means any restriction imposed by the Director on quantities,discharge rates,and concentrations of"pollutants"
which are"discharged"from"point sources"into"waters of the United States,"the waters of the"contiguous zone,"or the ocean.
EFFLUENT LIMITATIONS GUIDELINES means a regulation published by the Administrator under Section 304(b)of the CWA to adopt or
revise"effluent limitations."
ENVIRONMENTAL PROTECTION AGENCY(EPA)means the United States Environmental Protection Agency.
FACILITY or ACTIVITY means any NPDES"point source"or any other facility or activity(including land or appurtenances thereto)that is
subject to regulation under the NPDES program.
GENERAL PERMIT means an NPDES"permit"issued under§122.28 authorizing a category of discharges under the CWA within a
geographical area.
HAZARDOUS SUBSTANCE means any substance designated under 40 CFR part 116 pursuant to Section 311 of the CWA.
INDIAN COUNTRY(or INDAN LANDS)means:
• All land within the limits of any Indian reservation under the jurisdiction of the United States Government,notwithstanding the
issuance of any patent,and,including rights-of-way running through the reservation;
• All dependent Indian communities with the borders of the United States whether within the originally or subsequently acquired territory
thereof,and whether within or without the limits of a state;and
• All Indian allotments,the Indian titles to which have not been extinguished, including rights-of-way running through the same.
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FORM 1—GLOSSARY(CONTINUED)
INDIAN TRIBE means any Indian Tribe,band,group,or community recognized by the Secretary of the Interior and exercising
governmental authority over a Federal Indian reservation.
INDIRECT DISCHARGE means a nondomestic discharger introducing"pollutants"to a"publicly owned treatment works."
LARGE MUNICIPAL SEPARATE STORM SEWER SYSTEM(defined at§ 122.26(b)(4))means all municipal separate storm sewers that
are either:
(i)Located in an incorporated place with a population of 250,000 or more as determined by the 1990 Decennial Census by the Bureau of
the Census(Appendix F of 40 CFR 122);or
(ii)Located in the counties listed in appendix H of 40 CFR 122,except municipal separate storm sewers that are located in the
incorporated places,townships or towns within such counties;or
(iii)Owned or operated by a municipality other than those described in paragraphs(i)or(ii)and that are designated by the Director as part
of the large or medium municipal separate storm sewer system due to the interrelationship between the discharges of the designated
storm sewer and the discharges from municipal separate storm sewers described under paragraphs(i)or(ii).In making this determination
the Director may consider the following factors:
(A)Physical interconnections between the municipal separate storm sewers;
(B)The location of discharges from the designated municipal separate storm sewer relative to discharges from municipal separate storm
sewers described in paragraph(i);
(C)The quantity and nature of pollutants discharged to waters of the United States;
(D)The nature of the receiving waters;and
(E)Other relevant factors;or
(iv)The Director may,upon petition,designate as a large municipal separate storm sewer system,municipal separate storm sewers
located within the boundaries of a region defined by a storm water management regional authority based on a jurisdictional,watershed,or
other appropriate basis that includes one or more of the systems described in paragraphs(i),(ii),(iii).
LOG SORTING AND LOG STORAGE FACILITIES(defined at§ 122.27)means facilities whose discharges result from the holding of
unprocessed wood,for example,logs or roundwood with bark or after removal of bark held in self-contained bodies of water(mill ponds or
log ponds)or stored on land where water is applied intentionally on the logs(wet decking).(See 40 CFR 429,subpart I,including the
effluent limitations guidelines.)
MAJOR FACILITY means any NPDES"facility or activity"classified as such by the Regional Administrator,or,in the case of"approved
State programs,"the Regional Administrator in conjunction with the State Director.
MAXIMUM DAILY DISCHARGE LIMITATION means the highest allowable"daily discharge."
MEDIUM MUNICIPAL SEPARATE STORM SEWER SYSTEM(defined at§ 122.26(b)(7))means all municipal separate storm sewers that
are either:
(i)Located in an incorporated place with a population of 100,000 or more but less than 250,000,as determined by the 1990 Decennial
Census by the Bureau of the Census(appendix G of 40 CFR 122);or
(ii)Located in the counties listed in appendix I of 40 CFR 122,except municipal separate storm sewers that are located in the incorporated
places,townships or towns within such counties;or
(iii)Owned or operated by a municipality other than those described in paragraph(i)or(ii)and that are designated by the Director as part
of the large or medium municipal separate storm sewer system due to the interrelationship between the discharges of the designated
storm sewer and the discharges from municipal separate storm sewers described under paragraph(i)or(ii). In making this determination
the Director may consider the following factors:
(A)Physical interconnections between the municipal separate storm sewers;
(B)The location of discharges from the designated municipal separate storm sewer relative to discharges from municipal separate storm
sewers described in paragraph(i);
(C)The quantity and nature of pollutants discharged to waters of the United States;
(D)The nature of the receiving waters;or
(E)Other relevant factors;or
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FORM 1—GLOSSARY(CONTINUED)
(iv)The Director may, upon petition,designate as a medium municipal separate storm sewer system,municipal separate storm sewers
located within the boundaries of a region defined by a storm water management regional authority based on a jurisdictional,watershed,or
other appropriate basis that includes one or more of the systems described in paragraphs(i),(ii),(iii)of this section.
MUNICIPALITY means a city,town,borough,county, parish,district,association,or other public body created by or under State law and
having jurisdiction over disposal of sewage,industrial wastes,or other wastes,or an Indian tribe or an authorized Indian tribal organization,
or a designated and approved management agency under Section 208 of the CWA.
MUNICIPAL SEPARATE STORM SEWER(defined at§122.26(b)(8))means a conveyance or system of conveyances(including roads
with drainage systems,municipal streets,catch basins,curbs,gutters,ditches,man-made channels,or storm drains):
• Owned or operated by a State,city,town,borough,county, parish,district,association,or other public body(created by or pursuant to
State law)having jurisdiction over disposal of sewage,industrial wastes,stormwater,or other wastes,including special districts under
State law such as a sewer district,flood control district or drainage district,or similar entity,or an Indian tribe or an authorized Indian
tribal organization,or a designated and approved management agency under Section 208 of the CWA that discharges to waters of
the United States.
• Designed or used for collecting or conveying stormwater.
• Which is not a combined sewer;and
• Which is not part of a POTW as defined at 40 CFR 122.2.
MUNICIPAL SLUDGE e(see sewage sludge)
9 9 )
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM(NPDES)means the national program for issuing,modifying,revoking
and reissuing,terminating,monitoring and enforcing permits,and imposing and enforcing pretreatment requirements,under Sections 307,
402,318,and 405 of the CWA.The term includes an"approved program."
NEW DISCHARGER means any building,structure,facility,or installation:
• From which there is or may be a"discharge of pollutants;"
• That did not commence the"discharge of pollutants"at a particular"site"prior to August 13, 1979;
• Which is not a"new source;"and
• Which has never received a finally effective NPDES permit for discharges at that"site."
This definition includes an"indirect discharger"which commences discharging into"waters of the United States"after August 13, 1979. It
also means any existing mobile point source(other than an offshore or coastal oil and gas exploratory drilling rig or a coastal oil and gas
developmental drilling rig)such as a seafood processing rig,seafood processing vessel,or aggregate plant,that begins discharging at a
"site"for which it does not have a permit;and any offshore or coastal mobile oil and gas exploratory drilling rig or coastal mobile oil and gas
developmental drilling rig that commences the discharge of pollutants after August 13, 1979,at a"site"under EPA's permitting jurisdiction
for which it is not covered by an individual or general permit and which is located in an area determined by the Regional Administrator in
the issuance of a final permit to be an area of biological concern. In determining whether an area is an area of biological concern,the
Regional Administrator shall consider the factors specified in 40 CFR 125.122(a)(1)through(10).
An offshore or coastal mobile exploratory drilling rig or coastal mobile developmental drilling rig will be considered a"new discharger"only
for the duration of its discharge in an area of biological concern.
NEW SOURCE means any building,structure,facility,or installation from which there is or may be a"discharge of pollutants,"the
construction of which commenced:
• After promulgation of standards of performance under Section 306 of the CWA which are applicable to such source,or
• After proposal of standards of performance in accordance with Section 306 of the CWA which are applicable to such source,but only
if the standards are promulgated in accordance with Section 306 within 120 days of their proposal.
OWNER OR OPERATOR means the owner or operator of any"facility or activity"subject to regulation under the NPDES program.
PERMIT means an authorization,license,or equivalent control document issued by EPA or an"approved State"to implement the
requirements of this part and parts 123 and 124."Permit"includes an NPDES"general permit"(§ 122.28). Permit does not include any
permit which has not yet been the subject of final agency action,such as a"draft permit"or a"proposed permit."
PESTICIDE DISCHARGES TO WATERS OF THE UNITED STATES FROM PESTICIDE APPLICATION means the application of
biological pesticides,and the application of chemical pesticides that leave a residue,from point sources to waters of the United States. In
the context of this definition of pesticide discharges to waters of the United States from pesticide application,this does not include
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FORM 1—GLOSSARY(CONTINUED)
agricultural storm water discharges and return flows from irrigated agriculture,which are excluded by law(33 U.S.C. 1342(1);33 U.S.C.
1362(14)).
PESTICIDE RESIDUE for the purpose of determining whether an NPDES permit is needed for discharges to waters of the United States
from pesticide application,means that portion of a pesticide application that is discharged from a point source to waters of the United
States and no longer provides pesticidal benefits. It also includes any degradates of the pesticide.
POINT SOURCE means any discernible,confined,and discrete conveyance,including but not limited to,any pipe,ditch,channel,tunnel,
conduit,well,discrete fissure,container,rolling stock,concentrated animal feeding operation, landfill leachate collection system,vessel or
other floating craft from which pollutants are or may be discharged.This term does not include return flows from irrigated agriculture or
agricultural stormwater runoff.(See§122.3).
POLLUTANT means dredged spoil,solid waste,incinerator residue,filter backwash,sewage,garbage,sewage sludge,munitions,
chemical wastes,biological materials,radioactive materials(except those regulated under the Atomic Energy Act of 1954,as amended(42
U.S.C.2011 et seq.)),heat,wrecked or discarded equipment, rock,sand,cellar dirt and industrial,municipal,and agricultural waste
discharged into water.It does not mean:
• Sewage from vessels;or
• Water,gas,or other material which is injected into a well to facilitate production of oil or gas,or water derived in association with oil
and gas production and disposed of in a well,if the well used either to facilitate production or for disposal purposes is approved by
authority of the State in which the well is located,and if the State determines that the injection or disposal will not result in the
degradation of ground or surface water resources.Note: Radioactive materials covered by the Atomic Energy Act are those
encompassed in its definition of source,byproduct,or special nuclear materials.Examples of materials not covered include radium
and accelerator-produced isotopes.See Train v. Colorado Public Interest Research Group, Inc.,426 U.S. 1 (1976).
PRIMARY INDUSTRY CATEGORY means any industry category listed in the NRDC settlement agreement(Natural Resources Defense
Council et al.v. Train,8 E.R.C.2120(D.D.C. 1976),modified 12 E.R.C. 1833(D.D.C. 1979));also listed in appendix A of part 122.
PRIVATELY OWNED TREATMENT WORKS means any device or system which is(1)used to treat wastes from any facility whose
operator is not the operator of the treatment works and(2)not a"POTW."
P P
PROCESS WASTEWATER means any water which,during manufacturing or processing, comes into direct contact with or results from the
production or use of any raw material,intermediate product,finished product, byproduct,or waste product.
PROPOSED PERMIT means a state NPDES"permit"prepared after the close of the public comment period(and,when applicable,any
public hearing and administrative appeals)which is sent to EPA for review before final issuance by the State.A"proposed permit"is not a
"draft permit."
PUBLICLY OWNED TREATMENT WORKS or POTW(defined at§403.3)means a treatment works as defined by CWA Section 212,
which is owned by a state or municipality(as defined by CWA Section 502(4)).This definition includes any devices or systems used in the
storage,treatment,recycling,and reclamation)of municipal sewage or industrial wastes of a liquid nature.This definition also includes
sewers,pipes,and other conveyances only if they convey wastewater to a POTW.The term also means the municipality as defined in
CWA Section 502(4),which has jurisdiction over the indirect discharges to and the discharges from such a treatment works.
REGIONAL ADMINISTRATOR means the Regional Administrator of the appropriate Regional Office of the Environmental Protection
Agency or the authorized representative of the Regional Administrator.
ROCK CRUSHING AND GRAVEL WASHING FACILITIES(defined at§122.27)means facilities which process crushed and broken
stone,gravel,and riprap(See 40 CFR 436,subpart B,including the effluent limitations guidelines).
SCHEDULE OF COMPLIANCE means a schedule of remedial measures included in a"permit",including an enforceable sequence of
interim requirements(for example,actions,operations,or milestone events)leading to compliance with the CWA and regulations.
SECONDARY INDUSTRY CATEGORY means any industry category which is not a primary industry category.
SEWAGE FROM VESSELS means human body wastes and the wastes from toilets and other receptacles intended to receive or retain
body wastes that are discharged from vessels and regulated under Section 312 of the CWA,except that with respect to commercial
vessels on the Great Lakes this term includes graywater.For the purposes of this definition,"graywater"means galley,bath,and shower
water.
SEWAGE SLUDGE means any solid,semi-solid,or liquid residue removed during the treatment of municipal waste water or domestic
sewage.Sewage sludge includes,but is not limited to,solids removed during primary,secondary,or advanced waste water treatment,
scum,septage,portable toilet pumpings,type III marine sanitation device pumpings(33 CFR 159),and sewage sludge products.Sewage
sludge does not include grit or screenings,or ash generated during the incineration of sewage sludge.
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FORM 1—GLOSSARY(CONTINUED)
SILVICULTURAL POINT SOURCE(defined at§122.27)means any discernible,confined,and discrete conveyance related to rock
crushing,gravel washing,log sorting,or log storage facilities which are operated in connection with silvicultural activities and from which
pollutants are discharged into waters of the United States.This term does not include non-point source silvicultural activities such as
nursery operations,site preparation,reforestation and subsequent cultural treatment,thinning,prescribed burning,pest and fire control,
harvesting operations,surface drainage,or road construction and maintenance from which there is natural runoff.However,some of these
activities(such as stream crossing for roads)may involve point source discharges of dredged or fill material which may require a CWA
Section 404 permit(see 33 CFR 209.120 and part 233).
SITE means the land or water area where any"facility or activity"is physically located or conducted,including adjacent land used in
connection with the facility or activity.
SLUDGE-ONLY FACILITY means any"treatment works treating domestic sewage"whose methods of sewage sludge use or disposal are
subject to regulations promulgated pursuant to Section 405(d)of the CWA and is required to obtain a permit under§122.1(b)(2).
STANDARDS FOR SEWAGE SLUDGE USE OR DISPOSAL means the regulations promulgated pursuant to Section 405(d)of the CWA
which govern minimum requirements for sludge quality,management practices,and monitoring and reporting applicable to sewage sludge
or the use or disposal of sewage sludge by any person.
STATE means any of the 50 States,the District of Columbia,Guam,the Commonwealth of Puerto Rico,the Virgin Islands,American
Samoa,the Commonwealth of the Northern Mariana Islands,the Trust Territory of the Pacific Islands,or an Indian Tribe as defined in
these regulations which meets the requirements of§ 123.31 of this chapter.
STATE DIRECTOR means the chief administrative officer of any State or interstate agency operating an"approved program,"or the
delegated representative of the State Director. If responsibility is divided among two or more State or interstate agencies,"State Director
means the chief administrative officer of the State or interstate agency authorized to perform the particular procedure or function to which
reference is made.
STORMWATER(or STORM WATER)(defined at§122.26(b)(13))means stormwater runoff,snow melt runoff,and surface runoff and
drainage.
STORMWATER DISCHARGE ASSOCIATED WITH INDUSTRIAL ACTIVITY(defined at§ 122.26(b)(14))means the discharge from any
conveyance that is used for collecting and conveying stormwater and that is directly related to manufacturing,processing or raw materials
storage areas at an industrial plant.The term does not include discharges from facilities or activities excluded from the NPDES program
under this part 122.For the categories of industries identified in this section,the term includes,but is not limited to,stormwater discharges
from industrial plant yards; immediate access roads and rail lines used or traveled by carriers of raw materials,manufactured products,
waste material,or by-products used or created by the facility;material handling sites;refuse sites;sites used for the application or disposal
of process waste waters(as defined at 40 CFR 401);sites used for the storage and maintenance of material handling equipment;sites
used for residual treatment,storage,or disposal;shipping and receiving areas; manufacturing buildings;storage areas(including tank
farms)for raw materials,and intermediate and final products;and areas where industrial activity has taken place in the past and significant
materials remain and are exposed to stormwater.For the purposes of this paragraph,material handling activities include storage, loading
and unloading,transportation,or conveyance of any raw material,intermediate product,final product,by-product or waste product.The
term excludes areas located on plant lands separate from the plant's industrial activities,such as office buildings and accompanying
parking lots as long as the drainage from the excluded areas is not mixed with stormwater drained from the above described areas.
Industrial facilities(including industrial facilities that are federally,State,or municipally owned or operated that meet the description of the
facilities listed in paragraphs 1 through 14 below)include those facilities designated under the provisions of 40 CFR 122.26(a)(1)(v).The
following categories of facilities are considered to be engaging in"industrial activity"for purposes of 40 CFR 122.26(b)(14):
1. Facilities subject to stormwater effluent limitations guidelines,new source performance standards,or toxic pollutant effluent standards
under 40 CFR Subchapter N(except facilities with toxic pollutant effluent standards which are exempted under paragraph 11 below);
2. Facilities classified as Standard Industrial Classification 24, Industry Group 241 that are rock crushing,gravel washing, log sorting,or
log storage facilities operated in connection with silvicultural activities defined in 40 CFR 122.27(b)(2)—(3)and Industry Groups 242
through 249;26(except 265 and 267),28(except 283),29,311,32(except 323),33,3441,373;(not included are all other types of
silvicultural facilities);
3. Facilities classified as Standard Industrial Classifications 10 through 14(mineral industry)including active or inactive mining
operations(except for areas of coal mining operations no longer meeting the definition of a reclamation area under 40 CFR 434.11(1)
because the performance bond issued to the facility by the appropriate SMCRA authority has been released,or except for areas of
non—coal mining operations which have been released from applicable State or Federal reclamation requirements after December 17,
1990)and oil and gas exploration,production,processing,or treatment operations,or transmission facilities that discharge stormwater
contaminated by contact with or that has come into contact with,any overburden,raw material, intermediate products,finished
products,byproducts or waste products located on the site of such operations;(inactive mining operations are mining sites that are
not being actively mined,but which have an identifiable owner/operator;inactive mining sites do not include sites where mining claims
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FORM 1-GLOSSARY(CONTINUED)
are being maintained prior to disturbances associated with the extraction,beneficiation,or processing of mined materials,nor sites
where minimal activities are undertaken for the sole purpose of maintaining a mining claim);
4. Hazardous waste treatment,storage,or disposal facilities,including those that are operating under interim status or a permit under
subtitle C of RCRA;
5. Landfills,land application sites,and open dumps that receive or have received any industrial wastes(waste that is received from any
of the facilities described under this subsection)including those that are subject to regulation under subtitle D of RCRA;
6. Facilities involved in the recycling of materials,including metal scrapyards, battery reclaimers,salvage yards,and automobile
junkyards,including but limited to those classified as Standard Industrial Classification 5015 and 5093;
7. Steam electric power generating facilities,including coal handling sites;
8. Transportation facilities classified as Standard Industrial Classifications 40,41,42(except 4221-25),43,44,45,and 5171 which have
vehicle maintenance shops,equipment cleaning operations,or airport deicing operations.Only those portions of the facility that are
either involved in vehicle maintenance(including vehicle rehabilitation,mechanical repairs,painting,fueling,and lubrication),
equipment cleaning operations,airport deicing operations,or which are otherwise identified under paragraphs 1-7 or 9-11 are
associated with industrial activity;
9. Treatment works treating domestic sewage or any other sewage sludge or wastewater treatment device or system,used in the
storage treatment, recycling,and reclamation of municipal or domestic sewage,including land dedicated to the disposal of sewage
sludge that are located within the confines of the facility,with a design flow of 1.0 mgd or more,or required to have an approved
pretreatment program under 40 CFR 403.Not included are farm lands,domestic gardens or lands used for sludge management
where sludge is beneficially reused and which are not physically located in the confines of the facility,or areas that are in compliance
with Section 405 of the CWA;
10. Construction activity including clearing,grading and excavation,except operations that result in the disturbance of less than five acres
of total land area.Construction activity also includes the disturbance of less than five acres of total land area that is a part of a larger
common plan of development or sale if the larger common plan will ultimately disturb five acres or more;
11. Facilities under Standard Industrial Classifications 20,21,22,23,2434,25,265,267,27,283,285,30,31 (except 311),323,34
(except 3441),35,36,37(except 373),38,39,and 4221-25.
TOXIC POLLUTANT means any pollutant listed as toxic under Section 307(a)(1)or,in the case of"sludge use or disposal practices,"any
pollutant identified in regulations implementing Section 405(d)of the CWA.
TREATMENT WORKS TREATING DOMESTIC SEWAGE(TWTDS)means a POTW or any other sewage sludge or waste water
treatment devices or systems,regardless of ownership(including federal facilities),used in the storage,treatment,recycling,and
reclamation of municipal or domestic sewage,including land dedicated for the disposal of sewage sludge.This definition does not include
septic tanks or similar devices.For purposes of this definition,"domestic sewage"includes waste and waste water from humans or
household operations that are discharged to or otherwise enter a treatment works. In States where there is no approved State sludge
management program under Section 405(f)of the CWA,the Regional Administrator may designate any person subject to the standards for
sewage sludge use and disposal in 40 CFR 503 as a"treatment works treating domestic sewage,"where he or she finds that there is a
potential for adverse effects on public health and the environment from poor sludge quality or poor sludge handling,use or disposal
practices,or where he or she finds that such designation is necessary to ensure that such person is in compliance with 40 CFR 503.
UPSET(defined at§ 122.41(n))means an exceptional incident in which there is unintentional and temporary noncompliance with
technology based permit effluent limitations because of factors beyond the reasonable control of the permittee.An upset does not include
noncompliance to the extent caused by operational error,improperly designed treatment facilities,inadequate treatment facilities, lack of
preventive maintenance,or careless or improper operation.
VARIANCE means any mechanism or provision under Section 301 or 316 of the CWA or under 40 CFR 125,or in the applicable"effluent
limitations guidelines"which allows modification to or waiver of the generally applicable effluent limitation requirements or time deadlines of
hestablishment of alternative limitations based on fundamentallydifferent factors or on
the CWA.This includes provisions which allow the
Sections 301(c),301(g),301(h),301(i),or 316(a)of the CWA.
WATERS OF THE UNITED STATES as defined at§122.2.
WHOLE EFFLUENT TOXICITY(WET)means the aggregate toxic effect of an effluent measured directly by a toxicity test.
1-19

