NC0060224_Renewal (Application)_20240703

ROY COOPER
Govemor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
George Ware, Owner
George W Ware
PO Box 519
Newland, NC 28657-0519
Subject: Permit Renewal
Application No. NCO060224
Jonas Ridge Adult Care Facility WWTP
Burke County
Dear Applicant:
NORTH CAROLINA
Environmental Quality
July 03, 2024
The Water Quality Permitting Section acknowledges the July 3, 2024 receipt of your permit renewal application and
supporting documentation. Your application will be assigned to a permit writer within the Section's NPDES WW permitting
branch. Per G.S. 150E-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit. The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https://www.deg.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,
d ly4t I
Cynthia Demery
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
LQE Q� Nonh Carolina Department of Envlronmental Qualhy I DMslon of Water Resources
Ash"Me Reglonal Office 12090 US. Hlghway 70 I Swarmama. North Carolina 28778
828296.4500

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO060224
Jonas Ridge WWTP
Modified March 2021
Form
NC Department of Environmental Quardy - Application for NPDES Permit to Discharge Wastewater
MINOR SEWAGE FACILITIES (Before completing this form, please read the instructions. Failure to follow
NPDES
the Instructions maw result In denial of the application.
SECTION•N
INFORMATION FOR
Facility name 7 .•
1.1
Jonas Ridge Adult Care WWTP
Mailing address (street or P.O. box) JUL, 0 3 2024
P.O. Box 519
City or town
State
ZIP code
o
Newland
NC NCDE
*0WR/NPDE
EContact
name (first and last)
Title
Phone number
Email address
Lance Ware
Manager
[phone]
([e-mail]
Location address (street, route number, or other specific identifier) ❑ Same as mailing address
m
U-
9051 Highway 181
City or town
State
ZIP code
Jonas Ridge
NC
28641
1.2
Is this application for a facility that has yet to commence discharge?
❑ Yes 4 See instructions on data submission ❑ No
requirements for new dischargers.
1.3
Is applicant different from entity listed under Item 1.1 above?
0 Yes ❑ No 4 SKIP to Item 1.4.
Applicant name
Water Quality Labs
Applicant address (street or P.O. box)
.;
P.O. Box 1167
cCity
or town
State
ZIP code
Banner Elk
NC
28604
Contact name (first and last)
Title
Phone number
Email address
Paul Isenhour
Laboratory Manager
[phone]
[e-mail]
c
a
1.4
Is the applicant the facility's owner, operator, or both? (Check only one response.)
❑ Owner ❑✓ Operator ❑ Both
1.5
To which entity should the NPDES permitting authority send correspondence? (Check only one response.)
❑ Facility 21 Applicant ❑ Facility and applicant
(they are one and the same)
1.6
Indicate below any existing environmental permits. (Check all that apply and print or type the corresponding permit
number for each.
E
d
Existing Environmental Permits
a75-
© NPDES (discharges to surface
❑ RCRA (hazardous waste)
❑ UIC (underground injection
water)
control)
E
NCO060224
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
c
w
rn
E]Ocean dumping (MPRSA)
❑ Dredge or fill (CWA Section
❑ Other (specify)
w
40)
Page 1

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO060224
Jonas Ridge WWTP
Modified March 2021
1.7
Provide the collections stem information requested below for the treatment works.
Municipality
Population
Collection System Type
Ownership Status
Served
Served
indicate percentage)
100 % separate sanitary sewer
❑ Own ❑ Maintain
Z70
% combined storm and sanitary sewer
ElOwn ❑ Maintain
d
❑ Unknown
❑ Own ❑ Maintain
% separate sanitary sewer
❑ Own ❑ Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
❑ Unknown
❑ Own ❑ Maintain
a%
separate sanitary sewer
❑ Own ❑ Maintain
a
% combined storm and sanitary sewer
❑ Own ❑ Maintain
R
❑ Unknown
❑ Own ❑ Maintain
d%
separate sanitary sewer
❑ Own ❑ Maintain
N%
combined storm and sanitary sewer
❑ Own ❑ Maintain
❑ Unknown
❑ Own ❑ Maintain
Total
70
Population
c°�
Served
Combined Storm and
Separate Sanitary Sewer System
Sanitary Sewer
Total percentage of each type of
100 %
°
sewer line in miles)�0
z'
1.8
Is the treatment works located in Indian Country?
'o
❑ Yes ❑ No
0
a
1.9
Does the facility discharge to a receiving water that flows through Indian Country?
❑ Yes 0 No
1.10
Provide design and actual flow rates in the designated spaces.
Design Flow Rate
0.0075 mgd
Annual Average Flow Rates Actual
< 2
Two Years Ago
Last Year
This Year
c o
.0025 mgd
.0036 mgd
.0036 mgd
N "
a
Maximum Daily Flow Rates Actual
Two Years Ago
Last Year
This Year
.0047 mgd
.0038 mgd
.0036 mgd
1.11
Provide the total number of effluent discharge points to waters of the State of North Carolina by type.
Total Number of Effluent Discharge ointsbyType
a n
Combined Sewer
Constructed
Treated Effluent
Untreated Effluent
Overflows
Bypasses
Emergency
0
Overflows
h
C
1
Page 2

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO060224
Jonas Ridge WWTP
Modified March 2021
Outfalls Other Than to Waters of the Stets of North Ca dna
1.12
Does the POTW discharge wastewater to basins, ponds, or other surface impoundments that do not have outlets
for discharge to waters of the State of North Carolina?
❑ Yes 0 No 4 SKIP to Item 1.14.
1.13
Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Im oundment Location and Dischar a Data
Average Daily Volume
Continuous or Intermittent
Location
Discharged to Surface
(check one)
Impoundment
❑ Continuous
gpd
❑ Intermittent
❑ Continuous
gpd
❑ Intermittent
gpd
❑ Continuous
-v
❑ Intermittent
r°
1.14
Is wastewater applied to land?
❑ Yes ❑✓ No + SKIP to Item 1.16.
c1.15
Provide the land application site and discharge data requested below.
y
Land Application Site and Discharge Data
o
`o
Average Daily Volume
Continuous or
Location
Size
Applied
Intermittent
a,
check one
cc
acres
gpd❑
[I Continuous
o
Intermittent
acres
gpdElIntermittent
El Continuous
o
a
acres
gpd
❑ Continuous
❑ Intermittent
1.16
Is effluent transported to another facility for treatment prior to discharge?
o
ElYes © No + SKIP to Item 1.21.
1.17
Describe the means by which the effluent is transported (e.g., tank truck, pipe).
1.18
Is the effluent transported by a party other than the applicant?
❑ Yes ❑ No + SKIP to Item 1.20.
1.19
Provide information on the transporter below.
Trans orter Data
Entity name
Mailing address (street or P.O