EPA Identification Number NPDES Permit Number Facility Name OMB No.2040-0004
Expires 07/31/2026
Form U.S.Environmental Protection Agency
1 EPA Application for NPDES Permit to Discharge Wastewater
NPDES
GENERAL INFORMATION
SECTION 1.ACTIVITIES REQUIRING AN NPDES PERMIT(40 CFR 122.21(F)AND(F)(1))
1_1 Applicants Not Required to Submit Form 1
1.1.1 Is the facility a new or existing publicly owned 1.1.2 Is the facility a sludge-only facility(i.e.,a facility
treatment works or has your permitting authority that does not discharge wastewater to surface
directed you to submit Form 2A? waters)?
If yes,STOP.Do NOT complete ❑ No If yes,STOP.Do NOT complete 0 No
Form 1.Complete Form 2A. If the Form 1.Complete Form 2S.
facility is also a treatment works
treating domestic sewage,you
must also complete Form 2S.
1.2 Applicants Required to Submit Form 1
a 1.2.1 Is the facility a concentrated animal feeding 1.2.2 I Is the facility an existing manufacturing,
operation or a concentrated aquatic animal commercial, mining,or silvicultural facility that is
production facility? currently discharging process wastewater?
zD Yes 4 Complete Form 1 and ❑ No 0 Yes 4 Complete Form ❑ No
co
Form 2B. 1 and Form 2C.
L 1.2.3 Is the facility a new manufacturing,commercial, 1.2.4 Is the facility a new or existing manufacturing,
mining,or silvicultural facility that has not yet commercial,mining,or silvicultural facility that
CT
commenced to discharge? discharges only nonprocess wastewater?
cc
Yes 4 Complete Form 1 and ❑ No 0 Yes 4 Complete Form 1 0 No
Form 2D. and Form 2E.
a1.2.5 Is the facility a new or existing facility whose 1.2.6 Is the facility a new or existing treatment works
discharge is composed entirely of stormwater treating domestic sewage that discharges
associated with industrial activity or whose wastewater to surface waters?
discharge is composed of both stormwater and non-
stormwater?
Yes 4 Complete Form 1 and ❑ No 0 Yes 4 Complete Form 1, ❑ No
Form 2F unless Form 2S,and
exempted by 40 CFR any other
122.26(b)(14)(x)or applicable forms,
(b)(15). as directed by
your permitting
authori .
SECTION 2.NAME,MAILING ADDRESS,AND LOCATION(40 CFR 122-21(F)(2))
2_1 Facility Name
0
is
U _
2_2 EPA Identification Number
(n
2_3 Facility Contact
Name(first and last) Title Phone number
0)
Email address
co
EPA Form 3510-1 Page 1

EPA Identification Number NPDES Permit Number Facility Name OMB No.2040-0004
Expires 07/31/2026
2.4 Facility Mailing Address
Street or P.O.box
City or town State ZIP code
-d 2_5 Facility Location
.
=
Street,route number,or other specific identifier
< o
�U
•� o County name County code(if known)
3
R -0 City or town State ZIP code
z �
ECTION 3.SIC AND NAICS CODES(40 CFR 122.21(F)(3))
3_1 SIC Code(s) Description(optional)
ti
d
0
0
U
CI)
32 NAICS Code(s) Description(optional)
U
N
.ECTION 4.OPERATOR INFORMATION (40 CFR 122.21(F)(4))
4_1 Name of Operator
s 4.2 Is the name you listed in Item 4.1 also the owner?
❑ Yes ❑ No
4_3 Operator Status
❑ Public—federal 0 Public—state 0 Other public(specify)
o ❑ Private ❑ Other(specify)
4_4 Phone Number of Operator
EPA Form 3510-1 Page 2

EPA Identification Number NPDES Permit Number Facility Name OMB No.2040-0004
Expires 07/31/2026
•
4_5 Operator Address
s Street or P.O.Box
E 1,7
o
City or town State ZIP code
L
0 0
is U
oEmail address of operator
SECTION 5.INDIAN LAND(40 CFR 122.21(F)(5))
R —1 Is the facility located on Indian Land?
C El Yes ❑ No
.ECTION 6.EXISTING ENVIRONMENTAL PERMITS(40 CFR 122.21(F)(6))
6.1 Existing Environmental Permits(check all that apply and print or type the corresponding permit number for each)
d ❑ NPDES(discharges to ❑ RCRA(hazardous wastes) ❑ UIC(underground injection of
osurface water) fluids)
L .`4
>
w a ❑ PSD(air emissions) ❑ Nonattainment program(CM) ❑ NESHAPs(CM)
•
0 Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section 404) 0 Other(specify)
•ECTION 7.MAP(40 CFR 122.21(F)(7))
7_1 Have you attached a topographic map containing all required information to this application?(See instructions for
specific requirements.)
❑ Yes ❑ CAFO—Not Applicable(See requirements in Form 2B.)
,ECTION 8.NATURE OF BUSINESS(40 CFR 122.21(F)(8))
8_1 Describe the nature of your business.
N
d
fq
"5
d
Z
.ECTION 9.COOLING WATER INTAKE STRUCTURES(40 CFR 122.21(F)(9))
9_1 Does your facility use cooling water?
a.. d ❑ Yes 0 No 4 SKIP to Item 10.1.
L
9_2 Identify the source of cooling water. (Note that facilities that use a cooling water intake structure as described at
' 40 CFR 125,Subparts I and J may have additional application requirements at 40 CFR 122.21(r).Consult with your
o CI) permitting authority to determine what specific information needs to be submitted and when.)
o
c
EPA Form 3510-1 Page 3

EPA Identification Number NPDES Permit Number Facility Name OMB No.2040-0004
Expires 07/31/2026
SECTION 10.VARIANCE REQUESTS(40 CFR 122.21(F)(10))
10.1 Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(m)?(Check all that
N apply.Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
t/J
❑ Fundamentally different factors(CWA ❑ Water quality related effluent limitations(CWA Section
Section 301(n)) 302(b)(2))
CD
❑ Non-conventional pollutants(CWA ❑ Thermal discharges(CWA Section 316(a))
•co
r. Section 301(c)and(g))
❑ Not applicable
SECTION 11.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(A)AND(D))
11.1 In Column 1 below,mark the sections of Form 1 that you have completed and are submitting with your application.
For each section,specify in Column 2 any attachments that you are enclosing to alert the permitting authority.Note
that not all applicants are required to provide attachments.
Column 1 Column 2
❑ Section 1:Activities Requiring an NPDES ❑ w/attachments
Permit
❑ Section 2:Name, Mailing Address,and ❑ w/attachments
Location
❑ Section 3:SIC Codes ❑ w/attachments
❑ Section 4:Operator Information ❑ w/attachments
❑ Section 5: Indian Land ❑ w/attachments
❑ Section 6:Existing Environmental Permits ❑ wl attachments
£ ❑ wl additional
d ❑ Section 7:Map ❑ w/topographic map
co attachments
o ❑ Section 8:Nature of Business ❑ wl attachments
CCI
❑ Section 9:Cooling Water Intake Structures ❑ w/attachments
0 Section 10.:Variance Requests ❑ w/attachments
❑ Section 11:Checklist and Certification ❑ w/attachments
•
Statement
Y
11.2 Provide the following certification.(See instructions to determine the appropriate person to sign the application.)
Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision
in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted.Based on my inquiry of the person or persons who manage the system,or those persons directly
responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate,and complete. I am aware that there are significant penalties for submitting false information,including the
possibility of fine and imprisonment for knowing violations.
Name(print or type first and last name) Official title
Signature Date signed
EPA Form 3510-1 Page 4

Attachment 1B
Form 2C Existing Manufacturing
North Carolina Department of Environmental Quality I Division of Water Resources
'in" '� 512 North Salisbury Street 11611 Mail Service Center I Raleigh,North Carolina 27699-1611
hI CAROLINA 919.707.9000
ELMAIMneni of Environmental Vuaitry

United States Office of Water OMB No.2040-0004
Environmental Protection Agency Washington,D.C. Expires 07/31/2026
Water Permits Division
&EPA Application Form 2C
Existing Manufacturing,
Commercial , Mining , and
Silvicultural Operations
NPDES Permitting Program
Note: Complete this form and Form 1 if your facility is an existing manufacturing, commercial, mining,
or silvicultural facility that currently discharges process wastewater.

Paperwork Reduction Act Notice
This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C.
3501 et seq. (OMB Control No. 2040-0004). Responses to this collection of information are mandatory
(40 CFR 122.21). An agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a currently valid OMB control number. The public reporting
and recordkeeping burden for this collection of information is estimated to be 2.7 hours per response.
Send comments on the Agency's need for this information, the accuracy of the provided burden
estimates and any suggested methods for minimizing respondent burden to the Regulatory Support
Division Director, U.S. Environmental Protection Agency 2821T 1200 Pennsylvania Ave.
g Y( ), Y NW,
Washington, D.C. 20460.Include the OMB control number in any correspondence. Do not send the
completed form to this address.

FORM 2C—INSTRUCTIONS
General Instructions permitting authority.See Exhibit 1-1 of Form 1's"General
Who Must Complete Form 2C? Instructions"for contact information.Additionally,for Tables A
You must complete Form 2C if you answered"Yes"to Item 1.2.2 each rough provide the applicable outfall number at the top of
on Form 1—that is, if you are an existing manufacturing, page.
commercial,mining,or silvicultural facility that currently Section 1.Outfall Location
discharges process wastewater. Item 1.1. Identify each of the facility's outfall structures by
Where to File Your Completed Form number.For each outfall,specify the latitude and longitude to
Submitthe nearest 15 seconds or equivalent decimal degrees(e.g.,
your completed application package(Forms 1 and 2C)
to your National Pollutant Discharge Elimination System 38.893829,-77.029289)and name of the receiving water.The
(NPDES)permitting authority.Consult Exhibit 1-1 of Form is your
form provides reporting space for three outtalls. If
"General Instructions"to identify your NPDES permitting your facility has more than this number,attach additional sheets
authority. as necessary.The location of each outfall(i.e.,where the
coordinates are collected)shall be the point where the
Public Availability of Submitted Information discharge is released into a water of the United States.Latitude
The U.S.Environmental Protection Agency(EPA)will make and longitude coordinates may be obtained in a variety of ways,
information from NPDES permit application forms available to including use of hand held devices(e.g.,a GPS enabled
the public for inspection and copying upon request.You may not smartphone),Internet mapping tools,geographic information
claim any information on Form 2C(or related attachments)as systems(e.g.,ArcView),or paper maps from trusted sources
confidential. (e.g.,U.S.Geological Survey or USGS).For further guidance,
refer to http://www.eoa.gov/geospatial/latitudelongitude-data-
You may make a claim of confidentiality for any information that standard.
you submit to EPA that goes beyond the information required by
Form 2C.Note that NPDES authorities will deny claims for Section 2.Line Drawing
treating any effluent data as confidential. If you do not assert a Item 2.1.Attach a line drawing showing water flow through your
claim of confidentiality at the time you submit your information to facility,from intake to discharge. Indicate the sources of intake
the NPDES permitting authority,EPA may make the information water(e.g.,city,well,stream,other);operations contributing
available to the public without further notice to you.EPA will wastewater to the effluent including process and production
handle claims of confidentiality in accordance with its business areas,sanitary flows,cooling water,and stormwater runoff;and
confidentiality regulations at Part 2 of Title 40 of the Code of treatment units labeled to correspond to the more detailed
Federal Regulations(CFR). descriptions under Section 3.You may group similar operations
Completion of Forms into a single unit.
Print or type in the specified areas only. If you do not have Construct a water balance on the line drawing by showing
enough space on the form to answer a question,you may average flows(specify units)between intakes,operations,
continue on additional sheets,as necessary,using a format treatment units,and outfalls.Show all significant losses of water
consistent with the form. to products,the atmosphere,and discharge.You should use
actual measurements wherever available;otherwise use your
Do not leave any response areas blank unless the form directs
you to skip them. If the form directs you to respond to an item best estimate. If you cannot determine a water balance for your
that does not apply to your facility or activity,enter"NA"for"not activities(such as mining activities),provide a pictorial
description of the nature and amount of any sources of water
applicable"to show that you considered the item and
determinedand any collection and treatment measures.An example of an
a response was not necessary for your facility.
acceptable line drawing is provided in Exhibit 2C-1 at the end of
The NPDES permitting authority will consider your application these instructions.
complete when it and any supplementary material are received Section 3.Average Flows and Treatment
and completed according to the authority's satisfaction.The Item 3.1.For each outfall identified under Item 1.1,provide the
NPDES permitting authority will judge the completeness of any following information:(1)all processes,operations,or
application independently of the status of any other permit production areas that contribute wastewater to the effluent for
application or permit for the same facility or activity. the outfall,including process wastewater,sanitary wastewater,
Definitions cooling water,and stormwater runoff;(2)average flow of
The legal definitions of all key terms used in these instructions wastewater contributed by each operation in million gallons per
and Form 2C are in the"Glossary"at the end of the"General day(mgd);(3)a description of the treatment unit(including size
Instructions"in Form 1. of each treatment unit,flow rate through each treatment unit,
Line-by-Line Instructions retention time,etc.);(4)the applicable treatment code(s)from
Exhibit 2C-2(see end of instructions);and(5)the ultimate
EPA Identification Number,NPDES Permit Number,Facility disposal of any solid or fluid wastes that are not discharged to
Name,and Outfall Number the receiving water.You may describe processes,operations,or
Provide your EPA Identification Number from the Facility production areas in general terms(e.g.,"dye-making reactor"or
Registry Service,NPDES permit number,and facility name at "distillation tower").You may estimate the average flow of point
the top of each page of Form 2C and any attachments. If you do sources composed of stormwater;however,you must indicate
not know your EPA Identification Number,contact your NPDES
2C-1

FORM 2C—INSTRUCTIONS(CONTINUED)
the basis of the rainfall event and the method of estimation.Add biological oxygen demand per cubic foot of logs from which bark
additional sheets as necessary. is removed"or"pounds of total suspended solids per megawatt
Item 3.2.Answer whether you are applying for an NPDES hour of electrical energy consumed by smelting furnace").An
permit to operate a privately owned treatment works. If yes, ELG ELG Regulatory
continue to Item 3.3. If no,skip to Section 4. J 5.2 Category Subcategory Citation
Item 3.3.Attach a list to your application that includes the d Pulp,Paper, Secondary 40 CFR 430,
identity of each user of the treatment works,then answer"Yes" A and Fiber Non- Subpart J
to Item 3.3. For the purpose of this item,the term"user"means Paperboard Deink
any entity other than the applicant that contributes wastewater a Point Source Subcategory
to the treatment works. Category
Section 4.Intermittent Flows
Item 4.1.Answer"Yes"or"No"to indicate whether any of the example of an ELG not expressed in terms of a measure of
discharges you described in Sections 1 and 3 of Form 2C are operation is one that limits the concentration of pollutants. If yes,
intermittent or seasonal,except for stormwater runoff,spillage, continue to Item 5.4. If no,skip to Section 6.
or leaks.An intermittent discharge is one that is not continuous. Item 5.4.Indicate the operations,products,or materials
A continuous discharge is one that occurs without interruption produced at the facility for each outfall. For each operation,
during the operating hours of the facility,except for infrequent product,or material produced,denote the quantity produced per
shutdowns for maintenance,process changes,or other similar day using the measurement units specified in the applicable
activities.A discharge is seasonal if it occurs only during certain ELG.The NPDES permitting authority will use the production
parts of the year. If yes,continue to Item 4.2. If no,skip to information to apply ELGs to your facility.You may not claim
Section 5. that the production information you submit is confidential.You
Item 4.2.By relevant outfall number,identify each operation that do not need to indicate how you calculated the reported
has intermittent or seasonal discharges. Indicate the average information.The production figures provided must be based on
frequency(days per week and months per year),the long-term a reasonable measure of actual daily production, not on design
average and maximum daily flow rates in mgd,and the duration capacity or on predictions of future operations.
of the intermittent or seasonal discharges. Base your answers Item 5.5. Indicate if you are requesting alternative limits based
on actual data if available.Otherwise, provide your best on an anticipated increase in actual production during the next
estimate.Report the average of all daily values measured permit term.To obtain alternate limits,40 CFR 122.45(b)(2)(ii)
during days when the discharge occurred for"Long-Term requires you to define your maximum production capability and
Average,"and report the highest daily value for"Maximum demonstrate to the NPDES permitting authority that your actual
Daily." production is substantially below maximum production capability
Section 5.Production and that there is a reasonable potential for an increase above
Item 5.1.Indicate whether any effluent limitation guidelines actual production during the duration of the permit.Note that
(ELGs)promulgated under Section 304 of the Clean Water Act you are not being asked to submit this information at this time.
(CWA)apply to your facility. If yes,continue to Item 5.2. If no, Contact your NPDES permitting authority to determine the
skip to Section 6.All ELGs promulgated by EPA appear in the specifics of what you should provide and when.
Federal Register and are published annually in 40 CFR Section 6.Improvements
Subchapter N.See also www.epa.Qov/eq.An ELG applies if you Item 6.1.Indicate if you are required by any federal,state,or
have any operations contributing process wastewater in any local authority to meet an implementation schedule for
subcategory covered by a Best Practicable Control Technology constructing, upgrading,or operating wastewater treatment
Currently Available(BPT),Best Conventional Pollutant Control equipment or practices or any other environmental programs
Technology(BCT),or Best Available Technology Economically that could affect the discharges described in your application.
Achievable(BAT)guideline. If you are unsure whether you are The requirements include,but are not limited to,permit
covered by a promulgated ELG,consult your NPDES permitting conditions,administrative enforcement orders,enforcement
authority(see Exhibit 1-1 of the"General Instructions"of Form compliance schedule letters,stipulations,court orders,and
1).You must check"Yes"if an applicable ELG has been grant or loan conditions. If yes,continue to Item 6.2. If no,skip
promulgated,even if the ELG is being contested in court. If you to Item 6.3.
believe that a promulgated ELG has been remanded for Item 6.2.Briefly identify and describe each applicable project
reconsideration by a court and does not apply to your (e.g.,consent decree,enforcement order,or permit condition).
operations,you may answer"No"to Item 5.1 and skip to Section For each condition,specify the affected outfall number(s),the
6. source(s)of the discharge,the projected final compliance date,
Item 5.2.Complete Item 5.2 by indicating the applicable ELG and the required final compliance date.
category,ELG subcategory,and corresponding regulatory Item 6.3.OPTIONAL ITEM. If desired,attach descriptions of
citation.See the example below. any additional water pollution control programs(or other
Item 5.3.Indicate if the limitations in the applicable ELGs are environmental projects that could affect your discharges)that
expressed in terms of production or other measure of operation. are now underway or planned. Indicate in your attachments
An ELG is expressed in terms of production if it is expressed as whether each program is actuallyunderwayor is planned,and
P 9
mass of pollutant per operational parameter(e.g.,"pounds of indicate your actual or planned schedule for construction.
2C-2

FORM 2C—INSTRUCTIONS(CONTINUED)
General Instructions for Reporting,Sampling,and Analysis
Important note:Read these instructions before completing Tables A Concentration Mass
through E and Section 7 of Form 2C. ppm=parts per million lbs.=pounds
mg/L=milligrams per liter ton=tons(English tons)
General Items ppb=parts per billion mg=milligrams
Complete the applicable tables for each outfall at your facility. Be sure to fag/L=micrograms per liter g=grams
note the EPA Identification Number, NPDES permit number,facility MPN=most probable number kg=kilograms
name,and applicable outfall number at the top of each page of the tables per 100 milliliters T=tonnes(metric tons)
and any associated attachments.
You may report some or all of the required data by attaching separate All reporting of values for metals must be in terms of"total recoverable
sheets of paper instead of completing Tables A through E for each of metal,"unless:
your outfalls so long as the sheets contain all of the required information
and are similar in format to Tables A through E. For example,you may be • An applicable, promulgated ELG specifies the limitation for the
able to print a report in a compatible format from the data system used in metal in dissolved,valent,or total form;
your GC/MS analysis completed under Table B. • All approved analytical methods for the metal inherently measure
Table A requires you to report at least one analysis for each pollutant only its dissolved form(e.g., hexavalent chromium);or
listed.Tables B through D require you to report analytical data in two • The permitting authority has determined that in establishing case-
ways. For some pollutants,you may be required to check the box in the by-case limitations it is necessary to express the limitations of the
"Testing Required"column and test and report the levels of the pollutants metal in dissolved,valent,or total form to carry out the provisions
in your discharge whether or not you expect them to be present in your of the CWA.
discharge. For all other pollutants,you must check the box in either the Note that you are not required to complete the"Maximum Monthly
"Believed Present"or"Believed Absent"columns based on your best Discharge"and the"Long-Term Average Daily Discharge"columns of
estimate and test for thoseyou believe to be present(with some
exceptions).Base your determination that a pollutant is present in or Tables A through C; however,these fields should be completed if data
absent fromyour discharge onyour knowledge of your raw materials,
are available.
9 9
maintenance chemicals,intermediate and final products and byproducts, If you measure only one daily value,complete the"Maximum Daily
and any previous analyses known to you of your effluent or similar Discharge"columns of the tables and enter"1"in the"Number of
effluent. For example, if you manufacture pesticides,you should expect Analyses"columns.The NPDES permitting authority may require
those pesticides to be present in contaminated stormwater runoff. additional analyses to further characterize your discharges.
If you would expect a pollutant to be present solely because of its For composite samples,the daily value is the total mass or average
presence in your intake water,you must mark"Believed Present"but you concentration found in a composite sample taken over the operating
are not required to analyze for that pollutant. Instead, mark an"X"in the hours of the facility during a 24-hour period. For grab samples,the
long-term average value of the"Intake"column;optionally,you may daily value is the arithmetic or flow-weighted total mass or average
instead provide intake data. concentration found in a series of at least four grab samples taken
Reporting of Effluent Data over the operating hours of the facility during a 24-hour period.
Report sampling results for all pollutants in Tables A through C as If you measure more than one daily value for a pollutant and those
concentration and total mass,except for flow,temperature, pH,color, values are representative of your wastestream,you must report them.
and fecal coliform organisms. If you are reporting quantitative data under You must describe your method of testing and data analysis.
Table D,report concentration only. When an applicant has two or more outfalls with substantially identical
Flow,temperature, pH, color,and fecal coliform organisms must be effluents,the NPDES permitting authority may allow the applicant to
reported as mgd,degrees Celsius(°C),standard units,color units,and test only one outfall and report those quantitative data as applying to
most probable number per 100 milliliters(MPN/100 mL), respectively. the substantially identical outfall. If the permitting authority grants your
Use the following abbreviations in the columns requiring"units"in Tables request,attach a separate sheet to the application form identifying the
A through D. outfall tested and describing why the other outfall(s)are substantially
identical.
Concentration Mass Reporting of Intake Data
ppm=parts per million lbs.=pounds You are not required to report data under the"Intake"columns of
mg/L=milligrams per liter ton=tons(English tons) Tables A through C unless you wish to demonstrate your eligibility for a
ppb=parts per billion mg= milligrams
pg/L micrograms per liter g-grams "net"effluent limitation for one or more pollutants in Tables A through C
MPN most probable number kg=kilograms (i.e.,an effluent limitation adjusted by subtracting the average level of
per 100 milliliters T=tonnes(metric tons) the pollutant(s)present in your intake water). NPDES regulations allow
net limitations only in certain circumstances.To demonstrate your
2C-3

FORM 2C—INSTRUCTIONS(CONTINUED)
General Instructions for Reporting,Sampling,and Analysis Continued
eligibility, under the"Intake"columns report the average of the results of be flow proportional;either the time interval between each aliquot or the
analyses of your intake water and discuss the requirements for a net volume of each aliquot must be proportional to either the stream flow at
limitation with your NPDES permitting authority.If your water is treated the time of sampling or the total stream flow since the collection of the
before use,test the water after it has been treated. previous aliquot.
Sampling Aliquots may be collected manually or automatically. For"GC/MS
The collection of samples for the reported analyses should be Fraction—Volatile Compounds"in Table B,aliquots must be combined
supervised by a person experienced in performing sampling of industrial in the laboratory immediately before analysis. Four(rather than eight)
wastewater.You may contact your NPDES permitting authority for aliquots or grab samples should be collected for this fraction.These four
detailed guidance on sampling techniques and for answers to specific samples should be collected during actual hours of discharge over a 24-
hour period and need not be flow proportioned.Only one analysis is
questions.See Exhibit 1-1 of Form 1 for contact information.Any required.
specific requirements in the applicable analytical methods—for example,
sample containers,samplepreservation,holdingtimes,and the Use of Historical Data
P P
collection of duplicate samples—must be followed. Existing data may be used,if available,in lieu of sampling conducted
The time when you sample should be representative of your normal solely for the purposes of this application, provided that:all data
requirements are met;sampling wasperformed,collected,and analyzed
operation,to the extent feasible,with all processes that contribute
q P 9 Yz
P
w no more than 4.5 years prior to submission;all data are representative
astewater in normal operation,and with your treatment system of the discharge;and all available representative data are considered in
operating properly with no system upsets.Collect samples from th
9 P
C ec sa es o e
P 9 P P Y y P P the values reported.
center of the flow channel,where turbulence is at a maximum,at a site
specified in your present NPDES permit,or at any site adequate for the Analysis
collection of a representative sample. Except as specified below,all required quantitative data shall be
Grab samples must be used for pH,temperature,cyanide,total collected in accordance with sufficiently sensitive analytical methods
phenols,residual chlorine,oil and grease,fecal coliform(including E. approved under 40 CFR 136 or required under 40 CFR Chapter I,
cob),and enterococci(previously known as fecal streptococcus at 40 Subchapter N or 0.A method is"sufficiently sensitive"when:
CFR 122.26(d)(2)(iii)(A)(3)),and volatile organic compounds. • The method minimum level(ML)is at or below the level of the
For all other pollutants,a 24-hour composite sample,using a minimum applicable water quality criterion for the measured pollutant or
of four grab samples, must be used unless specified otherwise at 40 pollutant parameter.
CFR 136.However,a minimum of one grab sample may be taken for • The method ML is above the water quality criterion,but the amount
effluents from holding ponds or other impoundments with a retention of the pollutant or pollutant parameter in the facility's discharge is
period greater than 24 hours. high enough that the method detects and quantifies the level of the
For stormwater discharges,a minimum of one to four grab samples pollutant or pollutant parameter in the discharge.
must be taken,depending on the duration of the discharge.One grab • The method has the lowest ML of the analytical methods approved
sample must be taken in the first hour(or less)of discharge,with one under 40 CFR 136 or required under 40 CFR Chapter I,
more grab sample(up to a minimum of four)taken in each succeeding Subchapter N or 0,for the measured pollutant or pollutant
hour of discharge for discharges lasting four hours or more. parameter.
Except for stormwater discharges,the NPDES permitting authority may Consistent with 40 CFR 136,you may provide matrix-or sample-specific
waive composite sampling requirements for any outfall for which you MLs rather than the published levels.Further,where you can
demonstrate that use of an automatic sampler is infeasible and that the demonstrate that,despite a good faith effort to use a method that would
minimum of four grab samples will be representative of your discharge. otherwise meet the definition of"sufficiently sensitive,"the analytical
Results of analyses of individual grab samples for any parameter may results are not consistent with the quality assurance(QA)/quality control
be averaged to obtain the daily average.Grab samples that are not (QC)specifications for that method,then the NPDES permitting
required to be analyzed immediately may be composited in the authority may determine that the method is not performing adequately
laboratory,if the container,preservation,and holding time requirements and the NPDES permitting authority should select a different method
are met and if sample integrity is not compromised during compositing. from the remaining EPA-approved methods that is sufficiently sensitive
See Table II at 40 CFR 136.3 for further information. consistent with 40 CFR 122.21(e)(3)(i).Where no other EPA-approved
methods exist,you must select a method consistent with 40 CFR
A grab sample is an individual sample of at least 100 milliliters collected 122.21(e)(3)(ii).
at a randomly chosen time over a period not exceeding 15 minutes. When there is no analytical method that has been approved under 40
A composite sample is a combination of at least eight sample aliquots CFR 136;required under 40 CFR chapter I,subchapter N or 0;or
of at least 100 milliliters,collected at periodic intervals during the otherwise required by the NPDES permitting authority,you may use any
operating hours of a facility over a 24-hour period.The composite must suitable method but shall provide a description of the method.When
selecting a suitable method,you may consider other factors,such as a
method's precision,accuracy,or resolution.
2C-4

FORM 2C—INSTRUCTIONS(CONTINUED)
Section 7.Effluent and Intake Characteristics Item 7.3.Test your effluent from each outfall for each pollutant
Items 7.1 to 7.17.These items require you to collect and report listed in Table A for which you have not requested a waiver.You
data for the parameters and pollutants listed in Tables A through may also conduct optional tests of your intake water for the
E,located at the end of Form 2C.The instructions for Table A pollutants.See the"General Instructions for Reporting,
completing the tables are table-specific in addition to the criteria Sampling,and Analysis"on pages 2C-5 and 2C-6 for further
for determining who should complete them. In general,the information.
following conditions apply: Item 7.4 and Table B.This item asks whether any of the
Table Pollutants/Parameters Who Completes? facility's processes that contribute wastewater fall into one or
A Conventional and non- All applicants from all more of the primary industry categories listed in Exhibit 2C-3.If
conventional pollutants outfalls unless a waiver is you are applying for a permit for a privately owned treatment
obtained from the works,determine your testing requirements based on the
NPDES permitting industrial categories of your contributors.This is only an
authority. exercise to determine your testing requirements:you are not
B Toxic metals,cyanide, Applicants in the primary giving up your right to challenge your inclusion in the category
total phenols,and industry categories listed determined for testing(e.g.,for deciding whether an ELG is
organic toxic pollutants in Exhibit 2C-3 at the applicable)before your permit is issued. If yes,continue to Item
end of these instructions. 7.5. If no,skip to Item 7.8.
C Certain conventional Applicants subject to Complete a separate Table B for each outfall.Section 1 of Table
and non-conventional ELGs that limit pollutants B lists toxic metals,cyanide,and total phenols.Sections 2
pollutants directly or indirectly and through 5 of Table B list the pollutants in each of the gas
applicants who believe chromatography/mass spectrometry(GC/MS)fractions.Note
pollutants may be that inclusion of total phenols in Section 1 of Table B does not
present in their facilities' mean that EPA is classifying the group as toxic pollutants.
discharge.
D Certain hazardous Applicants who believe Item 7.5.Because you indicated in Item 7.4 that the facility's
substances and pollutants may be processes contribute wastewater that falls into one or more of
asbestos present in their facilities' the primary industry categories,check"Testing Required"for all
discharge. toxic metals,cyanide,and total phenols in Section 1 of Table B.
E 2,3,7,8- Applicants who use or Answer"Yes"to Item 7.5 once you have completed this task.
tetrachlorodibenzo-p- manufacture the pollutant Item 7.6.Because you indicated in Item 7.4 that the facility's
dioxin(2,3,7,8-TCDD) or believe the pollutant processes contribute wastewater that falls into one or more of
may be present in their the primary industry categories, list the primary industry
facilities'discharge. categories applicable to your facility. Next,review Exhibit 2C-3
Important note:Read the"General Instructions for Reporting, to determine whether testing is required and for which GC/MS
Sampling,and Analysis"on pages 2C-5 and 2C-6 before fraction(s):volatile compounds,acid compounds,base/neutral
completing Section 7 and Tables A through E. compounds,and pesticides.Check the applicable boxes for
each GC/MS fraction requiring testing.
Item 7.1 and Table A.All applicants must report at least one Item 7.7.For each of the required GC/MS fractions,check
analysis for each conventional and non-conventional pollutant "Testing Required"for each of the pollutants in the required
listed in Table A for each outfall(one table per outfall).This fraction in Sections 2 through 5 of Table B.Answer"Yes"to Item
includes outfalls discharging only noncontact cooling water or 7.7 once you have completed this task.
stormwater runoff.However,at your request,the NPDES Item 7.8 and Sections 1 through 5 of Table B.For all other
permitting authority may waive the requirement to test for one or cases(secondary industries,nonprocess wastewater outfalls,
more of the listed pollutants for specific outfalls,upon a and nonrequired GC/MS fractions)and remaining pollutants,
determination that available information is adequate to support check"Believed Present"or"Believed Absent"in Sections 1
issuance of your NPDES permit with less stringent reporting through 5 of Table B to indicate whether you have reason to
requirements.You may also request a waiver from your NPDES believe that any of the pollutants listed are discharged from your
permitting authority for one or more of the Table A pollutants for outfalls.Answer"Yes"to Item 7.8 after you have completed this
your industry category or subcategory. Indicate whether you are step.
requesting a waiver in response to Item 7.1. If yes,continue to
Item 7.2. If no,skip to Item 7.3. Item 7.9 and Section 1 of Table B.For each pollutant you
Item 7.2.Specify the outfalls for which you are requesting a know or have reason to believe is present in your discharge
from each applicable outfall
waiver or check the appropriate box to indicate that you are
outfall in concentrations of 10 parts per
requesting a waiver for some or all pollutants at all outfalls. billion(ppb)or greater,you must report quantitative data. For
Next,indicate in Table A for the applicable outfalls the pollutants every pollutant expected to be discharged in concentrations less
for which the waiver is being requested.Attach your waiver than 10 ppb,you must submit quantitative data or briefly
request and supporting information to your completed Form 2C. describe the reasons the pollutant is expected to be discharged.
For pollutants in intake water,see the discussion under
2C-5

FORM 2C—INSTRUCTIONS(CONTINUED)
"General Instructions for Reporting,Sampling,and Analysis" Once you have completed these tasks,answer"Yes"to Item
below.Answer"Yes"to Item 7.9 once you have completed 7.11.
Section 1 of Table B. Item 7.12 and Table C.For each outfall(including outfalls
Item 7.10.This item asks if you qualify as a"small business."If containing only noncontact cooling water or stormwater runoff),
so,you are exempt from submitting quantitative data for the indicate whether you know or have reason to believe that any of
organic toxic pollutants in Table B(Sections 2 through 5).You the pollutants listed in Table C are present in your discharge. If
still must indicate,though,whether you believe any of the so,mark the box in the"Believed Present"column for each
pollutants listed in Sections 1 through 5 are present in your applicable pollutant. If not, mark the box in the"Believed
discharge per the Instructions at Item 7.8 above. Absent"column for each applicable pollutant.Answer"Yes"to
You can qualify as a small business in two ways:(1)If your Item 7.12 once you have completed the required task for each
facility is a coal mine and if your probable total annual outfall.
production is less than 100,000 tons per year,you may submit Items 7.13 and 7.14 and Table C.You are required to report
past production data or estimated future production(such as a quantitative data for any Table C pollutants that are directly
schedule of estimated total production under 30 CFR 795.14(c)) limited in an applicable ELG or are indirectly limited in an
instead of conducting analyses for the organic toxic pollutants. applicable ELG through an expressed limitation on an indicator
(2)If your facility is not a coal mine and if your gross total annual (e.g.,use of total suspended solids,or TSS,as an indicator to
sales for the most recent three years average less than control the discharge of iron and aluminum).Mark"Not
$100,000 per year(in second quarter 1980 dollars),you may Applicable"in Item 7.13 if no Table C pollutants are limited
submit sales data for those years instead of conducting directly or indirectly in an applicable ELG. For all other pollutants
analyses for the organic toxic pollutants. that you marked as"Believed Present,"you must either report
The production or sales data must be for the facility that is the quantitative data or briefly describe the reasons the pollutant is
source of the discharge.The data should not be limited to expected to be discharged.
production or sales for the process or processes that contribute For pollutants in intake water,see the discussion under
to the discharge,unless those are the only processes at your "General Instructions for Reporting,Sampling,and Analysis"on
facility. pages 2C-5 and 2C-6 for further information.
For sales data,in situations involving intra-corporate transfer of Answer"Yes"to Items 7.13 and 7.14 when you have fully
goods and services,the transfer price per unit should completed the tasks associated with Table C and Items 7.12
approximate market prices for those goods and services as through 7.14 above.
closely as possible.Sales figures for years after 1980 should be Item 7.15 and Table D.For each outfall,indicate if you believe
indexed to the second quarter of 1980 by using the gross that any pollutant listed in Table D is"Believed Present"or
national product price deflator(second quarter of 1980= 100). "Believed Absent"in your facility's effluent.Check the boxes in
This index is available online from the U.S.Department of the applicable columns in Table D next to each pollutant. For
Commerce,Bureau of Economic Analysis,at every pollutant believed present,you must briefly describe the
https://apes.bea.govinational/pdf/SNTables.pdf. reasons the pollutant is expected to be discharged and report
If you qualify as a small business according to the criteria any quantitative data you have for that pollutant.Note that you
above,answer"Yes"to Item 7.10.Check the box at the top of are not required to perform analytical tests for any of the Table
Table B to show that you are not required to submit quantitative D pollutants at this time. However,if you have prior test results,
data for the organic toxic pollutants(Sections 2 through 5 of you must report them.
Table B),then skip to Item 7.12.Otherwise,answer"No"and Item 7.16.Answer"Yes"to this Item when you have completed
continue to Item 7.11. Table D.
Item 7.11 and Sections 2 through 5 of Table B.Unless you
qualify as a small business(see Item 7.10),you must provide Under 40 CFR 117.12(a)(2),certain discharges of
quantitative data for all pollutants for which you marked"Testing
Required"in Sections 2 through 5 of Table B.You must also hazardous substances(listed in Exhibit 2C-4 at the
provide quantitative data for all pollutants you marked as end of these instructions)may be exempted from the
"Believed Present"in Sections 2 through 5 of Table B if you requirements of Section 311 of the CWA,which
discharge those pollutants in concentrations of 10 ppb or establishes reporting requirements,civil penalties,and
greater,except for acrolein,acrylonitrile,2,4-dinitrophenol,and liability for cleanup costs for spills of oil and hazardous
2-methyl-4,6-dinitrophenol. If you discharge any of the four latter substances.A discharge of a particular substance can
pollutants in concentrations of 100 ppb or greater,you must be exempted if the origin,source,and amount of the
report quantitative data. If you discharge the pollutants in discharged substances are identified in the NPDES
Sections 2 through 5 of Table B less than these thresholds(i.e., permit application or in the permit,if the permit
<100 ppb for acrolein,acrylonitrile,2,4-dinitrophenol,and 2- contains a requirement for treatment of the discharge,
methyl-4,6-dinitrophenol and<10 ppb for all others),you must and if the treatment is in place.
submit quantitative data or briefly describe the reasons the
pollutant is in your discharge. Exemptions are allowed from the requirements of CWA
For pollutants in intake water,see the discussion under Section 311.Applications for exemptions must set forth
the following information:
"General Instructions for Reporting,Sampling,and Analysis"on
pages 2C-5 and 2C-6 for further information.
2C-6

FORM 2C—INSTRUCTIONS(CONTINUED)
1. The substance and the amount of each substance Section 9.Biological Toxicity Tests
that may be discharged. Item 9.1.Indicate if you have any knowledge or reason to
2. The origin and source of the discharge of the believe that any biological test for acute or chronic toxicity has
substance. been made on any of your discharges or on a receiving water in
3. The treatment to be provided for the discharge by: relation to your discharge within the last three years. If yes,
a. An onsite treatment system separate from any continue to Item 9.2.If no,skip to Section 10.
treatment system treating your normal discharge; Item 9.2. Identify the tests known to have been performed and
b. A treatment system designed to treat your the purposes of each.For each test,check"Yes"or"No"to
normal discharge and that is additionally capable indicate if you have submitted the test results to the NPDES
of treating the amount of the substance identified permitting authority and the date the results were submitted.
The NPDES permitting authority may ask you to provide
under paragraph 1 above;or additional details after reviewing your application.
c. Any combination of the above.
Section 10.Contract Analyses
See 40 CFR 117.12(a)(2)and(c)or contact your Item 10.1.Indicate if any of the analyses reported in Section 7
NPDES permitting authority for further information on were performed by a contract laboratory or consulting firm. If
exclusions from CWA Section 311. yes,continue to Item 10.2. If no,skip to Section 11.
Item 10.2.Identify each laboratory or firm used in the table
provided.For each,provide the name,address,and
phone
number of the laboratory or firm and the pollutants analyzed.
Item 7.17.Indicate whether: Section 11.Additional Information
• Your facility uses or manufactures 2,4,5-trichlorophenoxy Item 11.1.In addition to the information reported on the
acetic acid(2,4,5-T);2-(2,4,5-trichlorophenoxy)propanoic application form,the NPDES permitting authority may request
acid(Silvex,2,4,5-TP);2-(2,4,5-trichlorophenoxy)ethyl additional information reasonably required to assess the
2,2-dichloro-propionate(Erbon);0,0-dimethyl 0-(2,4,5- discharges of the facility and to determine whether to issue an
trichlorophenyl)phosphorothioate(Ronnel);2,4,5,- NPDES permit.The additional information may include
trchlorophenol(TCP);or hexachlorophene(HCP). additional quantitative data and bioassays to assess the relative
• You know or have reason to believe that 2.3.7,8- toxicity of discharges to aquatic life and requirements to
tetrachlorodibenzo-p-dioxin(TCDD)is or may be present determine the cause of the toxicity. Indicate under Item 11.1
whether the NPDES permitting authority has requested
in an effluent. additional information from you.If yes,continue to Item 11.2. If
If yes,continue to Item 7.18. If no,skip to Section 8. no,skip to Section 12.
Item 7.18 and Table E.If you answered"Yes"to Item 7.17,you Item 11.2.List the items requested and attach the required
must report qualitative data,generated using a screening information to the application.
procedure not calibrated with analytical standards,for TCDD. Section 12.Checklist and Certification Statement
Your screening analyses must be performed using gas Item 12.1.Review the checklist provided. In Column 1,mark the
chromatography with an electron capture detector.A TCDD sections of Form 2C that you have completed and are
standard for quantitation is not required.Describe the results of submitting with your application. In Column 2,indicate for each
your screening analysis(e.g.,"no measurable baseline section whether you are submitting attachments.
deflection at the retention time of TCDD"or"a measurable peak Item 12.2.The CWA provides for severe penalties for submitting
within the tolerances of the retention time of TCDD.")in Table E. false information on this application form.Section 309(c)(2)of
The NPDES permitting authority may require you to perform a the CWA provides that"Any person who knowingly makes any
quantitative analysis if you report a positive result. false statement,representation,or certification in any
Answer"Yes"to Item 7.18 when you have completed Table E. application, ...shall upon conviction,be punished by a fine of no
Section 8.Used or Manufactured Toxics more than$10,000 or by imprisonment for not more than six
Item 8.1.Indicate if any pollutant listed in Table B is used or months or both."
manufactured in your facility as an intermediate or final product FEDERAL REGULATIONS AT 40 CFR 122.22 REQUIRE THIS
or byproduct. If yes,continue to Item 8.2. If no,skip to Section 9. APPLICATION TO BE SIGNED AS FOLLOWS:
Item 8.2.List the applicable toxic pollutants.Note that the A. For a corporation,by a responsible corporate officer.For
NPDES permitting authority may waive or modify the the purpose of this section,a responsible corporate officer
requirement if you demonstrate that it would be unduly means:(1)a president,secretary,treasurer,or vice-
burdensome to identify each toxic pollutant and the permitting president of the corporation in charge of a principal
authority has adequate information to issue you a permit.You business function,or any other person who performs
may not claim this information as confidential.Note that you do similar policy-or decision-making functions for the
not need to distinguish between use or production of the corporation,or(2)the manager of one or more
pollutants or list amounts. manufacturing,production,or operating facilities,provided
the manager is authorized to make management decisions
which govern the operation of the regulated facility
2C-7

FORM 2C—INSTRUCTIONS(CONTINUED)
including having the explicit or implicit duty of making major C. For a municipality,state,federal,or other public facility,by
capital investment recommendations,and initiating and either a principal executive officer or ranking elected
directing other comprehensive measures to assure long official. For purposes of this section,a principal executive
term environmental compliance with environmental laws officer of a federal agency includes:(1)the chief executive
and regulations;the manager can ensure that the officer of the agency or(2)a senior executive officer having
necessary systems are established or actions taken to responsibility for the overall operations of a principal
gather complete and accurate information for permit geographic unit of the agency(e.g., Regional
application requirements;and where authority to sign Administrators of EPA).
documents has been assigned or delegated to the END
manager in accordance with corporate procedures.
B. For a partnership or sole proprietorship,by a general Submit your completed Form 1,Form 2C,and
partner or the proprietor,respectively. all associated attachments
(and any other required NPDES application forms)
to your NPDES permitting authority.
2C-8

FORM 2C—INSTRUCTIONS(CONTINUED)
Exhibit 2C-1.Example Line Drawing
Blue River Municipal
90,000 GPO Water Supply Blue River
• 10,000 GPD
j 45,000 GPD 45,000 GPD 30,000 GPD Cooling Water
♦ ♦ r
Raw Materials Fiber 15,000 Dyeing 20,000 1. Washing 10,000 Drying 5,000 GPD
10.000 GPD Preparation GPD GPD GPD To Atmosphere
40,000 GPD 40.000 GPD 40.000 10,000 To Product
GPD GPD 5,000 GPD
Solid Waste Grit Neutralization Loss Waste
f Separator Tank 6,000 GPD Treatment
4,000 GPD Plant 2
36,000 GPD 34.000 GPD Outfall 002
• ♦ 50,000 GPD
Waste
Outtall
001
Stormwater Treatment 70,000 GPD+S ormwat'er
Max:20,000 GPO Plant z1
Schematic of Water Flow
Brown Mills,Inc.
City.County, State
2C-9

FORM 2C—INSTRUCTIONS(CONTINUED)
Exhibit 2C-2.Codes for Treatment Units and Disposal of Wastes Not Discharged
1. PHYSICAL TREATMENT PROCESSES
1-A Ammonia stripping 1-M Grit removal
1-B Dialysis 1-N Microstraining
1-C Diatomaceous earth filtration 1-0 Mixing
1-D Distillation 1-P Moving bed filters
1-E Electrodialysis 1-Q Multimedia filtration
1-F Evaporation 1-R Rapid sand filtration
1-G Flocculation 1-S Reverse osmosis(hyperfiltration)
1-H Flotation 1-T Screening
1-I Foam fractionation 1-U Sedimentation(settling)
1-J Freezing 1-V Slow sand filtration
1-K Gas-phase separation 1-W Solvent extraction
1-L Grinding(comminutors) 1-X Sorption
2. CHEMICAL TREATMENT PROCESSES
2-A Carbon adsorption 2-G Disinfection(ozone)
2-B Chemical oxidation 2-H Disinfection(other)
2-C Chemical precipitation 2-I Electrochemical treatment
2-D Coagulation 2-J Ion exchange
2-E Dechlorination 2-K Neutralization
2-F Disinfection(chlorine) 2-L Reduction
3. BIOLOGICAL TREATMENT PROCESSES
3-A Activated sludge 3-E Pre-aeration
3-B Aerated lagoons 3-F Spray irrigation/land application
3-C Anaerobic treatment 3-G Stabilization ponds
3-D Nitrification-denitrification 3-H Trickling filtration
4. WASTEWATER DISPOSAL PROCESSES
4-A Discharge to surface water 4-C Reuse/recycle of treated effluent
4-B Ocean discharge to outfall 4-D Underground injection
5. SLUDGE TREATMENT AND DISPOSAL PROCESSES
5-A Aerobic digestion 5-M Heat drying
5-B Anaerobic digestion 5-N Heat treatment
5-C Belt filtration 5-0 Incineration
5-D Centrifugation 5-P Land application
5-E Chemical conditioning 5-Q Landfill
5-F Chlorine treatment 5-R Pressure filtration
5-G Composting 5-S Pyrolysis
5-H Drying beds 5-T Sludge lagoons
5-I Elutriation 5-U Vacuum filtration
5-J Flotation thickening 5-V Vibration
5-K Freezing 5-W Wet oxidation
5-L Gravity thickening
2C-10

FORM 2C—INSTRUCTIONS(CONTINUED)
Exhibit 2C-3.Testing Requirements for Organic Toxic Pollutants Industry Categories*
INDUSTRY CATEGORY GC/MS FRACTIONt
Volatile Acid Base/Neutral Pesticide
Adhesives and sealants X X X ❑
Aluminum forming X X X ❑
Auto and other laundries X X X X
Battery manufacturing X ❑ X ❑
Coal mining E E ❑
Coil coating X X X ❑
Copper forming X X X ❑
Electric and electronic compounds X X X X
Electroplating X X X ❑
Explosives manufacturing ❑ X X ❑
Foundries X X X ❑
Gum and wood chemicals(all subparts except D and F) X X ❑ ❑
Gum and wood chemicals,Subpart D(tall oil rosin) X X X ❑
Gum and wood chemicals,Subpart F(rosin-based X X X ❑
derivatives)
Inorganic chemicals manufacturing X X X ❑
Iron and steel manufacturing X X X ❑
Leather tanning and finishing X X X ❑
Mechanical products manufacturing X X X ❑
Nonferrous metals manufacturing X X X X
Ore mining,Subpart B(base and precious metals) ❑ X I ❑
Organic chemicals manufacturing X X X X
Paint and ink formulation X X X ❑
Pesticides X X X X
Petroleum refining X ❑ LI ❑
Pharmaceutical preparations X X X ❑
Photographic equipment and supplies X X X ❑
Plastic and synthetic materials manufacturing X X X X
Plastic processing X ❑ [
Printing and publishing X X X X
Pulp and paperboard mills X X X X
Rubber processing X X X ❑
Soap and detergent manufacturing X X X ❑
Steam electric power plants X X I ❑
Textile mills(except Subpart C,Greige Mills) X X X ❑
Timber products processing X X X X
See note at conclusion of 40 CFR 122,Appendix D(1983)for explanation of effect of suspensions on testing requirements for
primary industry categories. 1
t The pollutants in each fraction are listed in Table B.
X=Testing is required.
=Testing is not required.
2C-11

FORM 2C-INSTRUCTIONS(CONTINUED)
Exhibit 2C-4.Hazardous Substances
1.Acetaldehyde 73.Captan 144.Ferrous sulfate
2.Acetic acid 74.Carbaryl 145.Formaldehyde
3.Acetic anhydride 75.Carbofuran 146.Formic acid
4.Acetone cyanohydrin 76.Carbon disulfide 147.Fumaric acid
5.Acetyl bromide 77.Carbon tetrachloride 148.Furfural
6.Acetyl chloride 78.Chlordane 149.Guthion
7.Acrolein 79.Chlorine 150.Heptachlor
8.Acrylonitrile 80.Chlorobenzene 151.Hexachlorocyclopentadiene
9.Adipic acid 81.Chloroform 152.Hydrochloric acid
10.Aldrin 82.Chloropyrifos 153.Hydrofluoric acid
11.Allyl alcohol 83.Chlorosulfonic acid 154.Hydrogen cyanide
12.Allyl chloride 84.Chromic acetate 155.Hydrogen sulfide
13.Aluminum sulfate 85.Chromic acid 156.Isoprene
14.Ammonia 86.Chromic sulfate 157.Isopropanolamine dodecylbenzenesulfonate
15.Ammonium acetate 87.Chromous chloride 158.Kelthane
16.Ammonium benzoate 88.Cobaltous bromide 159.Kepone
17.Ammonium bicarbonate 89.Cobaltous formate 160.Lead acetate
18.Ammonium bichromate 90.Cobaltous sulfamate 161.Lead arsenate
19.Ammonium bifluonde 91.Coumaphos 162.Lead chloride
20.Ammonium bisulfate 92.Cresol 163.Lead fluoborate
21.Ammonium carbamate 93.Crotonaldehyde 164.Lead fluorite
22.Ammonium carbonate 94.Cupric acetate 165.Lead iodide
23.Ammonium chloride 95.Cupric acetoarsenite 166.Lead nitrate
24.Ammonium chromate 96.Cupric chloride 167.Lead stearate
25.Ammonium citrate 97.Cupric nitrate 168.Lead sulfate
26.Ammonium fluoroborate 98.Cupric oxalate 169.Lead sulfide
27.Ammonium fluoride 99.Cupric sulfate 170.Lead thiocyanate
28.Ammonium hydroxide 100.Cupric sulfate ammoniated 171.Lindane
29.Ammonium oxalate 101.Cupric tartrate 172.Lithium chromate
30.Ammonium silicofluoride 102.Cyanogen chloride 173.Malathion
31.Ammonium sulfamate 103.Cyclohexane 174.Maleic acid
32.Ammonium sulfide 104.2,4-D acid(2,4-dichlorophenoxyacetic acid) 175.Maleic anhydride
33.Ammonium sulfite 105.2,4-D esters(2,4-dichlorophenoxyacetic acid esters) 176.Mercaptodimethur
34.Ammonium tartrate 106.DDT(dichlorodiphenyltrichloroethane) 177.Mercuric cyanide
35.Ammonium thiocyanate 107.Diazinon 178.Mercuric nitrate
36.Ammonium thiosulfate 108.Dicamba 179.Mercuric sulfate
37.Amyl acetate 109.Dichlobenil 180.Mercuric thiocyanate
38.Aniline 110.Dichlone 181.Mercurous nitrate
39.Antimony pentachloricle 111.Dichlorobenzene 182.Methoxychlor
40.Antimony potassium tartrate 112.Dichloropropane 183.Methyl mercaptan
41.Antimony tribromide 113.Dichloropropene 184.Methyl methacrylate
42.Antimony trichloride 114.Dichloropropene-dichloproropane mix 185.Methyl parathion
43.Antimony trifluoride 115.2,2-dichloropropionic acid 186.Mevinphos
44.Antimony trioxide 116.Dichlorvos 187.Mexacarbate
45.Arsenic disulfide 117.Dieldrin 188.Monoethylamine
46.Arsenic pentoxide 118.Diethylamine 189.Monomethylamine
47.Arsenic trichloride 119.Dimethylamine 190.Naled
48.Arsenic trioxide 120.Dinitrobenzene 191.Naphthalene
49.Arsenic trisulfide 121.Dinitrophenol 192.Naphthenic acid
50.Barium cyanide 122.Dinitrotoluene 193.Nickel ammonium sulfate
51.Benzene 123.Diquat 194.Nickel chloride
52.Benzoic acid 124.Disulfoton 195.Nickel hydroxide
53.Benzonitrile 125.Diuron 196.Nickel nitrate
54.Benzoyl chloride 126.Dodecylbenzesulfonic acid 197.Nickel sulfate
55.Benzyl chloride 127.Endosulfan 198.Nitric acid
56.Beryllium chloride 128.Endrin 199.Nitrobenzene
57.Beryllium fluoride 129.Epichlorohydrin 200.Nitrogen dioxide
58.Beryllium nitrate 130.Ethion 201.Nitrophenol
59.Butytacetate 131.Ethylbenzene 202.Nitrotoluene
60.n-butylphthalate 132.Ethylenediamine 203.Paraformaldehyde
61.Butylamine 133.Ethylene dibromide 204.Parathion
62.Butyric acid 134.Ethylene dichloride 205.Pentachlorophenol
63.Cadmium acetate 135.EDTA(ethylene diaminetetracetic acid) 206.Phenol
64.Cadmium bromide 136.Ferric ammonium citrate 207.Phosgene
65.Cadmium chloride 137.Ferric ammonium oxalate 208.Phosphoric acid
66.Calcium arsenate 138.Ferric chloride 209.Phosphorus
67.Calcium arsenite 139.Ferric fluoride 210.Phosphorus oxychloride
68.Calcium carbide 140.Ferric nitrate 211.Phosphorus pentasulfide
69.Calcium chromate 141.Ferric sulfate 212.Phosphorus trichloride
70.Calcium cyanide 142.Ferrous ammonium sulfate 213.PCBs(polychlorinated biphenyls)
71.Calcium dodecylbenzenesulfonate 143.Ferrous chloride 214.Potassium arsenate
72.Calcium hypochlorite
2C-12

FORM 2C-INSTRUCTIONS(CONTINUED)
Exhibit 2C-4.Hazardous Substances(Continued)
215.Potassium arsenite 244.Sodium nitrite 270.Trimethylamine
216.Potassium bichromate 245.Sodium phosphate(dibasic) 271.Uranyl acetate
217.Potassium chromate 246.Sodium phosphate(tribasic) 272.Uranyl nitrate
218.Potassium cyanide 247.Sodium selenite 273.Vanadium penoxide
219.Potassium hydroxide 248.Strontium chromate 274.Vanadyl sulfate
220.Potassium permanganate 249.Strychnine 275.Vinyl acetate
221.Propargite 250.Styrene 276.Vinylidene chloride
222.Propionic acid 251.Sulfuric acid 277.Xylene
223.Propionic anhydride 252.Sulfur monochloride 278.Xylenol
224.Propylene oxide 253.2,4,5-T acid(2,4,5-trichlorophenoxyacetic acid) 279.Zinc acetate
225.Pyrethrins 254.2,4,5-T amines(2,4,5-trichlorophenoxy acetic acid 280.Zinc ammonium chloride
226.Quinoline amines) 281.Zinc borate
227.Resorcinol 255.2,4,5-T esters(2,4,5-trichlorophenoxy acetic acid 282.Zinc bromide
228.Selenium oxide esters) 283.Zinc carbonate
229.Silver nitrate 256.2,4,5-T salts(2,4,5-trichlorophenoxy acetic acid salts) 284.Zinc chloride
230.Sodium 257.2,4,5-TP acid(2,4,5-trichlorophenoxy propanoic acid) 285.Zinc cyanide
231.Sodium arsenate 258.2,4,5-TP acid esters(2,4,5-trichlorophenoxy propanoic 286.Zinc fluoride
232.Sodium arsenite acid esters) 287.Zinc formate
233.Sodium bichromate 259.TDE(tetrachlorodiphenyl ethane) 288.Zinc hydrosulfite
234.Sodium bifluoride 260.Tetraethyl lead 289.Zinc nitrate
235.Sodium bisulfite 261.Tetraethyl pyrophosphate 290.Zinc phenolsulfonate
236.Sodium chromate 262.Thallium sulfate 291.Zinc phosphide
237.Sodium cyanide 263.Toluene 292.Zinc silicofluoride
238.Sodium dodecylbenzenesulfonate 264.Toxaphene 293.Zinc sulfate
239.Sodium fluoride 265.Trichlorofon 294.Zirconium nitrate
240.Sodium hydrosulfide 266.Trichloroethylene 295.Zirconium potassium fluoride
241.Sodium hydroxide 267.Trichlorophenol 296.Zirconium sulfate
242.Sodium hypochlorite 268.Triethanolamine dodecylbenzenesulfonate 297.Zirconium tetrachloride
243.Sodium methylate 269.Triethylamine
2C-13

EPA Identification Number NPDES Permit Number Facility Name OMB No.2040-0004
Expires 07/31/2026
Form U.S.Environmental Protection Agency
2C tea",,►EPA Application for NPDES Permit to Discharge Wastewater
NPDES EXISTING MANUFACTURING,COMMERCIAL,MINING,AND SILVICULTURE OPERATIONS
SECTION 1.OUTFALL LOCATION(40 CFR 122.21(G)(1))
1.1 Provide information on each of the facility's outfalls in the table below.
0 Numbelr Receiving Water Name Latitude Longitude
U
0
J
A
7
0
SECTION 2. LINE DRAWING(40 CFR 122.21(G)(2))
p, 2_1 Have you attached a line drawing to this application that shows the water flow through your facility with a water
. balance?(See instructions for drawing requirements.See Exhibit 2C-1 at end of instructions for example.)
Yes
SECTION 3.AVERAGE FLOWS AND TREATMENT(40 CFR 122.21(G)(3))
3_1 For each outfall identified under Item 1.1,provide average flow and treatment information.Add additional sheets if
necessary.
**Outfall Number**
Operations Contributing to Flow
Operation Average Flow
mgd
mgd
rg
d
mgd
a
H mgd
° Treatment Units
Description Code from Final Disposal of Solid or
(include size,flow rate through each treatment unit, Exhibit 2C-2 Liquid Wastes Other Than
retention time,etc.) by Discharge
•
EPA Form 3510-2C Page 1

EPA Identification Number NPDES Permit Number Facility Name OMB No.2040-0004
Expires 07/31/2026
3_1 *"Outfall Number**
cont. Operations Contributing to Flow
Operation Average Flow
mgd
mgd
mgd
- - mgd
Treatment Units
Description Code from Final Disposal of Solid or
(include size,flow rate through each treatment unit, Liquid Wastes Other Than
retention time,etc.) Exhibit 2C-2 by Discharge
-v
a)
c
c
0
C�
c
m
E
iv
**Outfall Number**
Operations Contributing to Flow
o Operation Average Flow
LT
a, mgd
' mgd
mgd
mgd
Treatment Units
Description Code from Final Disposal of Solid or
(include size,flow rate through each treatment unit, Exhibit 2C-2 Liquid Wastes Other Than
retention time,etc.) by Discharge
3_2 Are you applying for an NPDES permit to operate a privately owned treatment works?
d d ❑ Yes ❑ No 4 SKIP to Section 4.
Nfg
3.3 Have you attached a list that identifies each user of the treatment works?
❑ Yes
EPA Form 3510-2C Page 2

EPA Identification Number NPDES Permit Number Facility Name OMB No.2040-0004
Expires 07/31/2026
SECTION 4. INTERMITTENT FLOWS(40 CFR 122.21(G)(4))
4.1 Except for storm runoff, leaks,or spills,are any discharges described in Sections 1 and 3 intermittent or seasonal?
❑ Yes ❑ No 4 SKIP to Section 5.
4.2 Provide information on intermittent or seasonal flows for each applicable outfall.Attach additional pages, if
necessary.
Outfall Operation Frequency Flow Rate
Number (list) Average Average Long-Term Maximum Duration
Days/Week Months/Year Average Daily
days/week months/year mgd mgd days
days/week months/year mgd mgd days
c
c: days/week months/year mgd mgd days
E
days/week months/year mgd mgd days
c
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
SECTION 5.PRODUCTION (40 CFR 122.21(G)(5))
5_1 Do any effluent limitation guidelines(ELGs)promulgated by EPA under Section 304 of the CWA apply to your
facility?
❑ Yes ❑ No . SKIP to Section 6.
c� 5.2 Provide the following information on applicable ELGs.
w ELG Category ELG Subcategory Regulatory Citation
d
� I
a
a
Q I
5 3 Are any of the applicable ELGs expressed in terms of production(or other measure of operation)?
❑ Yes ❑ No 4 SKIP to Section 6.
0
Y 5_4 Provide an actual measure of daily production expressed in terms and units of applicable ELGs.
Outfall Unit of
o Number Operation,Product,or Material Quantity per Day Measure
c �
0
.0
0
L
a
EPA Form 3510-2C Page 3

EPA Identification Number NPDES Permit Number Facility Name OMB No.2040-0004
Expires 07/31/2026
5_5 Are you requesting alternative limits based on an anticipated increase in the actual production during the next permit
term?(Consult with your NPDES permitting authority to determine what information needs to be submitted and
when.)
❑ Yes ❑ No
SECTION 6.IMPROVEMENTS(40 CFR 122.21(G)(6))
6_1 Are you presently required by any federal,state,or local authority to meet an implementation schedule for
constructing,upgrading,or operating wastewater treatment equipment or practices or any other environmental
programs that could affect the discharges described in this application?
❑ Yes ❑ No 4 SKIP to Item 6.3.
6.2 Briefly identify each applicable project in the table below.
Affected Final Compliance Dates
E Brief Identification and Description of Outfalls Source(s)of
Project (list outfall Discharge Required Projected
number)
E
C
a
it)
0.
rn
6.3 Have you attached sheets describing any additional water pollution control programs(or other environmental
projects that may affect your discharges)that you now have underway or planned?(optional item)
❑ Yes 0 No ❑ Not applicable
SECTION 7.EFFLUENT AND INTAKE CHARACTERISTICS(40 CFR 122.21(G)(7))
See the instructions to determine the pollutants and parameters you are required to monitor and,in turn,the tables you must
complete.Not all applicants need to complete each table.
Table A.Conventional and Non-Conventional Pollutants
7.1 Are you requesting a waiver from your NPDES permitting authority for any Table A pollutants for any of your
outfalls?
❑ Yes ❑ No 4 SKIP to Item 7.3.
7_2 If yes,indicate the applicable outfalls below or check the appropriate box to indicate that you are requesting a waiver
for all outfalls.Attach waiver request and other required information to the application.
Outfall number Outfall number Outfall number
❑ I am requesting a waiver for some pollutants at all outfalls.
❑ I am requesting a waiver for all pollutants at all outfalls 4 SKIP to Item 7.4.
7.3 Have you completed monitoring for all Table A pollutants at each of your outfalls for which a waiver has not been
requested and attached the results to this application package?
❑ Yes
w Table B.Toxic Metals,Cyanide,Total Phenols,and Organic Toxic Pollutants
7_4 Do any of the facility's processes that contribute wastewater fall into one or more of the primary industry categories
listed in Exhibit 2C-3?(See end of instructions for exhibit.)
❑ Yes ❑ No 4 SKIP to Item 7.8.
7.5 Have you checked"Testing Required"for all toxic metals,cyanide,and total phenols in Section 1 of Table B?
❑ Yes
EPA Form 3510-2C Page 4

EPA Identification Number NPDES Permit Number Facility Name OMB No.2040-0004
Expires 07/31/2026
7_6 List the applicable primary industry categories and check the boxes indicating the required GC/MS fraction(s)
identified in Exhibit 2C-3.
Primary Industry Category Required GC/MS Fraction(s)
(check applicable boxes)
❑Volatile ❑Acid 0 Base/neutral ❑ Pesticide
❑Volatile 0 Acid ❑ Base/neutral 0 Pesticide
❑Volatile ❑Acid ❑ Base/neutral 0 Pesticide
7_7 Have you checked"Testing Required"for all required pollutants in Sections 2 through 5 of Table B for each of the
GC/MS fractions checked in Item 7.6?
❑ Yes
7_8 Have you checked"Believed Present"or"Believed Absent"for all pollutants listed in Sections 1 through 5 of Table B
where testing is not required?
❑ Yes
7_9 Have you provided(1)quantitative data for those Section 1,Table B,pollutants for which you have indicated testing
is required or(2)quantitative data or other required information for those Section 1,Table B, pollutants that you
have indicated are"Believed Present"in your discharge?
❑ Yes
7.10 Does the applicant qualify for a small business exemption under the criteria specified in the instructions?
❑ Yes 4 Note that you qualify at the top of Table B, ❑ No
then SKIP to Item 7.12.
d 7.11 Have you provided(1)quantitative data for those Sections 2 through 5,Table B,pollutants for which you have
determined testing is required or(2)quantitative data or an explanation for those Sections 2 through 5,Table B,
cpollutants you have indicated are"Believed Present"in your discharge?
❑ Yes
Z.;H Table C.Certain Conventional and Non-Conventional Pollutants
7.12 I Have you indicated whether pollutants are"Believed Present"or"Believed Absent"for all pollutants listed in Table C
for all outfalls?
❑ Yes
7.13 Have you completed Table C by providing quantitative data for those pollutants that are limited either directly or
indirectly in an ELG?You must provide quantitative data even if the pollutant is"Believed Absent."
❑ Yes ❑ Not applicable
co 7.14 Haveyou completed Table C byprovidingquantitative data or an explanation for those pollutants for which you have
P
indicated"Believed Present"?
w ❑ Yes
Table D.Certain Hazardous Substances and Asbestos
7.15 Have you indicated whether pollutants are"Believed Present"or"Believed Absent"for all pollutants listed in Table D
for all outfalls?
❑ Yes
7.16 Have you completed Table D by(1)describing the reasons the applicable pollutants are expected to be discharged
and(2)providing quantitative data,if available?
❑ Yes ❑ No
Table E.2,3,7,8-Tetrachlorodibenzo-p-Dioxin(2,3,7,8-TCDD)
7.17 Does the facility use or manufacture one or more of the 2,3,7,8-TCDD congeners listed in the instructions,or do you
know or have reason to believe that TCDD is or may be present in the effluent?
❑ Yes 4 Complete Table E. ❑ No 4 SKIP to Section 8.
T18 Have you completed Table E by reporting qualitative data for TCDD?
❑ Yes
EPA Form 3510-2C Page 5

EPA Identification Number NPDES Permit Number Facility Name OMB No.2040-0004
Expires 07/31/2026
SECTION 8.USED OR MANUFACTURED TOXICS(40 CFR 122.21(G)(9))
8_1 Is any pollutant listed in Table B a substance or a component of a substance used or manufactured at your facility as
0 an intermediate or final product or byproduct?
tp
❑ Yes ❑ No 4 SKIP to Section 9.
a to 8_2 List the pollutants below.Attach additional sheets,if necessary.
P
3. 6. 9.
.ECTION 9. BIOLOGICAL TOXICITY TESTS(40 CFR 122.21(G)(11))
9_1 Do you have any knowledge or reason to believe that any biological test for acute or chronic toxicity has been made
within the last three years on(1)any of your discharges or(2)a receiving water in relation to your discharge?
N ❑ Yes ❑ No 4 SKIP to Section 10.
° 9_2 Identify the tests and their purposes below.
Test(s) Purpose of Test(s) Submitted to NPDES Date Submitted
Permitting Authority?
0
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
.ECTION 10.CONTRACT ANALYSES(40 CFR 122.21(G)(12))
10.1 Were any of the analyses reported in Section 7 performed by a contract laboratory or consulting firm?
❑ Yes ❑ No 4 SKIP to Section 11.
10.2 Provide information for each contract laboratory or consulting firm below.
Laboratory Number 1 Laboratory Number 2 Laboratory Number 3
Name of
laboratory/firm
N
Laboratory address
0 Phone number
Pollutant(s)analyzed
EPA Form 3510-2C Page 6

EPA Identification Number NPDES Permit Number Facility Name OMB No.2040-0004
Expires 07/31/2026
SECTION 11.ADDITIONAL INFORMATION(40 CFR 122.21(G)(13))
11.1 Has the NPDES permitting authority requested additional information?
0 0 Yes ❑ No +SKIP to Section 12.
E11.2 List the information requested and attach it to this application.
o
5 1. 4.
O
a 2. 5.
3. 6.
SECTION 12.CI-ECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(A)AND(D))
12.1 In Column 1 below,mark the sections of Form 2C that you have completed and are submitting with your application.
For each section,specify in Column 2 any attachments that you are enclosing to alert the permitting authority.Note
that not all applicants are required to complete all sections or provide attachments.
Column 1 Column 2
❑ Section 1:Outfall Location ❑ w/attachments
❑ Section 2: Line Drawing ❑ w/line drawing ❑ w/additional attachments
Section 3:Average Flows and
w/list of each user of
❑ Treatment ❑ w/attachments ❑ privately owned treatment
works
❑ Section 4: Intermittent Flows ❑ w/attachments
❑ Section 5:Production ❑ w/attachments
co w/optional additional
c 0 Section 6: Improvements ❑ w/attachments ❑ sheets describing any
additional pollution control
plans
❑ w/request for a waiver and ❑ w/explanation for
supporting information identical outfalls
w/small business exemption
H ❑ request ❑ w/other attachments
❑ Section 7:Effluent and Intake
d Characteristics ❑ w/Table A ❑ w/Table B
s
U
❑ w/Table C ❑ w/Table D
❑ w/Table E ❑ w/analytical results as an
attachment
Section 8: Used or Manufactured
❑ Toxics ❑ w/attachments
Section 9:Biological Toxicity
Tests ❑ w/attachments
❑ Section 10:Contract Analyses ❑ w/attachments
❑ Section 11:Additional ❑ w/attachments
Information
Section 12:Checklist and
❑ Certification Statement ❑ w/attachments
EPA Form 3510-2C Page 7

EPA Identification Number NPDES Permit Number Facility Name OMB No.2040-0004
Expires 07/31/2026
SECTION 12.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))(Continued)
12.2 Provide the following certification.(See instructions to determine the appropriate person to sign the application.)
Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my direction or
co supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate
o the information submitted.Based on my inquiry of the person or persons who manage the system,or those persons
'1 directly responsible for gathering the information,the information submitted is,to the best of my knowledge and
w belief,true,accurate,and complete.I am aware that there are significant penalties for submitting false information,
4, including the possibility of fine and imprisonment for knowing violations.
Name(print or type first and last name) Official title
tp
Signature Date signed
EPA Form 3510-2C Page 8

EPA Identification Number NPDES Permit Number Facility Name Outfall Number OMB No.2040-0004
Expires 07/31/2026
TABLE A.CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(iii))1
Effluent Intake
(optional)
Waiver
Pollutant Requested Units Maximum Maximum Long-Term
(if applicable) (specify) Daily Monthly Average Daily Number of Long-Term Number of
Discharge Discharge Discharge Analyses Average Value Analyses
(required) (if available) (if available)
❑ Check here if you have applied to your NPDES permitting authority for a waiver for all of the pollutants listed on this table for the noted outfall.
Biochemical oxygen demand Concentration
1' (BOD5) ❑ Mass
Chemical oxygen demand Concentration
2. (COD) ❑ Mass
Concentration
3. Total organic carbon(TOC) ❑
Mass
Concentration
4. Total suspended solids(TSS) ❑
Mass
Concentration
5. Ammonia(as N) ❑
Mass
6. Flow ❑ Rate
Temperature(winter) ❑ °C °C
7.
Temperature(summer) ❑ °C °C
pH(minimum) ❑ Standard units s.u.
8.
pH(maximum) ❑ Standard units s.u.
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR Chapter I,Subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C Page 9

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number OMB No.2040-0004
Expires 07/31/2026
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Term
Daily
of of
Discharge Discharge Di Average
sca� a Analyses Analyses
(required) (if available) (if available)
Value
� Check here if you qualify as a small business per the instructions to Form 2C and,therefore,do not need to submit quantitative data for any of the organic toxic pollutants in Sections
2 through 5 of this table. Note,however,that you must still indicate in the appropriate column of this table if you believe any of the pollutants listed are present in your discharge.
Section 1.Toxic Metals,Cyanide,and Total Phenols
Antimony,total0 Concentration
1.1 (7440 36 0) 0 0
Mass
1.2 Arsenic,total 0 Concentration
El El
(7440-38-2) Mass
1.3 Beryllium,total 0 Concentration
0 0
(7440-41-7) Mass
Cadmium,total Concentration
1.4 El
(7440-43-9) 0 0 Mass
Chromium,total Concentration
1.5 (7440-47-3) 0 0 0 Mass
1.6 Copper,total 0 Concentration
El 1=I
(7440-50-8) Mass
1.7 Lead,total 0 Concentration
0 0
(7439-92-1) Mass
Mercury,total0 Concentration
1.8 0 El
(7439-97-6) Mass
1.9 Nickel,total 0 Concentration
El 0
(7440-02-0) Mass
Selenium,total Concentration
1.10 El 1:1
(7782-49-2) �
Mass
Silver,total Concentration
1.11 (7440-22-4) 0
Mass
EPA Form 3510-2C Page 11

EPA Identification Number NPDES Permit Number Facility Name Outfall Number OMB No.2040-0004
Expires 07/31/2026
' TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Daily of Term of
Discharge Discharge Discharge Analyses Average Analyses
(required) (if available) Value
(if available)
1.12 Thallium,total 0 Concentration
CI 0
(7440-28-0) Mass
1.13 Zinc,total 0 Concentration
0 CI
(7440-66-6) Mass
1.14 Cyanide,total ❑ Concentration
0 0
(57-12-5) Mass _
1.15 Phenols,total CI CI Concentration
Mass
Section 2.Organic Toxic Pollutants(GC/MS Fraction—Volatile Compounds)
2.1 Acrolein ElConcentration
CI CI
(107-02-8) Mass
2.2 Acrylonitrile ❑ Concentration
CI CI
(107-13-1) Mass
2.3 Benzene ❑ Concentration
0 CI
(71-43-2) Mass
2 4 Bromoform 0 Concentration
CI CI
(75-25-2) Mass
2.5 Carbon tetrachloride CI CI Concentration
(56-23-5) Mass
Chlorobenzene El Concentration
2.6 0 CI
(108-90-7) Mass
2.7 Chlorodibromomethane CI CI Concentration
(124-48-1) Mass
2.8 Chloroethane ❑ Concentration
CI CI
(75-00-3) Mass
EPA Form 3510-2C Page 12

EPA Identification Number NPDES Permit Number Facility Name Outfall Number OMB No.2040-0004
Expires 07/31/2026
TABLE B.TOXIC METALS, CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Term
of
Discharge Discharge Di Average of a Analyses Average Analyses
(required) (if available) (if avails rge) Value
2-chloroethylvinyl ether Concentration
2.9 (110-75-8) ❑ ❑ ❑ Mass
Concentration
2.10 Chloroform(67-66-3) ❑ ❑ ❑ Mass
2.11 Dichlorobromomethane ❑ ❑ Concentration
(75-27-4) Mass
2.12 1,1-dichloroethane 0 0 0 Concentration
(75-34-3) Mass
2.13 1,2-dichloroethane 0
0
❑ Concentration
(107-06-2) Mass •
2.14 11-dichloroethylene 0 ❑ Concentration
(75-35-4) Mass
2.15 12-dichloropropane ❑ Concentration
(78-87-5) Mass
2.16 1,3-dichloropropylene ❑ ❑ Concentration
(542-75-6) Mass
217 Ethylbenzene El ❑ Concentration
(100-41-4) Mass
2.18 Methyl bromide ❑ ❑ Concentration
(74-83-9) Mass
2.19 Methyl chloride ❑ Concentration
1:1 El
(74-87-3) Mass
2.20 Methylene chloride ❑ I: Concentration
(75-09-2) Mass
2.21 1 1,2 2-tetrachloroethane 0 0 Concentration
(79-34-5) Mass
EPA Form 3510-2C Page 13

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ssew (b-1.0-9L)
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ssew (9-00-6L)
uol;ea;uaou00 ❑ El Elauey;aaolyoia;-Z`l.`I. 9Z'Z
ssew (9-99-1L)
uoi;ea;ueouo0 0 0 0 auey;aaolyou;-r VI.
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ssew (£-99-90 0
uol;ea;uaouo0 ❑ ❑ ❑ auenIol £Z'Z
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P000-04OZ ON SWO JagwnN Ileilnp aweN 1G!IPed JagwnN iluliad S3GdN JagwnN uogeogpuapI Vd3

EPA Identification Number NPDES Permit Number Facility Name Outfall Number OMB No.2040-0004
Expires 07/31/2026
TABLE B.TOXIC METALS, CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Daily of Term of
Disc req h aribge) Df ava labllee) verag
Discharge Analyses AValuee Analyses
(if available)
3.6 2-nitrophenol Concentration
0 0 0
(88-75-5) Mass
4-nitrophenol Concentration
3.7 0 0 0
(100-02-7) Mass
3.8 p-chloro-m-cresol 0 0 Concentration
(59-50-7) Mass
3.9 Pentachlorophenol � Concentration
(87-86-5) Mass
Phenol Concentration
3.10 (108-95-2)
Mass
3.11 2 4,6-trichlorophenol � Concentration
(88-05-2) Mass
Section 4.Organic Toxic Pollutants(GC/MS Fraction—Base/Neutral Compounds)
4.1 Acenaphthene Concentration
(83-32-9) Mass
4.2 Acenaphthylene � Concentration
(208-96-8) Mass
4.3 Anthracene I Concentration
0 0 0
(120-12-7) Mass
4.4 Benzidine Concentration
0 0 0
(92-87-5) Mass
4.5 Benzo(a)anthracene � Concentration
(56-55-3) Mass
4.6 Benzo(a)pyrene � Concentration
(50-32-8) Mass
EPA Form 3510-2C Page 15

EPA Identification Number NPDES Permit Number Facility Name Outfall Number OMB No.2040-0004
Expires 07/31/2026
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent (optional)
Pollutant/Parameter Testing Units Long-Term
Maximum Maximum Long-
(and CAS Number,if available) Required Believed Believed (specify) Daily Monthly Average Number Term Number
Present Absent Daily of of
Discharge Discharge Discharge Analyses Average Analyses
(required) (if available) Value
(if available)
4.7 3,4-benzofluoranthene 0 Concentration
0 0
(205-99-2) Mass
4.8 Benzo(ghi)perylene ❑ Concentration
(191-24-2) Mass
4.9 Benzo(k)fluoranthene El Concentration
(207-08-9) Mass
Bis(2-chloroethoxy)methane 0 Concentration
4.10 0 0
(111-91-1) Mass
Bis(2-chloroethyl)ether 0 Concentration
4.11 (111-44-4) Mass
Bis(2-chloroisopropyl)ether 0 Concentration
4.12 (102-80-1) 0 El
Mass
4.13 Bis(2-ethylhexyl)phthalate 0 ❑ 0 Concentration
(117-81-7) Mass
4.14 4-bromophenyl phenyl ether ❑ Concentration
0 El
(101-55-3) Mass
4.15 Butyl benzyl phthalate ❑ ❑ 0 Concentration
(85-68-7) Mass
4.16 2-chloronaphthalene ❑ Concentration
El El
(91-58-7) Mass
4-chlorophenyl phenyl ether 0 Concentration
4.17 0 0
(7005-72-3) Mass
Chrysene Concentration
4.18 (218-01-9) 0 El
Mass
4.19 Dibenzo(a,h)anthracene ❑ El0 Concentration
(53-70-3) Mass
EPA Form 3510-2C Page 16

EPA Identification Number NPDES Permit Number Facility Name Outfall Number OMB No.2040-0004
Expires 07/31/2026
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent
(optional)
Pollutant/Parameter Testing Units Long-Term
Long-
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Present Absent
Daily Monthly Average Number Term Number
of of
Discharge Discharge Di Averagea Analyses Average Analyses
(required) (if available) g Value
(if available)
4.20 12-dichlorobenzene 0 Concentration
El El
(95-50-1) Mass
4.21 1,3-dichlorobenzene 0 Concentration
0 0
(541-73-1) Mass
4.22 1 4-dichlorobenzene 0 Concentration
(106-46-7) Mass
4.23 3,3-dichlorobenzidine 0 Concentration
0 0
(91-94-1) Mass
4.24 Diethyl phthalate 0 Concentration
El 11
(84-66-2) Mass
4.25 Dimethyl phthalate El ID Concentration
(131-11-3) Mass
4.26 Di-n-butyl phthalate 0 Concentration
El 11(84-74-2) Mass
4.27 2,4-dinitrotoluene 0 Concentration
11 El
(121-14-2) Mass
4.28 2,6-dinitrotoluene 0 Concentration
El 11
(606-20-2) Mass
4 29 Di-n-octyl phthalate ❑ El Concentration
(117-84-0) Mass
4.30 1,2-Diphenylhydrazine ❑ ❑ 0
Concentration
(as azobenzene)(122-66-7) Mass
4.31 Fluoranthene 0 Concentration
(206-44-0) Mass
4.32 Fluorene 0 Concentration
11 El
(86-73-7) Mass
EPA Form 3510-2C Page 17

EPA Identification Number NPDES Permit Number Facility Name Outfall Number OMB No.2040-0004
Expires 07/31/2026
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Daily of Term of
D ch ge Discharge
available) Discharge Analyses AverageValue Analyses
(required) ( (if available)
4.33 Hexachlorobenzene El 0 0 Concentration
(118-74-1) Mass
4.34 Hexachlorobutadiene 0 Concentration
(87-68-3) Mass
4.35 Hexachlorocyclopentadiene ❑ Concentration
(77-47-4) Mass
4.36 Hexachloroethane 0 ❑ ❑ Concentration
(67-72-1) Mass
4.37 Indeno(1,2,3-cd)pyrene 0 ❑ Concentration
(193-39-5) Mass
4.38 Isophorone 0 Concentration
(78-59-1) Mass
4.39 Naphthalene ❑ Concentration
(91-20-3) Mass
4.40 Nitrobenzene ❑ Concentration
(98-95-3) Mass
4.41 N-nitrosodimethylamine ❑ ❑ ❑ Concentration
(62-75-9) Mass
4.42 N-nitrosodi-n-propylamine ❑ ❑ ❑ Concentration
(621-64-7) Mass
4.43 N-nitrosodiphenylamine ❑ ❑ ❑ Concentration
(86-30-6) Mass
4.44 Phenanthrene 0 Concentration
0 0
(85-01-8) Mass
Pyrene Concentration
4.45 (129-00-0) 0 0 0 Mass
EPA Form 3510-2C Page 18

EPA Identification Number NPDES Permit Number Facility Name Outfall Number OMB No.2040-0004
Expires 07/31/2026
TABLE B.TOXIC METALS, CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent (optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Term
of of
Discharge Discharge DailyAnalyses Average
DischargeAnalyses
(required) (if available) (if available)
Value
4.46 1,2 4-trichlorobenzene ID ❑ ❑ Concentration
(120-82-1) Mass
Section 5.Organic Toxic Pollutants(GC/MS Fraction—Pesticides)
Aldrin Concentration
5.1 (309-00-2) GI ❑ ❑ Mass
a-BHC Concentration
5.2 (319-84-6) ❑ El Mass
I3-BHC Concentration
5.3 (319-85-7) El El Mass
y-BHC Concentration
5.4 (58-89-9) ❑ 0 0 Mass
b-BHC Concentration
5.5 (319-86-8) ❑ ❑ ❑ Mass
5.6 Chlordane ❑ ❑ 0 Concentration
(57-74-9) Mass
5.7 4 4'-DDT 0
0 0 Concentration
(50-29-3) Mass
5.8 4 4'-DDE 0
0 0 Concentration
(72-55-9) Mass
5.9 4 4'-DDD El ❑ ❑ Concentration
(72-54-8) Mass
Dieldrin Concentration
5.10 (60-57-1) 0 ❑ 0 Mass
5.11 a-endosulfan 0
0 0 Concentration
(115-29-7) Mass
EPA Form 3510-2C Page 19

EPA Identification Number NPDES Permit Number Facility Name Outfall Number OMB No.2040-0004
Expires 07/31/2026
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent (optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Daily of Term of
Discharge DischargeDischarge Analyses AverageValue Analyses
(required) f available) (if available)
5.12 R-endosulfan 0 ❑ ❑ Concentration
(115-29-7) Mass
Endosulfan sulfate Concentration
5.13 (1031-07-8) El El El
Mass
5.14 Endrin ❑ 0
❑ Concentration
(72-20-8) Mass
Endrin aldehyde Concentration
5.15 (7421-93-4) 0 0 0
Mass
5.16 Heptachlor ❑ ❑ ❑ Concentration
(76-44-8) Mass
Heptachlor epoxide Concentration
5.17 (1024-57-3) 0 0 0
Mass
PCB-1242 Concentration
5.18 (53469-21-9) ❑ 0 0
Mass
PCB-1254 Concentration
5.19 (11097-69-1) ❑ ❑ ❑
Mass
PCB-1221 Concentration
5.20 (11104-28-2) ❑ ❑ ❑
Mass
PCB-1232 Concentration
5.21 (11141-16-5) 0 0 0
Mass
PCB-1248 Concentration
5.22 (12672-29-6) ❑ ❑ ❑
Mass
PCB-1260 Concentration
5.23 (11096-82-5) ❑ ❑ ❑
Mass
PCB-1016 Concentration
5.24 (12674-11-2) 0 0 0
Mass
EPA Form 3510-2C
Page 20

EPA Identification Number NPDES Permit Number Facility Name Outfall Number OMB No.2040-0004
Expires 07/31/2026
TABLE B.TOXIC METALS, CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent (optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Daily of Term of
Discharge Discharge Discharge Analyses Average Analyses
(required) (if available) Value
(if available)
Toxaphene Concentration
5.25 (8001-35-2) ❑ ❑
Mass
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR Chapter I,Subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C Page 21

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number OMB No.2040-0004
Expires 07/31/2026
TABLE C.CERTAIN CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(vi))1
Presence or Absence Intake
(check one) Effluent (optional)
1 Pollutant Units Maximum Long-Term
Believed Believed (specify) Maximum Daily Long-Term
Present Absent Discharge Monthly Average Daily Number of Average Number of
(required) Discharge Discharge Analyses Analyses
(if available) (if available) Value
El Check here if you believe all pollutants in Table C to be present in your discharge from the noted outfall.You need not complete the"Presence or Absence"column of Table C for
each pollutant.
0 Check here if you believe all pollutants in Table C to be absent in your discharge from the noted outfall.You need not complete the"Presence or Absence"column of Table C for
each pollutant.
1 Bromide El El Concentration
(24959-67-9) Mass
2 Chlorine,total ❑ El Concentration
residual Mass
0 CI
3. Color
Mass
Concentration
4. Fecal coliform ❑ ❑ Mass
5 Fluoride CI ❑ Concentration
(16984-48-8) Mass
Concentration
6 Nitrate-nitrite ❑ ❑ Mass
7 Nitrogen,total CI CI
organic(as N) Mass
8. Oil and grease CI CIConcentration
Mass
9 Phosphorus(as CI ❑ Concentration
P),total(7723-14-0) Mass
10. Sulfate(as SO4) 0 El Concentration
(14808-79-8) Mass
Concentration
11. Sulfide(as S) ❑ ❑ Mass
EPA Form 3510-2C Page 23

4Z e6ed
OZ-0l9E wood t/d3
SSeW (9-Z£-044L)
uo!}e�}uaouo0 0 0 Rol`wn!uel!1 'EZ
•
SSew (s-i.e-044L)
uol;ei}uaouo0 0 0 lelo}'u!1 .ZZ
SSew (9-96-6£4L)
uol}ei}uaouo0 0 0 le;o;'esaue6ueW lZ
SSeW (L-86-6£4L)
- ❑ 0 le;o} 'OZ
uo!}eJ}uaouo0 `wnuapgAloj
sseW (4-5s-s£4L)
uol}e�lueouo0 0 0 le}o}'wnpu6eW •6l
SSew (9-69-6CPL)
uol}e�luaouo0 El Elle}o;'ual 8l
sseW (4-84-044L)
uol;ei}uaouo0 0 0 le}o;';lego0 •L 6
SSeW (8-Z4-044L)
uo!le�luaouo0 El El `uoJo8 96
SSeW (£-6£-044L)
uoge.i}uaouo0 0 0 le}ol'wnue9 .S6
SSeW (9-06-6ZpL)
uo4eJ}uaouo0 ❑ 0 le}ol'wnu!wnly b• 6
sseW
uogBJ}uaouo0
❑ Els}ue}oejns 'El,
SSeW (£-54-993p6) Z6
uolle�luaouo0 0 0 (cos se)owns
(aIgellene i!) (aigepene j!)
SeSi(leUy anleA saslcleuy a6iegas!a arming]
aa (pa�g3s
a6eny a6aeyasla }uasgy }uesaid
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waal-6uol wnw!xeW spun lue;nllod
(leuoi}do)
axle;ul ;uanl}13 (auo�loayo)
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((!n)(L)(6)1.Z.ZZI.2130 0p)SINVllll1Od 1VNOI1N3ANO0 NON ONV 1VN011N3ANO0 NI`d12130 '0 318‘11
9Z0U1£ILO sei!dx3
4000-040Z ON MO JagwnN I1e10O aweN Icl!Iped JagwnN;hued S34dN JagwnN uogeogguepl Vd3

EPA Identification Number NPDES Permit Number Facility Name Outfall Number OMB No.2040-0004
Expires 07/31/2026
TABLE C.CERTAIN CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(vi))1
Presence or Absence Intake
(check one) Effluent (optional)
Pollutant Units Maximum Long-Term
Believed Believed (specify) Maximum DailyLong-Term
Present Absent Discharge Monthly Average Daily Number of Average Number of
Discharge Discharge Analyses Analyses
(required) Value
(if available) (if available)
24. Radioactivity
Concentration
Alpha,total ❑ ❑ Mass
Beta,total ❑ ❑ Concentration
Mass
Concentration
Radium,total ❑ ❑ Mass
Concentration
Radium 226,total ❑ ❑ Mass
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR Chapter I,Subchapter N or O.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C Page 25

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Duffel'Number OMB No.2040-0004
Expires 07/31/2026
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 12221(g)(7)(vii))1
Presence or Absence
Pollutant (check one) Available Quantitative Data
Believed Believed Reason Pollutant Believed Present in Discharge (specify units)
Present Absent
1. Asbestos ❑ ❑
2. Acetaldehyde ❑ ❑
3. Allyl alcohol ❑ ❑
4. Allyl chloride ❑ ❑
5. Amyl acetate 0 ❑
6. Aniline ❑ ❑
7. Benzonitrile ❑ ❑
8. Benzyl chloride ❑ ❑
9. Butyl acetate ❑ ❑
10. Butylamine ❑ ❑
11. Captan ❑ ❑
12. Carbaryl ❑ ❑
13. Carbofuran ❑ El
14. Carbon disulfide ❑ ❑
15. Chlorpyrifos ❑ ❑
16. Coumaphos El ❑
17. Cresol ❑ ❑
18. Crotonaldehyde ❑ ❑
19. Cyclohexane ❑ ❑
EPA Form 3510-2C Page 27

EPA Identification Number NPDES Permit Number Facility Name Outfall Number OMB No.2040-0004
Expires 07/31/2026
TABLE D. CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 122.21(g)(7)(vii))1
Presence or Absence
Pollutant (check one) Reason Pollutant Believed Present in Discharge Available Quantitative Data
Believed Believed (specify units)
Present Absent
20. 2,4-D(2,4-dichlorophenoxyacetic acid) ❑ ❑
21. Diazinon ❑ ❑
22. Dicamba ❑ ❑
23. Dichlobenil ❑ ❑
24. Dichlone ❑ 0
25. 2,2-dichloropropionic acid 0 ❑
26. Dichlorvos ❑ ❑
27. Diethyl amine 0 ❑
28. Dimethyl amine 0 0
29. Dintrobenzene 0 ❑
30. Diquat ❑ ❑
31. Disulfoton ❑ ❑
32. Diuron ❑ ❑
33. Epichlorohydrin 0 ❑
34. Ethion ❑ ❑
35. Ethylene diamine ❑ ❑
36. Ethylene dibromide ❑ ❑
37. Formaldehyde ❑ ❑
38. Furfural ❑ ❑
EPA Form 3510-2C Page 28

EPA Identification Number NPDES Permit Number Facility Name Outfall Number OMB No.2040-0004
Expires 07/31/2026
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 12221(g)(7)(vii))r
Presence or Absence
Pollutant (check one) Available Quantitative Data
Believed Believed Reason Pollutant Believed Present in Discharge
(specify units)
Present Absent
39. Guthion ❑ 0
40. Isoprene 0 0
41. Isopropanolamine 0 0
42. Kelthane 0 0
43. Kepone 0 0
44. Malathion 0 0
45. Mercaptodimethur 0 0
46. Methoxychlor ❑ 0
47. Methyl mercaptan 0 0
48. Methyl methacrylate ❑ 0
49. Methyl parathion 0 0
50. Mevinphos 0 0
51. Mexacarbate 0 0
52. Monoethyl amine 0 0
53. Monomethyl amine 0 0
54. Naled 0 0
55. Naphthenic acid 0 0
56. Nitrotoluene 0 0
57. Parathion ❑ 0
EPA Form 3510-2C Page 29

EPA Identification Number NPDES Permit Number Facility Name Outfall Number OMB No.2040-0004
Expires 07/31/2026
TABLE D. CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 12221(g)(7)(vii))'
Presence or Absence
Pollutant (check one) Available Quantitative Data
Believed Believed Reason Pollutant Believed Present in Discharge (specify units)
Present Absent
58. Phenolsulfonate ❑ ❑
59. Phosgene ❑ ❑
60. Propargite ❑ ❑
61. Propylene oxide ❑ 0
62. Pyrethrins 0 0
63. Quinoline ❑ ❑
64. Resorcinol ❑ ❑
65. Strontium ❑ ❑
66. Strychnine ❑ ❑
67. Styrene ❑ ❑
68. 2,4,5-T(2,4,5-trichlorophenoxyacetic ❑ ❑
acid)
69. TDE(tetrachlorodiphenyl ethane) ❑ ❑
70. 2,4,5-TP[2-(2,4,5-trichlorophenoxy) ❑ ❑
propanoic acid]
71. Trichlorofon 0 0
72. Triethanolamine ❑ 0
73. Triethylamine ❑ ❑
74. Trimethylamine ❑ ❑
75. Uranium ❑ ❑
76. Vanadium ❑ ❑
EPA Form 3510-2C Page 30

EPA Identification Number NPDES Permit Number Facility Name Outfall Number OMB No.2040-0004
Expires 07/31/2026
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 122.21(g)(7)(vii))'
Presence or Absence
Pollutant (check one) Available Quantitative Data
Believed Believed Reason Pollutant Believed Present in Discharge (specify units)
Present Absent
77. Vinyl acetate ❑ ❑
78. Xylene ❑ ❑
79. Xylenol ❑ ❑
80. Zirconium ❑ ❑
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR Chapter I,Subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C Page 31

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number OMB No.2040-0004
Expires 07/31/2026
TABLE E.2,3,7,8 TETRACHLORODIBENZO P DIOXIN(2,3,7,8 TCDD)(40 CFR 122.21(g)(7)(viii))
TCDD Presence or
Congeners Absence
Pollutant Used or (check one) Results of Screening Procedure
Manufactured Believed Believed
Present Absent
2,3,7,8-TCDD 0 0 ❑
EPA Form 3510-2C Page 33

Attachment 1C
Form 2F Major industrial facilities with stormwater outfalls
D E Q North Carolina Department im Qu Dices
,,,,--
512 North Salisbury Street 1 of1611Env Mail Serviceental CenteralityI I Raleigh,NorthWater CarolinaResour 27699-1611
d uN^ o..�r\ r 919.707.9000

United States Office of Water OMB No.2040-0004
Environmental Protection Agency Washington, D.C. Expires 07/31/2026
Water Permits Division
EPA Application Form 2F
Stormwater Discharges
Associated with Industrial
Activity
NPDES Permitting Program
Note: Complete this form and Form 1 if you are a new or existing facility whose discharge is composed
entirely of stormwater associated with industrial activity, excluding discharges from construction
activity under 40 CFR 122.26(b)(14)(x) or(b)(15). If your discharge is composed of stormwater and
non-stormwater, you must complete Forms 1 and 2F, and you must complete Form 2C, 2D, or 2E, as
appropriate. See the "Instructions" inside for further details.

Paperwork Reduction Act Notice
This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C.
3501 et seq. (OMB Control No. 2040-0004). Responses to this collection of information are mandatory
(40 CFR 122.21 and 40 CFR 122.26). An agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it displays a currently valid OMB control
number. The public reporting and recordkeeping burden for this collection of information is estimated to
be 2.7 hours per response. Send comments on the Agency's need for this information, the accuracy of
the provided burden estimates and any suggested methods for minimizing respondent burden to the
Regulatory Support Division Director, U.S. Environmental Protection Agency(2821T), 1200
Pennsylvania Ave.,NW, Washington, D.C. 20460.Include the OMB control number in any
correspondence. Do not send the completed form to this address.

FORM 2F—INSTRUCTIONS
General Instructions Public Availability of Submitted Information
Who Must Complete Form 2F? The U.S. Environmental Protection Agency(EPA)will make
You must complete Form 2F if you answered"Yes"to Item 1.2.5 information from NPDES permit application forms available to
on Form 1—that is,you are a new or existing facility and your the public for inspection and copying upon request.You may not
discharge is composed entirely of stormwater associated with claim any information on Form 2F(or related attachments) as
industrial activity(excluding discharges from construction confidential.
activity under 40 CFR 122.26(b)(14)(x)or(b)(15)) or composed You may make a claim of confidentiality for any information that
of stormwater and non-stormwater and are seeking coverage you submit to EPA that goes beyond the information required by
under an individual National Pollutant Discharge Elimination Form 2F. Note that NPDES permitting authorities will deny
System(NPDES)permit. Note that applicants in the latter claims for treating any effluent data(estimated or actual)as
category must also complete Forms 2C, 2D, or 2E, as confidential. If you do not assert a claim of confidentiality at the
applicable. See inset below. time you submit your information to the NPDES permitting
Notes authority, EPA may make the information available to the public
without further notice to you. EPA will handle claims of
• Form 2F must be completed by any operator of a confidentiality in accordance with its business confidentiality
facility that discharges stormwater associated with regulations in Part 2 of Title 40 of the Code of Federal
industrial activity or the operator of any Regulations(CFR).
stormwater discharger that EPA is evaluating for Completion of Forms
designation as a significant contributor of
pollutants to waters of the United States, or as Print or type in the specified areas only. If you do not have
contributing to a violation of a water quality enough space on the form to answer a question,you may
standard. continue on additional sheets, as necessary, using a format
• For discharges composed entirely of stormwater, consistent with the form.
the operator must complete Form 2F in Do not leave any response areas blank unless the form directs
conjunction with Form 1. you to skip them. If the form directs you to respond to an item
• For discharges of stormwater combined with that does not apply to your facility or activity, enter"NA"for"not
process wastewater,the operator must complete applicable"to show that you considered the item and
and submit Form 2F, Form 1, and Form 2C. determined a response was not necessary for your facility.
Process wastewater is water that comes into The NPDES permitting authority will consider your application
direct contact with or results from the production complete when it and any supplementary material are received
or use of any raw material,intermediate product, and completed according to the authority's satisfaction.The
finished product,byproduct,waste product, or NPDES permitting authority will judge the completeness of any
wastewater. application independently of the status of any other permit
• For discharges of stormwater combined with application or permit for the same facility or activity.
nonprocess wastewater,the operator must
complete Form 2F, Form 1, and Form 2E. Definitions
Nonprocess wastewater indudes noncontact The legal definitions of all key terms used in these instructions
cooling water and sanitary wastes that are not and Form 2F are in the"Glossary"at the end of the"General
regulated by effluent guidelines, except Instructions"in Form 1.
discharges by educational, medical, or
commercial chemical laboratories. Line-by-Line Instructions
• For new discharges of stormwater associated with EPA Identification Number, NPDES Permit Number, Facility
industrial activity that will be combined with other Name,and Outfall Number
new non-stormwater discharges,the operator Provide your EPA Identification Number from the Facility
must submit Form 2F, Form 1, and Form 2D. Registry Service, NPDES permit number.and facility name at
the top of each page of Form 2F and any attachments. If your
facility is new(i.e., not yet constructed),write or type"New
Where to File Your Completed Form Facility"in the space provided for the EPA Identification Number
an NPDES permit number. If you do not know your EPA
Submit your completed application package(Forms 1 and 2F Identification Number, contact your NPDES permitting authority.
plus any other applicable forms)to your NPDES permitting See Exhibit 1-1 of Form 1's"General Instructions"for contact
authority.Consult Exhibit 1-1 of Form l's"General Instructions" information.Additionally,for Tables A through D,provide the
to identify your NPDES permitting authority. applicable outfall number at the top of each page.
2F-1

FORM 2F—INSTRUCTIONS(CONTINUED)
Section 1.Outfall Location an outline of drainage areas served by the outfall(s)covered in
Item 1.1.Identify each of the facility's outfalls by number. For the application.The site map must include the following
each outfall, specify the latitude and longitude to the nearest 15 information:
seconds or equivalent decimal degrees(e.g.,38.893829,- • Each of its drainage and discharge structures.
77.029289)and name of the receiving water. Latitude and • The drainage area of each stormwater outfall.
longitude coordinates may be obtained in a variety of ways,
including use of hand held devices(e.g.,a GPS enabled • Paved areas and buildings within the drainage area of each
smartphone),internet mapping tools,geographic information stormwater outfall;each past or present area used for
systems(e.g.,ArcView),or paper maps from trusted sources outdoor storage or disposal of significant materials; each
(e.g.,U.S.Geological Survey or USGS).The location of each existing structural control measure to reduce pollutants in
outfall(i.e.,where the coordinates are collected)shall be the stormwater runoff;materials loading and access areas;and
location where collected and concentrated stormwater flows are areas where pesticides,herbicides,soil conditioners,and
discharged from the facility such that the first receiving water fertilizers are applied.
body into which the discharge flows,either directly or through a • Each hazardous waste treatment,storage,or disposal
separate storm sewer system,is a water of the United States. If facility(including each area not required to have a
you need further guidance in responding to Item 1.1,refer to Resource Conservation and Recovery Act permit and is
http://www.epa.gov/geospatial/latitudelongitude-data-standard. used for accumulating hazardous waste for less than 90
Note: In EPA's stormwater permits,`outfalls"are referred to as days under 40 CFR 262.34).
"discharge points." • Each well where fluids from the facility are injected
Note that space has been provided on the form for six outfalls. If
underground.
you have more than this number,type your information on a • Springs and other surface water bodies that receive
separate sheet of paper in a format similar to that of the form. stormwater discharges from the facility.
Make sure you note the EPA Identification Number, NPDES When you have completed and attached your site map to Form
permit number,and facility name at the top of the page and 2F,answer"Yes"to Item 3.1.
indicate the specific item of the form to which you are Section 4.Pollutant Sources
responding—Item 1.1 in this case. In other sections of the form,
you will be asked to provide information by outfall number Item 4.1.List all outfalls discharging stormwater.Provide an
(Sections 2,4, 5,and 7). estimate of the impervious surface area drained by the outfall.
Specify units of measure.(Impervious surfaces are surfaces
Section 2.Improvements where stormwater runs off at rates significantly higher than
Item 2.1.Indicate if you are required by any federal,state,or background rates—e.g.,predevelopment levels.They include
local authority to meet an implementation schedule for paved areas, building roofs,parking lots,and roadways.)
constructing,upgrading,or operating wastewater treatment Provide an estimate of the total surface area(impervious and
equipment or practices or any other environmental programs pervious areas)drained by each outfall(within a mile radius of
that could affect the discharges described in this application. the facility).You may use the site map developed under Item 3.1
The requirements include,but are not limited to,permit to estimate the total area drained by each outfall.For areas
conditions,administrative enforcement orders,enforcement under 5 acres,consult your NPDES permitting authority to
compliance schedule letters, stipulations,court orders,and determine whether the area should be reported to the nearest
grant or loan conditions. If yes, continue to Item 2.2. If no,skip tenth of an acre or nearest quarter of an acre.
to Section 3.
Item 4.2.Provide a narrative description of the following:
Item 2.2.Briefly identify and describe each applicable project
(e.g.,consent decree,enforcement order,or permit condition). • Significant materials that in three years prior to the
For each condition,specify the affected outfall number(s),the submittal of this application have been treated,stored,or
source(s)of the discharge,the required final compliance date, disposed of in a manner to allow exposure to stormwater.
and the projected final compliance date. • Method of treatment, storage, or disposal of such
Item 2.3.OPTIONAL ITEM. Indicate if you have attached any materials.
sheets describing any additional water pollution control • Materials management practices employed,in the three
programs(or other environmental projects that could affect your years prior to the submittal of this application,to minimize
discharges)that you may now have underway or planned. If you contact by these materials with stormwater runoff.
attach additional sheets,indicate in the attachment whether • Materials loading and access areas.
each program is actually underway or is planned,and indicate
your actual or planned schedule for construction.Be sure to •
The location, manner,and frequency in which pesticides,
note your EPA Identification Number,NPDES permit number, herbicides,soil conditioners, and fertilizers are applied.
and facility name at the top of any attached pages. You should identify your significant materials by chemical name,
Section 3.Site Drainage Map form(e.g.,powder,liquid),and type of container or treatment
unit. Indicate any materials treated,stored,or disposed of
Item 3.1 Attach a site drainage map showing the topography of together.The term"significant materials"includes,but is not
the facility.If a topographic map is unavailable,you may provide
2F-2

FORM 2F—INSTRUCTIONS(CONTINUED)
limited to:raw materials;fuels;materials such as solvents, parameters and pollutants listed in Exhibits 2F-2,2F-3,and
detergents,and plastic pellets;finished materials such as 2F-4(at the end of the instructions).The instructions for
metallic products;raw materials used in food processing or completing Tables A through D are table-specific, as are the
production; hazardous substances designated under Section criteria for determining who should complete them.
101(14)of the Comprehensive Environmental Response, Important note: Read the"General Instructions for Reporting,
Compensation,and Liability Act; any chemical the facility is Sampling,and Analysis"below before completing Items 7.2 to
required to report pursuant to Section 313 of Title III of the 7.17.
Superfund Amendments and Reauthorization Act; and fertilizers;
pesticides;and waste products such as ashes,slag,and sludge Item 7.2 and Table A.All applicants must complete Table A. If
that have the potential to be released with stormwater the discharge is an existing discharge and your discharge is
discharges. composed exclusively of stormwater(i.e.,no process or
Item 4.3.For each outfall,list the location and type of existing nonprocess wastewater)then you only need to provide
structural and non-structural control measure(s)to reduce monitoring data for oil and grease,total phosphorus,total
pollutants in stormwater runoff.Structural controls include Kjeldahl nitrogen,and total nitrogen. Indicate"NA"for"not
structures that enclose materials handling or storage areas; applicable"in the columns for all other parameters.Answer
structures that cover materials; and berms,dikes,or diversion "Yes"to Item 7.2 once you have completed this task.
ditches around manufacturing,production,storage,or treatment Item 7.3 and Table B.Indicate whether the facility is subject to
units and retention ponds.Spill prevention plans,employee an effluent limitations guideline(ELG)(see 40 CFR Subchapter
training,visual inspections, preventive maintenance,and N to determine which pollutants are limited in ELGs)or if the
housekeeping measures are examples of non-structural facility is subject to effluent limitations in an NPDES permit for
controls. its process wastewater or stormwater(if the facility is operating
Describe the treatment,including the schedule and type of under an existing NPDES permit). If yes,continue to Item 7.4.If
no,skip to Item 7.5.
maintenance activities performed,and the ultimate disposal of
any solid or fluid wastes other than by discharge.For each Note:Stormwater discharges from certain industrial sources or
structural control identified,indicate the type of treatment the activities have specific ELGs for which they must comply.These
stormwater receives using the codes in Exhibit 2F-1, at the end stormwater-specific ELGs include:
of the instructions. For each non-structural control identified, Regulated Discharge 40 CFR Section
indicate"Not Applicable"in the"Codes from Exhibit 2F-1"
column. Discharges resulting from spraydown or Part 429,
intentional wetting of logs at wet deck storage Subpart I
Section 5.Non-Stormwater Discharges areas
Item 5.1.Provide a certification that all outfalls that should Runoff from phosphate fertilizer manufacturing Part 418,
contain stormwater discharges associated with industrial activity facilities that comes into contact with any raw Subpart A
have been tested or evaluated for the presence of non- materials,finished product,byproducts,or
stormwater discharges.Tests for such non-stormwater waste products(SIC 2874)
discharges can include smoke tests,fluorometric dye tests, Runoff from asphalt emulsion facilities Part 443,
analysis of accurate schematics,and others. Subpart A
Item 5.2. Include a description of the method used,the date of Runoff from material storage piles at cement Part 411,
any testing,and the onsite drainage points that were directly manufacturing facilities Subpart C
observed during a test used to support the certification in Item Mine dewatering discharges at crushed stone, Part 436,
5.1.All non-stormwater discharges must be identified in a Form construction sand and gravel,or industrial sand Subparts B,C,
2C, 2D,or 2E.See"Who Must Complete Form 2F?"above for mining facilities and D
more information. Runoff from hazardous waste and non- Part 445,
Section 6.Significant Leaks or Spills hazardous waste landfills Subparts A and
Item 6.1.Describe any significant leaks or spills of toxic or
hazardous pollutants at the facility within the three years prior to Runoff from coal storage piles at steam electric Part 423
the submittal of this application. Include the approximate date generating facilities
and location of the spill or leak and the type and amount of Runoff containing urea from airfield pavement Part 449
material released. deicing at existing and new primary airports
with 1,000 or more annual non-propeller
Section 7.Discharge Information aircraft departures
Item 7.1.Answer whether you are a new source or new Item 7.4.In Table B, list all pollutants that are limited in an ELG
discharge.Contact your NPDES permitting authority to to which the facility is subject and all pollutants listed in the
determine if you are a new source or new discharge. facility's NPDES permit for its process wastewater(if the facility
Tables A,B,C,and D is operating under an existing NPDES permit)and provide
Items 7.2 to 7.17.These items require you to collect and report quantitative data for each pollutant(provide actual data for
data in Tables A through D,at the end of Form 2F,for the existing dischargers and estimated data for new sources and
new dischargers). If a pollutant in Exhibits 2F-2 or 2F-3 is
2F-3

FORM 2F—INSTRUCTIONS(CONTINUED)
indirectly limited by an ELG through an indicator(e.g.,use of Item 7.10. Indicate whether you expect any of the pollutants
total suspended solids as an indicator to control the discharge of from Exhibit 2F-3 to be discharged in concentrations of 10 parts
iron and aluminum),you must provide data for the pollutant in per billion(ppb)or greater. If yes, continue to Item 7.11.If no,
Table B.Complete one table for each outfall.Answer"Yes"to skip to Item 7.12.
Item 7.4 once you have completed this task. Item 7.11.Provide quantitative data in Table C for those
Item 7.5 and Table C.Table C requires you to address the pollutants in Exhibit 2F-3 that you expect to be discharged in
pollutants in Exhibits 2F-2,2F-3,and 2F-4 for each outfall. concentrations of 10 ppb or greater(provide actual data for
Pollutants in each of these exhibits are addressed differently. existing dischargers and estimated data for new sources and
Indicate whether you know or have reason to believe any new dischargers).Answer"Yes"to Item 7.11 once you have
pollutants in Exhibit 2F-2 are present in the discharge. If yes, completed this task.
continue to Item 7.6. If no,skip to Item 7.7. Item 7.12.Indicate whether you expect acrolein,acrylonitrile,
Item 7.6.For each outfall,list all pollutants in Exhibit 2F-2 that 2,4-dinitrophenol,or 2-methyl-4,6-dinitrophenol to be discharged
you know or have reason to believe are present in the discharge in concentrations of 100 ppb or greater. If yes,continue to Item
in Table C(except pollutants previously listed in Table B that are 7.13. If no,skip to Item 7.14.
limited directly or indirectly by an ELG)and either report Item 7.13.Provide quantitative data in Table C for the pollutants
quantitative data or briefly describe the reasons the pollutant is identified in Item 7.12 that you expect to be discharged in
expected to be discharged.Answer"Yes"to Item 7.6 once you concentrations of 100 ppb or greater(provide actual data for
have completed this task. existing dischargers and estimated data for new sources and
Item 7.7.This item asks if you qualify as a"small business."If new dischargers).Answer"Yes"to Item 7.13 once you have
so,you are exempt from the reporting requirements for the completed this task.
organic toxic pollutants listed in Exhibit 2F-3. Item 7.14.For any pollutants you expect to be present in the
You can qualify as a small business in two ways:(1)if your discharge at concentrations less than 10 ppb(or less than
facility is a coal mine and if your probable total annual 100 ppb for the above four pollutants),either submit quantitative
production is less than 100,000 tons per year,you may submit data or briefly describe the reasons the pollutant is expected to
past production data or estimated future production(such as a be discharged in Table C.Answer"Yes"to Item 7.14 once you
schedule of estimated total production under 30 CFR 795.14(c)) have completed this task.
instead of conducting analyses for the organic toxic pollutants; Item 7.15.Indicate whether you know or have reason to believe
(2)if your facility is not a coal mine and if your gross total annual any pollutants in Exhibit 2F-4 are present in the discharge. If
sales for the most recent three years average less than yes,continue to Item 7.16. If no,skip to Item 7.17.
$100,000 per year(in second quarter 1980 dollars),you may Item 7.16.For each outfall, list any pollutant in Exhibit 2F-4 that
submit sales data for those years instead of conducting you know or believe to be present in the discharge in Table C
analyses for the organic toxic pollutants.The production or sales and explain why you believe it to be present. No analysis is
data must be for the facility that is the source of the discharge. required,but if you have analytical data,you must report it.
The data should not be limited to production or sales for the Answer"Yes"to Item 7.16 once you have completed this task.
process or processes that contribute to the discharge,unless
those are the only processes at your facility. For sales data,in Note:Under 40 CFR 117.12(a)(2),certain discharges of hazardous
situations involving intra-corporate transfer of goods and substances(listed in Exhibit 2F-5)may be exempted from the
services,the transfer price per unit should approximate market requirements of CWA Section 311,which establishes reporting
prices for those goods and services as closely as possible. requirements,civil penalties,and liability for cleanup costs for spills
Sales figures for years after 1980 should be indexed to the of oil and hazardous substances.A discharge of a particular
second quarter of 1980 by using the gross national product price substance can be exempted if the origin,source,and amount of the
deflator(second quarter of 1980=100).This index is available discharged substances are identified in the NPDES permit
online from the U.S.Department of Commerce, Bureau of application or in the permit,if the permit contains a requirement for
Economic Analysis, at treatment of the discharge,and if the treatment is in place.If you
https://apps.bea.gov/national/pdf/SNTables.pdf. would like to apply for an exemption from the requirements of CWA
Section 311,attach additional sheets of paper to your application,
If you qualify as a small business according to the criteria setting forth the following information:
above,answer"Yes"to Item 7.7 and skip to Item 7.18.
Otherwise,answer"No"and continue to Item 7.8. 1. The substance and the amount of each substance that might be
discharged.
Item 7.8.Indicate whether you know or have reason to believe 2. The origin and source of the discharge of the substance.
any pollutants in Exhibit 2F-3 are present in the discharge. If
yes, continue to Item 7.9. If no,skip to Item 7.10. 3. The treatment to be provided for the discharge by:
a. An onsite treatment system separate from any treatment
Item 7.9.For each outfall, list all pollutants in Exhibit 2F-3 that system treating your normal discharge;
you know or have reason to believe are present in the discharge b. A treatment system designed to treat your normal discharge
in Table C(except pollutants previously listed in Table B). and that is additionally capable of treating the amount of the
Answer"Yes"to Item 7.9 once you have completed this task. substance identified under paragraph 1 above;or
2F-4

FORM 2F—INSTRUCTIONS(CONTINUED)
c. Any combination of the above. Item 9.2.Provide the name,address, phone number, and
See 40 CFR 117.12(a)(2)and(c)or contact your NPDES permitting pollutants analyzed by the laboratory or consulting firm(s)in the
authority for further information on exclusions from CWA spaces provided.
Section 311. Section 10.Checklist and Certification Statement
Item 10.1.Review the checklist provided on the application. In
Item 7.17 and Table D.Provide data for the storm event(s)that Column 1,mark the sections of Form 2F that you have
resulted in the maximum daily discharges for the flow weighted completed and are submitting with your application. For each
composite sample in Table D. If sampling is conducted during section in Column 2,indicate whether you are submitting
more than one storm event,you only need to report the attachments.
information requested in Table D for the storm event(s)that Item 10.2.The Clean Water Act(CWA)provides for severe
resulted in any maximum pollutant concentration reported in penalties for submitting false information on this application
Tables A through C. form.Section 309(c)(2)of the CWA provides that, "Any person
Provide flow measurements or estimates of the flow rate,as well who knowingly makes any false material statement,
as the total amount of discharge for the storm event(s)sampled, representation,or certification in any application, ...shall upon
the method of flow measurement,or estimation. Provide the conviction be punished by a fine of not more than$10,000 or by
data and duration of the storm event(s)sampled,rainfall imprisonment for not more than six months or both."
measurements,or estimates of the storm event that generated FEDERAL REGULATIONS AT 40 CFR 122.22 REQUIRE THIS
the sampled runoff and the duration between the storm event APPLICATION TO BE SIGNED AS FOLLOWS:
sampled and the end of the previous measurable(greater than
0.1 inch rainfall)storm event.Answer"Yes"to Item 7.17 once A. For a corporation,by a responsible corporate officer.For
you have completed this task. the purpose of this section, a responsible corporate officer
Used or Manufactured Toxics means:(1)a president, secretary,treasurer,or vice-
president of the corporation in charge of a principal
Item 7.18.Review Exhibits 2F-2 through 2F-4 and determine if business function,or any other person who performs
you currently use or manufacture any of the pollutants listed as similar policy-or decision-making functions for the
intermediate or final products or byproducts. If so,answer"Yes." corporation,or(2)the manager of one or more
You should also answer"Yes"if you know or have reason to manufacturing, production,or operating facilities,provided
believe that 2,3,7,8-tetrachloro-dibenzo-p-dioxin(TCDD)is the manager is authorized to make management decisions
discharged or if you use or manufacture 2,4,5-trichlorphenoxy which govern the operation of the regulated facility
acetic acid(2,4,5-T); 2-(2,4,5-trichlorophenoxy)propanoic acid including having the explicit or implicit duty of making major
(Silvex,2,4,5-TP);2-(2,4,5-trichlorophenoxy)ethyl,2,2- capital investment recommendations,and initiating and
dichloropropionate(Erbon);0,0-dimethyl 0-(2,4,5-trichlorphenyl) directing other comprehensive measures to assure long
phosphorothioate(Ronnel);2,4,5-trichlorophenol(TCP);or term environmental compliance with environmental laws
hexachlorophene(HCP). If your answer to Item 7.18 is"No," and regulations;the manager can ensure that the
skip to Section 8. necessary systems are established or actions taken to
gather complete and accurate information for permit
Item 7.19.List all of the toxic pollutants identified under Item application requirements;and where authority to sign
7.18,including TCDD.Note that the NPDES permitting authority documents has been assigned or delegated to the
may waive or modify the requirement if you demonstrate that it manager in accordance with corporate procedures.
would be unduly burdensome to identify each toxic pollutant and B. For a partnership or sole proprietorship, by a general
the NPDES permitting authority has adequate information to partner or the proprietor,respectively.
issue your permit.You may not claim any information submitted C. For a municipality,state,federal,or other public facility,by
in response to Item 7.18 as confidential; however,you do not either a principal executive officer or ranking elected
have to distinguish between use or production of the pollutants official. For purposes of this section, a principal executive
or list the amounts. officer of a federal agency includes:(1)the chief executive
Section 8.Biological Toxicity Testing Data officer of the agency or(2)a senior executive officer having
Item 8.1.Answer whether you know of or have reason to responsibility for the overall operations of a principal
believe that biological toxicity testing has been conducted of geographic unit of the agency(e.g.,Regional
your wastewater treatment,including engineering reports or pilot Administrators of EPA).
plant studies. If no,skip to Section 9.Otherwise, continue. END
Item 8.2.List any tests of which you are aware and their Submit your completed Form 1,Form 2F,and
purposes. all associated attachments
(and any other required NPDES application forms)
Section 9.Contract Analysis Information to your NPDES permitting authority.
Item 9.1.Indicate if any of the analyses performed in Section 7
were performed by a contract laboratory or consulting firm. If no,
skip to Section 10. If yes,continue to Item 9.2.
2F-5

FORM 2F—INSTRUCTIONS(CONTINUED)
General Instructions for Reporting,Sampling,and Analysis
Important note: Read these instructions before completing Base your determination that a pollutant is/will be present in your
Tables A through C and Section 7 of Form 2F. discharge on your knowledge of the facility's raw materials,
General Items material management practices,maintenance chemicals,history
of spills and releases,intermediate and final products and
Complete the applicable tables for each outfall at your facility.Be byproducts,and any previous analyses known to you of your
sure to note the EPA Identification Number, NPDES permit effluent or similar effluent.
number,facility name,and applicable outfall number at the top of Sampling
each table page and any associated attachments.
You may report some or all of the required data by attaching The collection of the samples for the reported analyses should be
separate sheets of paper instead of completing Tables A through supervised by a person experienced in performing sampling of
C for each of your outfalls so long as the sheets contain all of the industrial wastewater or stormwater discharges.You may contact
required information and are similar in format to Tables A through your NPDES permitting authority for detailed guidance on
C. For example,you may be able to print a report in a compatible sampling techniques and for answers to specific questions.See
format from the data system used in your gas chromatography/ Exhibit 1-1 of Form 1 for contact information.Any specific
mass spectrometry(GC/MS)analysis completed under Table B. requirements in the analytical methods—for example,sample
containers,sample preservation,holding times,and the collection
If you are an existing discharger,you are required to report actual of duplicate samples—must be followed.
quantitative data.See"Use of Historical Data"below for use of The time when you sample should be representative of your
historical data. If you are a new source or discharge,you may normal operation to the extent feasible,with all processes that
supply estimated data along with the source of each estimate. If contribute wastewater in normal operation,and with your
you have quantitative data available,however,you must provide treatment system operating properly with no system upsets.
it.Base estimates on available in-house or contractor engineering Collect samples from the center of the flow channel,where
reports or any other studies performed on the proposed facility. turbulence is at a maximum,at a site specified in your present
Use the following codes to report your source information in the NPDES permit or at any site adequate for the collection of a
"Source of Information"column: representative sample.
Data Source Code Grab samples must be taken in the first 30 minutes of discharge
Engineering reports 1 (or as soon thereafter as practicable)for pH,temperature,
Actual data from pilot plants 1 cyanide,total phenols, residual chlorine,oil and grease,fecal
Estimates from other engineering 2 coliform(including E. coli)and enterococci(previously known as
reports fecal streptococcus at 40 CFR 122.26(d)(2)(iii)(A)(3)),and volatile
Data from other similar plants 3 organic compounds.You are not required to analyze a flow-
Best professional estimates 4 weighted composite for these parameters.
Others 5 and specify on
the table For all other pollutants,both a grab sample collected during the
first 30 minutes(or as soon thereafter as practicable)of the
No later than 24 months after your facility commences to discharge and a flow-weighted composite sample must be
discharge,you must complete and submit sampling and analysis analyzed.However,a minimum of one grab sample may be taken
data for the pollutants and parameters in Tables A through C. for effluents from holding ponds or other impoundments with a
However,you need not report results for tests you have already retention period of greater than 24 hours.
performed and reported under the discharge monitoring
requirements of your NPDES permit. All samples must be collected from the discharge resulting from a
Table A requires you to report at least one analysis for each storm event that is greater than 0.1 inches and at least 72 hours
from the previously measurable(greater than 0.1 inch rainfall)
pollutant listed.Tables B and C require you to report analytical storm event.Where feasible,the variance in the duration of the
data in two ways.For some pollutants addressed in Tables B and event and the total rainfall of the event should not exceed 50
C,if you know or have reason to know that the pollutant is percent from the average or median rainfall event in that area.
present in your discharge,you may be required to list the
pollutant and test(sample and analyze)and report the levels of A grab sample must be taken during the first 30 minutes of the
the pollutants in your discharge.For all other pollutants discharge(or as soon thereafter as practicable),and a flow-
addressed in Tables B and C,you must list the pollutant if you weighted composite must be taken for the entire event or for the
know or have reason to know that it is present in the discharge; first three hours of the event.
you must also either report quantitative data for the pollutant or Grab and composite samples are defined as follows:
briefly describe the reasons it is expected to be discharged.(See
Items 7.2 through 7.17 of the instructions for completing Tables A Grab sample:An individual sample of at least 100 milliliters
through C.) collected during the first 30 minutes(or as soon thereafter as
practicable)of the discharge.This sample is to be analyzed
separately from the composite sample.
2F-6

FORM 2F—INSTRUCTIONS(CONTINUED)
General Instructions for Reporting,Sampling,and Analysis Continued
Flow-weighted composite sample:A flow-weighted composite Concentration Mass
sample may be taken with a continuous sampler that proportions ppm=parts per million lbs.=pounds
the amount of sample collected with the flow rate or as a mg/L=milligrams per liter ton=tons(English
combination of a minimum of three sample aliquots taken in each tons)
hour of discharge for the entire event or for the first three hours of ppb=parts per billion mg=milligrams
the event,with each aliquot being at least 100 milliliters and pg/L=micrograms per liter g=grams
collected with a minimum period of 15 minutes between aliquot kg=kilograms
collections.The composite must be flow proportional;the time MPN=most probable number T=tonnes(metric
interval between either each aliquot or the volume of each aliquot per 100 milliliters
must be proportional to either the stream(effluent)flow at the tons)
time of sampling or the total stream(effluent)flow since the All reporting of values for metals must be in terms of"total
collection of the previous aliquot.Aliquots may be collected recoverable metal"unless:
manually or automatically.Where GC/MS volatile organic
analysis is required,aliquots must be combined in the laboratory • An applicable,promulgated ELG specifies the limitation for
immediately before analysis.Only one analysis for the composite the metal in dissolved,valent,or total form;
sample is required. • All approved analytical methods for the metal inherently
Use of Historical Data measure only its dissolved form(e.g.,hexavalent chromium);
or
Existing data may be used,if available,in lieu of sampling
conducted solely for the purposes of this application,provided • The NPDES permitting authority has determined that in
they are representative of the present discharge and were establishing case-by-case limitations it is necessary to
collected within 3 years of the application due date. If you sample express the limitations of the metal in dissolved,valent,or
for a listed pollutant on a monthly or more frequent basis, total form to carry out the provisions of the CWA.
summarize the data collected within one year of the application If you measure only one grab sample and one flow-weighted
for the pollutant(s)at issue. composite sample for a given outfall,complete only the"Maximum
Among the factors that would cause the data to be Daily Discharge"columns in the tables and enter"1"in the
unrepresentative are significant changes in production level; "Number of Storm Events Sampled"column.The NPDES
9
permitting authoritymayrequire you to conduct additional
changes in raw materials,processes,or final products;and p g
changes in stormwater treatment.The NPDES permitting analyses to further characterize your discharges.
authority may request additional information,including current If you measure more than one value for a grab sample or a flow-
quantitative data, if they determine it to be necessary to assess weighted composite sample for a given outfall and those values
your discharges.The NPDES permitting authority may allow or are representative of your discharge,you must report them.You
establish appropriate site-specific sampling procedures or must describe your method of testing and analysis.
requirements including sampling locations,the season in which
the sampling takes place,the minimum duration between the The"Average Daily Discharge"column in Tables A to C is not
previous measurable storm event and the storm event sampled, compulsory but should be filled out if data are available.To
the minimum or maximum level of precipitation required for an complete the"Average Daily Discharge"column,determine the
appropriate storm event,the form of precipitation sampled(snow average of all values within the last year and report the
melt or rainfall),protocols for collecting samples under 40 CFR concentration and mass.Report the total number of storm events
136,and additional time for submitting data on a case-by-case sampled under the"Number of Storm Events Sampled"column.
basis. Substantially Identical Outfalls
Reporting If you have two or more substantially identical outfalls,you may
Report sampling results for all pollutants in Tables A through C request permission from your NPDES permitting authority to
as concentration and mass,with the exception of flow, sample and analyze only one outfall and submit the results of the
temperature,pH,color,and fecal coliform organisms. analysis for all substantially identical outfalls. If your request is
granted,submit the following information on a separate sheet
Flow,temperature,pH,color,and fecal coliform organisms must
be reported as million gallons per day(mgd),degrees Celsius attached to the application form:the identity of the outfall you did
test and an explanation of how it is substantially identical to the
(°C),standard units,color units,and most probable number per
100 milliliters(MPN/100 mL),respectively.Use the following outfall(s)that you did not test.
abbreviations in the columns requiring"units"in Tables A
through C.
2F-7

FORM 2F—INSTRUCTIONS(CONTINUED)
General Instructions for Reporting,Sampling,and Analysis Continued
Analysis Consistent with 40 CFR 136,you may provide matrix-or sample-
Except as specified below,all required quantitative data shall be specific MLs rather than the published levels.Further,where you
collected in accordance with sufficiently sensitive analytical can demonstrate that,despite a good faith effort to use a method
methods approved under 40 CFR 136 or required under 40 CFR that would otherwise meet the definition of"sufficiently sensitive,"
Chapter I,Subchapter N or 0.A method is"sufficiently sensitive" the analytical results are not consistent with the quality assurance
when: (QA)/quality control(QC)specifications for that method,then the
NPDES permitting authority may determine that the method is not
• The method minimum level(ML)is at or below the level of performing adequately and the NPDES permitting authority should
the applicable water quality criterion for the measured select a different method from the remaining EPA-approved
pollutant or pollutant parameter. methods that is sufficiently sensitive consistent with 40 CFR
The method ML is above the water quality criterion,but the 122.21(e)(3)(i).Where no other EPA-approved methods exist,you
• amount of the pollutant or pollutant parameter in the facility's must select a method consistent with 40 CFR 122.21(e)(3)(ii).
discharge is high enough that the method detects and When there is no analytical method that has been approved under
quantifies the level of the pollutant or pollutant parameter in 40 CFR 136;required under 40 CFR Chapter I,Subchapter N or
the discharge. 0;or otherwise required by the NPDES permitting authority,you
The method has the lowest ML of the analytical methods may use any suitable method but shall provide a description of the
• approved under 40 CFR 136 or required under 40 CFR method.When selecting a suitable method,you may consider
Chapter I,Subchapter N or 0,for the measured pollutant or other factors such as a method's precision,accuracy,or
pollutant parameter. resolution.
2F-8

FORM 2F—INSTRUCTIONS(CONTINUED)
Exhibit 2F-1.Codes for Treatment Units and Disposal of Wastes Not Discharged
1. PHYSICAL TREATMENT PROCESSES
1-A Ammonia stripping 1-M Grit removal
1-B Dialysis 1-N Microstraining
1-C Diatomaceous earth filtration 1-0 Mixing
1-D Distillation 1-P Moving bed filters
1-E Electrodialysis 1-Q Multimedia filtration
1-F Evaporation 1-R Rapid sand filtration
1-G Flocculation 1-S Reverse osmosis(hyperfiltration)
1-H Flotation 1-T Screening
1-I Foam fractionation 1-U Sedimentation(settling)
1-J Freezing 1-V Slow sand filtration
1-K Gas-phase separation 1-W Solvent extraction
1-L Grinding(comminutors) 1-X Sorption
2. CHEMICAL TREATMENT PROCESSES
2-A Carbon adsorption 2-G Disinfection(ozone)
2-B Chemical oxidation 2-H Disinfection(other)
2-C Chemical precipitation 2-I Electrochemical treatment
2-D Coagulation 2-J Ion exchange
2-E Dechlorination 2-K Neutralization
2-F Disinfection(chlorine) 2-L Reduction
3. BIOLOGICAL TREATMENT PROCESSES
3-A Activated sludge 3-E Pre-aeration
3-B Aerated lagoons 3-F Spray irrigation/land application
3-C Anaerobic treatment 3-G Stabilization ponds
3-D Nitrification-denitrification 3-H Trickling filtration
4. WASTEWATER DISPOSAL PROCESSES
4-A Discharge to surface water 4-C Reuse/recycle of treated effluent
4-B Ocean discharge through outfall 4-D Underground injection
5. SLUDGE TREATMENT AND DISPOSAL PROCESSES
5-A Aerobic digestion 5-M Heat drying
5-B Anaerobic digestion 5-N Heat treatment
5-C Belt filtration 5-0 Incineration
5-D Centrifugation 5-P Land application
5-E Chemical conditioning 5-Q Landfill
5-F Chlorine treatment 5-R Pressure filtration
5-G Composting 5-S Pyrolysis
5-H Drying beds 5-T Sludge lagoons
5-I Elutriation 5-U Vacuum filtration
5-J Flotation thickening 5-V Vibration
5-K Freezing 5-W Wet oxidation
5-L Gravity thickening
2F-9

FORM 2F—INSTRUCTIONS(CONTINUED)
Exhibit 2F-2.Conventional and Nonconventional Pollutants(40 CFR 122.21,Appendix D,Table IV)
Bromide
Chlorine,total residual
Color
Fecal coliform
Fluoride
Nitrate-nitrite
Nitrogen,total organic(as N)
Oil and grease
Phosphorus(as P),total
Radioactivity(as alpha,total;beta,total;radium,total;and radium 226,total)
Sulfate(as SO4)
Sulfide(as S)
Sulfite(as SO3)
Surfactants
Aluminum,total
Barium,total
Boron,total
Cobalt,total
Iron,total
Magnesium,total
Molybdenum,total
Manganese,total
Tin,total
Titanium,total
2F-10

FORM 2F—INSTRUCTIONS(CONTINUED)
Exhibit 2F-3.Toxic Pollutants(40 CFR 122.21,Appendix D,Tables II and III)
Toxic Pollutants and Total Phenol
Antimony,total Copper,total Silver,total
Arsenic,total Lead,total Thallium,total
Beryllium,total Mercury,total Zinc,total
Cadmium,total Nickel,total Cyanide,total
Chromium,total Selenium,total Phenols,total
GC/MS Fraction—Volatile Compounds
Acrolein Dichlorobromomethane 1,1,2,2-tetrachloroethane
Acrylonitrile 1,1-dichloroethane Tetrachloroethylene
Benzene 1,2-dichloroethane Toluene
Bromoform 1,1-dichloroethylene 1,2-trans-dichloroethylene
Carbon tetrachloride 1,2-dichloropropane 1,1,1-trichloroethane
Chlorobenzene 1,3-dichloropropylene 1,1,2-trichloroethane
Chlorodibromomethane Ethyl benzene Trichloroethylene
Chloroethane Methyl bromide Vinyl chloride
2-Chloroethylvinyl ether Methyl chloride
Chloroform Methylene chloride
GC/MS Fraction—Acid Compounds
2-chlorophenol 2,4-dinitrophenol Pentachlorophenol
2,4-dichlorophenol 2-nitrophenol Phenol
2,4-dimethylphenol 4-nitrophenol 2,4,6-trichlorophenol
4,6-dinitro-o-cresol P-chloro-m-cresol
GCIMS Fraction—Base/Neutral Compounds
Acenaphthene 4-chlorophenyl phenyl ether Hexachlorobenzene
Acenaphthylene Chrysene Hexachlorobutadiene
Anthracene Dibenzo(a,h)anthracene Hexachlorocyclopentadiene
Benzidine 1,2-dichlorobenzene Hexachloroethane
Benzo(a)anthracene 1,3-dichlorobenzene Indeno(1,2,3-cd)pyrene
Benzo(a)pyrene 1,4-dichlorobenzene Isophorone
3,4-benzofluoranthene 3,3-dichlorobenzidine Naphthalene
Benzo(ghi)perylene Diethyl phthalate Nitrobenzene
Benzo(k)fluoranthene Dimethyl phthalate N-nitrosodimethylamine
Bis(2-chloroethoxy)methane Di-n-butyl phthalate N-nitrosodi-n-propylamine
Bis(2-chloroethyl)ether 2,4-dinitrotoluene N-nitrosodiphenylamine
Bis(2-chloroisopropyl)ether 2,6-dinitrotoluene Phenanthrene
Bis(2-ethylhexyl)phthalate Di-n-octyl phthalate Pyrene
4-bromophenyl phenyl ether 1,2-diphenylhydrazine(as azobenzene) 1,2,4-trichlorobenzene
Butyl benzyl phthalate Fluoranthene
2-chloronaphthalene Fluorene
GC/MS Fraction—Pesticides
Aldrin Dieldrin PCB-1254
a-BHC a-endosulfan PCB-1221
13-BHC 13-endosulfan PCB-1232
y-BHC Endosulfan sulfate PCB-1248
b-BHC Endrin PCB-1260
Chlordane Endrin aldehyde PCB-1016
4,4'-DDT Heptachlor Toxaphene
4,4'-DDE Heptachlor epoxide
4,4'-DDD PCB-1242
2F-11

FORM 2F—INSTRUCTIONS(CONTINUED)
Exhibit 2F-4.Certain Hazardous Substances and Asbestos(40 CFR 122.21,Appendix D,Table V)
Toxic Pollutant
Asbestos
Hazardous Substances
Acetaldehyde Dintrobenzene Naphthenic acid
Allyl alcohol Diquat Nitrotoluene
Allyl chloride Disulfoton Parathion
Amyl acetate Diuron Phenolsulfonate
Aniline Epichlorohydrin Phosgene
Benzonitrile Ethion Propargite
Benzyl chloride Ethylene diamine Propylene oxide
Butyl acetate Ethylene dibromide Pyrethrins
Butylamine Formaldehyde Quinoline
Captan Furfural Resorcinol
Carbaryl Guthion Strontium
Carbofuran Isoprene Strychnine
Carbon disulfide Isopropanolamine Styrene
Chlorpyrifos Kelthane 2,4,5-T(2,4,5-trichlorophenoxyacetic
acid)
Coumaphos Kepone TDE(tetrachlorodiphenyl ethane)
Cresol Malathion 2,4,5-TP[2-(2,4,5-trichlorophenoxy)
propanoic aad]
Crotonaldehyde Mercaptodimethur Trichlorofon
Cyclohexane Methoxychlor Triethanolamine
2,4-D(2,4-dichlorophenoxyacetic acid) Methyl mercaptan Triethylamine
Diazinon Methyl methacrylate Trimethylamine
Dicamba Methyl parathion Uranium
Dichlobenil Mevinphos Vanadium
Dichlone Mexacarbate Vinyl acetate
2,2-dichloropropionic acid Monoethyl amine Xylene
Dichlorvos Monomethyl amine Xylenol
Diethyl amine Naled Zirconium
Dimethyl amine
2F-12

FORM 2F-INSTRUCTIONS(CONTINUED)
Exhibit 2F-5.Hazardous Substances
1.Acetaldehyde 73.Captan 144.Ferrous sulfate
2.Acetic acid 74.Carbaryl 145.Formaldehyde
3.Acetic anhydride 75.Carbofuran 146.Formic acid
4.Acetone cyanohydrin 76.Carbon disulfide 147.Fumaric acid
5.Acetyl bromide 77.Carbon tetrachloride 148.Furfural
6.Acetyl chloride 78.Chlordane 149.Guthion
7.Acrolein 79.Chlorine 150.Heptachlor
8.Acrylonitrile 80.Chlorobenzene 151.Hexachlorocyclopentadiene
9.Adipic acid 81.Chloroform 152.Hydrochloric acid
10.Aldrin 82.Chloropyrifos 153.Hydrofluoric acid
11.AIlyl alcohol 83.Chlorosulfonic acid 154.Hydrogen cyanide
12.Ally!chloride 84.Chromic acetate 155.Hydrogen sulfide
13.Aluminum sulfate 85.Chromic acid 156.Isoprene
14.Ammonia 86.Chromic sulfate 157.Isopropanolamine dodecylbenzenesulfonate
15.Ammonium acetate 87.Chromous chloride 158.Kelthane
16.Ammonium benzoate 88.Cobaltous bromide 159.Kepone
17.Ammonium bicarbonate 89.Cobaltous formate 160.Lead acetate
18.Ammonium bichromate 90.Cobaltous sulfamate 161.Lead arsenate
19.Ammonium bifluoride 91.Coumaphos 162.Lead chloride
20.Ammonium bisulfite 92.Cresol 163.Lead fluoborate
21.Ammonium carbamate 93.Crotonaldehyde 164.Lead fluorite
22.Ammonium carbonate 94.Cupric acetate 165.Lead iodide
23.Ammonium chloride 95.Cupric acetoarsenite 166.Lead nitrate
24.Ammonium chromate 96.Cupric chloride 167.Lead stearate
25.Ammonium citrate 97.Cupric nitrate 168.Lead sulfate
26.Ammonium fluoroborate 98.Cupric oxalate 169.Lead sulfide
27.Ammonium fluoride 99.Cupric sulfate 170.Lead thiocyanate
28.Ammonium hydroxide 100.Cupric sulfate ammoniated 171.Lindane
29.Ammonium oxalate 101.Cupric tartrate 172.Lithium chromate
30.Ammonium silicofluoride 102.Cyanogen chloride 173.Malathion
31.Ammonium sulfamate 103.Cyclohexane 174.Maleic acid
32.Ammonium sulfide 104.2,4-D acid(2,4-dichlorophenoxyacetic acid) 175.Maleic anhydride
33.Ammonium sulfite 105.2,4-D esters(2,4-dichlorophenoxyacetic acid esters) 176.Mercaptodimethur
34.Ammonium tartrate 106.DDT(dichlorodiphenyltrichloroethane) 177.Mercuric cyanide
35.Ammonium thiocyanate 107.Diazinon 178.Mercuric nitrate
36.Ammonium thiosulfate 108.Dicamba 179.Mercuric sulfate
37.Amyl acetate 109.Dichlobenil 180.Mercuric thiocyanate
38.Aniline 110.Dichlone 181.Mercurous nitrate
39.Antimony pentachloricle 111.Dichlorobenzene 182.Methoxychlor
40.Antimony potassium tartrate 112.Dichloropropane 183.Methyl mercaptan
41.Antimony tribromide 113.Dichloropropene 184.Methyl methacrylate
42.Antimony trichloride 114.Dichloropropene-dichloproropane mix 185.Methyl parathion
43.Antimony trifluoride 115.2,2-dichloropropionic acid 186.Mevinphos
44.Antimony trioxide 116.Dichlorvos 187.Mexacarbate
45.Arsenic disulfide 117.Dieldrin 188.Monoethylamine
46.Arsenic pentoxide 118.Diethylamine 189.Monomethylamine
47.Arsenic trichloride 119.Dimethylamine 190.Naled
48.Arsenic trioxide 120.Dinitrobenzene 191.Naphthalene
49.Arsenic trisulfide 121.Dinitrophenol 192.Naphthenic acid
50.Barium cyanide 122.Dinitrotoluene 193.Nickel ammonium sulfate
51.Benzene 123.Diquat 194.Nickel chloride
52.Benzoic acid 124.Disulfoton 195.Nickel hydroxide
53.Benzonitrile 125.Diuron 196.Nickel nitrate
54.Benzoyl chloride 126.Dodecylbenzesulfonic acid 197.Nickel sulfate
55.Benzyl chloride 127.Endosulfan 198.Nitric acid
56.Beryllium chloride 128.Endrin 199.Nitrobenzene
57.Beryllium fluoride 129.Epichlorohydrin 200.Nitrogen dioxide
58.Beryllium nitrate 130.Ethion 201.Nitrophenol
59.Butylacetate 131.Ethylbenzene 202.Nitrotoluene
60.n-butylphthalate 132.Ethylenediamine 203.Paraformaldehyde
61.Butylamine 133.Ethylene dibromide 204.Parathion
62.Butyric acid 134.Ethylene dichloride 205.Pentachlorophenol
63.Cadmium acetate 135.EDTA(ethylene diaminetetracetic acid) 206.Phenol
64.Cadmium bromide 136.Ferric ammonium citrate 207.Phosgene
65.Cadmium chloride 137.Ferric ammonium oxalate 208.Phosphoric acid
66.Calcium arsenate 138.Ferric chloride 209.Phosphorus
67.Calcium arsenite 139.Ferric fluoride 210.Phosphorus oxychloride
68.Calcium carbide 140.Ferric nitrate 211.Phosphorus pentasulfide
69.Calcium chromate 141.Ferric sulfate 212.Phosphorus trichloride
70.Calcium cyanide 142.Ferrous ammonium sulfate 213.PCBs(polychlorinated biphenyls)
71.Calcium dodecylbenzenesulfonate 143.Ferrous chloride 214.Potassium arsenate
72.Calcium hypochlorite 215.Potassium arsenite
2F-13

FORM 2F-INSTRUCTIONS(CONTINUED)
Exhibit 2F-5.Hazardous Substances(Continued)
216.Potassium bichromate 245.Sodium phosphate(dibasic) 271.Uranyl acetate
217.Potassium chromate 246.Sodium phosphate(tribasic) 272.Uranyl nitrate
218.Potassium cyanide 247.Sodium selenite 273.Vanadium penoxide
219.Potassium hydroxide 248.Strontium chromate 274.Vanadyl sulfate
220.Potassium permanganate 249.Strychnine 275.Vinyl acetate
221.Propargite 250.Styrene 276.Vinylidene chloride
222.Propionic acid 251.Sulfuric acid 277.Xylene
223.Propionic anhydride 252.Sulfur monochloride 278.Xylenol
224.Propylene oxide 253.2,4,5-T acid(2,4,5-trichlorophenoxyacetic acid) 279.Zinc acetate
225.Pyrethrins 254.2,4,5-T amines(2,4,5-trichlorophenoxy acetic acid 280.Zinc ammonium chloride
226.Quinoline amines) 281.Zinc borate
227.Resorcinol 255.2,4,5-T esters(2,4,5-trichlorophenoxy acetic acid 282.Zinc bromide
228.Selenium oxide esters) 283.Zinc carbonate
229.Silver nitrate 256.2,4,5-T salts(2,4,5-trichlorophenoxy acetic acid 284.Zinc chloride
230.Sodium salts) 285.Zinc cyanide
231.Sodium arsenate 257.2,4,5-TP acid(2,4,5-trichlorophenoxy propanoic 286.Zinc fluoride
232.Sodium arsenite acid) 287.Zinc formate
233.Sodium bichromate 258.2,4,5-TP acid esters(2,4,5-trichlorophenoxy 288.Zinc hydrosulfite
234.Sodium bifluoride propanoic acid esters) 289.Zinc nitrate
235.Sodium bisulfite 259.TDE(tetrachlorodiphenyl ethane) 290.Zinc phenolsulfonate
236.Sodium chromate 260.Tetraethyl lead 291.Zinc phosphide
237.Sodium cyanide 261.Tetraethyl pyrophosphate 292.Zinc silicofluoride
238.Sodium dodecylbenzenesulfonate 262.Thallium sulfate 293.Zinc sulfate
239.Sodium fluoride 263.Toluene 294.Zirconium nitrate
240.Sodium hydrosulfide 264.Toxaphene 295.Zirconium potassium fluoride
241.Sodium hydroxide 265.Trichlorofon 296.Zirconium sulfate
242.Sodium hypochlorite 266.Trichloroethylene 297.Zirconium tetrachloride
243.Sodium methylate 267.Trichlorophenol
244.Sodium nitrite 268.Triethanolamine dodecylbenzenesulfonate
269.Triethylamine
270.Trimethylamine
2F-14

EPA Identification Number NPDES Permit Number Facility Name OMB No.2040-0004
Expires 07/31/2026
Form U.S Environmental Protection Agency
2F \".EPA Application for NPDES Permit to Discharge Wastewater
NPDES STORMWATER DISCHARGES ASSOCIATED WITH INDUSTRIAL ACTIVITY
SECTION 1.OUTFALL LOCATION(40 CFR 122.21(G)(1))
1.1 Provide information on each of the facility's outfalls in the table below
Outfall Receiving Water Name Latitude Longitude
Number
0
io
0
0
SECTION 2. IMPROVEMENTS(40 CFR 122.21(G)(6))
2.1 Are you presently required by any federal,state,or local authority to meet an implementation schedule for
constructing,upgrading,or operating wastewater treatment equipment or practices or any other environmental
programs that could affect the discharges described in this application?
❑ Yes ❑ No 4 SKIP to Section 3.
2_2 Briefly identify each applicable project in the table below.
Final Compliance
Brief Identification and Affected Outfalls Dates
Source(s)of Discharge
Description of Project (list outfall numbers)
Required Projected
of
E
O
L
CQ.
G
2.3 Have you attached sheets describing any additional water pollution control programs(or other environmental
projects that may affect your discharges)that you now have underway or planned?(optional item)
❑ Yes ❑ No
EPA Form 3510-2F Page 1

EPA Identification Number NPDES Permit Number Facility Name OMB No.2040-0004
Expires 07/31/2026
SECTION 3.SITE DRAINAGE MAP(40 CFR 122.26(C)(1)(I)(A))
3_1 Have you attached a site drainage map containing all required information to this application?(See instructions for
w 2 R specific guidance.)
N R
o ❑ Yes
SECTIOIII 4.POLLUTANT SOURCES(40 CFR 122.26(C)(1)(I)(B))
4_1 Provide information on the facility's pollutant sources in the table below.
Outfall Impervious Surface Area Total Surface Area Drained
Number (within a mile radius of the facility) (within a mile radius of the facility)
specify units specify units
specify units specify units
specify units specify units
specify units specify units
specify units specify units
specify units specify units
4.2 Provide a narrative description of the facility's significant material in the space below.(See instructions for content
requirements.)
N
N
L
7
0
CO
C
R
0
a_
4.3 Provide the location and a description of existing structural and non-structural control measures to reduce pollutants
in stormwater runoff.(See instructions for specific guidance.)
Stormwater Treatment
Codes
Outfall from
Number Control Measures and Treatment Exhibit
2F-1
(list)
EPA Form 3510-2F Page 2

EPA Identification Number NPDES Permit Number Facility Name OMB No.2040-0004
Expires 07/31/2026
SECTION 5. NON STORMWATER DISCHARGES(40 CFR 122.26(C)(1)(I)(C))
51 Provide the following certification.(See instructions to determine the appropriate person to sign the application.)
I certify under penalty of law that the outfall(s) covered by this application have been tested or evaluated for the
presence of non-stormwater discharges. Moreover, I certify that the outfalls identified as having non-stormwater
discharges are described in either an accompanying NPDES Form 2C, 2D,or 2E application.
Name(print or type first and last name) Official title
Signature Date signed
d
5_2 Provide the testing information requested in the table below.
Outfall Onsite Drainage Points
cl) Number Description of Testing Method Used Date(s)of Testing Directly Observed
During Test
E
0
in
0
SECTION 6.SIGNIFICANT LEAKS OR SPILLS(40 CFR 122.26(C)(1)(I)(D))
6_1 Describe any significant leaks or spills of toxic or hazardous pollutants in the last three years.
.a
cn
SECTION 7.DISCHARGE INFORMATION(40 CFR 122.26(C)(1)(I)(E))
See the instructions to determine the pollutants and parameters you are required to monitor and, in turn,the tables you must
o complete.Not all applicants need to complete each table.
7_1 Is this a new source or new discharge?
0 ❑ Yes 4 See instructions regarding submission of ❑ No 4 See instructions regarding submission of
estimated data. actual data.
a' Tables A, B,C, and D
7.2 Have you completed Table A for each outfall?
❑ Yes
EPA Form 3510-2F Page 3

EPA Identification Number NPDES Permit Number Facility Name OMB No.2040-0004
Expires 07/3112026
7.3 Is the facility subject to an effluent limitation guideline(ELG)or effluent limitations in an NPDES permit for its
process wastewater?
❑ Yes 0 No 4 SKIP to Item 7.5.
7.4 Have you completed Table B by providing quantitative data for those pollutants that are(1)limited either directly or
indirectly in an ELG and/or(2)subject to effluent limitations in an NPDES permit for the facility's process
wastewater?
❑ Yes
7.5 Do you know or have reason to believe any pollutants in Exhibit 2F-2 are present in the discharge?
❑ Yes ❑ No 4 SKIP to Item 7.7.
7.6 Have you listed all pollutants in Exhibit 2F-2 that you know or have reason to believe are present in the discharge
and provided quantitative data or an explanation for those pollutants in Table C?
❑ Yes
7.7 Do you qualify for a small business exemption under the criteria specified in the Instructions?
❑ Yes 4SKIP to Item 7.18. 0 No
-0 7.8 Do you know or have reason to believe any pollutants in Exhibit 2F-3 are present in the discharge?
0
❑ Yes 0 No 4 SKIP to Item 7.10.
7_9 Have you listed all pollutants in Exhibit 2F-3 that you know or have reason to believe are present in the discharge in
Table C?
❑ Yes
E 7.10 Do you expect any of the pollutants in Exhibit 2F-3 to be discharged in concentrations of 10 ppb or greater?
❑ Yes 0 No 4 SKIP to Item 7.12.
7.11 Have you provided quantitative data in Table C for those pollutants in Exhibit 2F-3 that you expect to be discharged
in concentrations of 10 ppb or greater?
❑ Yes
7.12 Do you expect acrolein, acrylonitrile,2,4-dinitrophenol,or 2-methyl-4,6-dinitrophenol to be discharged in
concentrations of 100 ppb or greater?
❑ Yes 0 No 4 SKIP to Item 7.14.
7.13 Have you provided quantitative data in Table C for the pollutants identified in Item 7.12 that you expect to be
discharged in concentrations of 100 ppb or greater?
❑ Yes
7.14 Have you provided quantitative data or an explanation in Table C for pollutants you expect to be present in the
discharge at concentrations less than 10 ppb(or less than 100 ppb for the pollutants identified in Item 7.12)?
❑ Yes
7.15 Do you know or have reason to believe any pollutants in Exhibit 2F-4 are present in the discharge?
❑ Yes 0 No 4 SKIP to Item 7.17.
EPA Form 3510-2F Page 4

EPA Identification Number NPDES Permit Number Facility Name OMB No.2040-0004
Expires 07/31/2026
7.16 Have you listed pollutants in Exhibit 2F-4 that you know or believe to be present in the discharge and provided an
explanation in Table C?
❑ Yes
0 7.17 Have you provided information for the storm event(s)sampled in Table D?
._ ❑ Yes
0
Used or Manufactured Toxics
718 Is any pollutant listed on Exhibits 2F-2 through 2F-4 a substance or a component of a substance used or
o manufactured as an intermediate or final product or byproduct?
❑ Yes ❑ No 4 SKIP to Section 8.
L
7.19 List the pollutants below,including TCDD if applicable.Attach additional sheets,if necessary.
_
6 1. 4. 7.
2. 5. 8.
3. 6. 9.
SECTION 8.BIOLOGICAL TOXICITY TESTING DATA(40 CFR 122.21(G)(11))
8_1 Do you have any knowledge or reason to believe that any biological test for acute or chronic toxicity has been made
on any of your discharges or on a receiving water in relation to your discharge within the last three years?
�' ❑ Yes ❑ No 4 SKIP to Section 9.
; 8_2 Identify the tests and their purposes below.
Test(s) Purpose of Test(s) Submitted to NPDES Date Submitted
Permitting Authority?
❑ Yes ❑ No
o ❑ Yes ❑ No
m
❑ Yes ❑ No
SECTION 9.CONTRACT ANALYSIS INFORMATION(40 CFR 122.21(G)(12))
9_1 Were any of the analyses reported in Section 7(in Tables A through C)performed by a contract laboratory or
consulting firm?
❑ Yes ❑ No 4 SKIP to Section 10.
0 9_2 Provide information for each contract laboratory or consulting firm below.
Laboratory Number 1 Laboratory Number 2 Laboratory Number 3
Name of laboratory/firm
Laboratory address
Phone number
0
U
Pollutant(s)analyzed
EPA Form 3510-2F Page 5

EPA Identification Number NPDES Permit Number Facility Name OMB No.2040-0004
Expires 07/31/2026
SECTION 10.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(A)AND(D))
10.1 In Column 1 below,mark the sections of Form 2F 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 complete all sections or provide attachments.
Column 1 Column 2
❑ Section 1 ❑ wl attachments(e.g.,responses for additional outfalls)
❑ Section 2 ❑ wl attachments
❑ Section 3 ❑ w/site drainage map
❑ Section 4 ❑ w/attachments
❑ Section 5 ❑ w/attachments
❑ Section 6 ❑ w/attachments
❑ Section 7 ❑ Table A ❑ wl small business exemption request
cr,, ❑ Table B ❑ w/analytical results as an attachment
.173
73 ❑ Table C ❑ Table D
U
❑ Section 8 ❑ w/attachments
U
❑ Section 9 ❑ w/attachments(e.g.,responses for additional contact laboratories or firms)
t/l
2 ❑ Section 10
10•2 Provide the following certification.(See instructions to determine the appropriate person to sign the application.)
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.lam 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
Signature Date signed
EPA Form 3510-2F Page 6

EPA Identification Number NPDES Permit Number Facility Name Outfall Number OMB No.2040-0004
Expires 07/31/2026
TABLE A. CONVENTIONAL AND NON CONVENTIONAL PARAMETERS(40 CFR 122.26(C)(1)(I)(E)(3))1
You must provide the results of at least one analysis for every pollutant in this table.Complete one table for each outfall. See instructions for additional details and requirements.
Maximum Daily Discharge Average Daily Discharge Source of
(specify units) (specify units) Number of Storm Information
Pollutant or Parameter Grab Sample Taken Grab Sample Taken (new source/new
Flow-Weighted Flow-Weighted Events Sampled
During First During First dischargers only;use
30 Minutes Composite Composite
30 Minutes codes in instructions)
1. Oil and grease
2. Biochemical oxygen demand(BOD5)
3. Chemical oxygen demand(COD)
4. Total suspended solids(TSS)
5. Total phosphorus
6. Total Kjeldahl nitrogen(TKN)
7. Total nitrogen(as N)
pH(minimum)
8.
pH(maximum)
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e., methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR Chapter I,Subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2F Page 7

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EPA Identification Number NPDES Permit Number Facility Name Outfall Number OMB No.2040-0004
Expires 07/31/2026
TABLE B. CERTAIN CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.26(C)(1)(I)(E)(4)AND 40 CFR 122.21(G)(7)(VI)(A))1
List each pollutant that is limited in an effluent limitation guideline(ELG)that the facility is subject to or any pollutant listed in the facility's NPDES permit for its process wastewater(if the
facility is operating under an existing NPDES permit).Complete one table for each outfall.See the instructions for additional details and requirements.
Maximum Daily Discharge Average Daily Discharge Source of
Pollutant and CAS Number (specify units) (specify units) Number of Storm Information
(if available) Grab Sample Taken Flow-Weighted Grab Sample Taken Flow-Weighted Events Sampled (new source/new
During First During First dischargers only;use
30 Minutes Composite 30 Minutes Composite codes in instructions)
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR Chapter I,Subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2F Page 9

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EPA Identification Number NPDES Permit Number Facility Name Outfall Number OMB No.2040-0004
Expires 07/31/2026
TABLE C. TOXIC POLLUTANTS,CERTAIN HAZARDOUS SUBSTANCES,AND ASBESTOS(40 CFR 122.26(C)(1)(I)(E)(4)AND 40 CFR 122.21(G)(7)(VI)(B)AND(VII))1
List each pollutant shown in Exhibits 2F-2,2F-3,and 2F-4 that you know or have reason to believe is present. Complete one table for each outfall. See the instructions for additional
details and requirements.
Maximum Daily Discharge Average Daily Discharge Source of
(specify units) (specify units) Information
Pollutant and CAS Number Number of Storm
Grab Sample Taken Grab Sample Taken (new source/new
(if available) Flow-Weighted Flow-Weighted Events Sampled
During FirstDuring First dischargers only;use
Composite Composite
30 Minutes 30 Minutes codes in instructions)
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e., methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR Chapter I,Subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2F Page 11

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EPA Identification Number NPDES Permit Number Facility name Outfall Number OMB No.2040-0004
Expires 07/31/2026
TABLE D. STORM EVENT INFORMATION (40 CFR 122.26(C)(1)(I)(E)(6))
Provide data for the storm event(s)that resulted in the maximum daily discharges for the flow-weighted composite sample.
Number of Hours Between
Duration of Storm Event Total Rainfall During Beginning of Storm Measured and Maximum Flow Rate Total Flow from Rain Event
Date of Storm Event Storm Event During Rain Event
(in hours) End of Previous Measurable Rain (in gallons or specify units)
(in inches) (in gpm or specify units)
Event
Provide a description of the method of flow measurement or estimate.
EPA Form 3510-2F Page 13

Attachment ID
Chemical Addendum
Chemical Addendum Form able
EPA Identification No. NPDES Number Faoli 'Name/Site Address Outfall Number
Method Number(if Estimated Concentration (If
PIM CAS number A. licable Reason Pollutant Believed Present in Dischar e Known
I --
D_ North
512North CarolinaSalisbury St Departmreetent o1 f1611 EnvironMailmentalServi ce QualiCentyter I I DivisionRaleigh of WaterNorth Resources
, Carolina 27699-1611
TM� � 919.707.9000

Attachment 1E
FLUORINATED CHEMICALS (e.g., PFAS) QUESTIONNAIRE
1. Do you use any material or products(directly or indirectly)in your operations that contain
fluorinated chemicals?If so,please identify what materials or products contain fluorinated
chemicals.
• Please also address if you have any historical conditions and/or information for past
practices at the site related to fluorinated chemicals?
2. Will your facility formulate or create products (directly or indirectly) which contain
fluorinated chemicals?If so,please identify the specific fluorinated chemicals that may be
formulated or created.
3. Will your facility produce solid waste, liquid waste, wastewater effluent, or other waste
containing fluorinated chemicals? Please be as specific as possible to describe what
fluorinated chemicals may result in the facility's wastewater, solid waste, or sludge.
4. Are there processes or operations that use equipment,material,or components that contain
PFAS chemicals (e.g., surface coating, clean room applications, solvents, lubricants,
fittings,tubing,processing tools,packaging, facility infrastructure)?Could these activities
result in fluorinated chemicals being discharged as products, or by-products (i.e.,through
leaching, chemical process,heat treatment,pressurization, etc.)?
5. List CAS numbers of all known or believed present fluorinated compounds from the
questions above. Please provide descriptions, quantities, and whether there are any
unknowns related to the above questions.
6. Are there other facilities or operations in the U.S. or internationally that are identical to or
may use processes similar to the facility in North Carolina? If so, please provide facility
identification information and wastewater characterization including all PFAS
compounds?
7. Additionally, have any PFAS analytical results been collected with any analytical test
method similar to the following EPA Test Methods.Are any of the fluorinated compounds
listed in one of the following methods and can you provide us with data resulting from
these test:
• Methods 533 & 537.1 (drinking water)
• SW-846: Method 8327 (water)
• Draft Method 1633 (water, solids,tissue)
• "Total PFAS"Draft Method 1621 (wastewater)
D E Q Nh li ofEnvironmental Qvisio Resources
512ort NorthCaro SalisburynaDepartment Street 1161En I Mailironmen Service Centeruality IDi Raleighnof,NorthWater Carolina 27699-1611
+^ � 919 707 9000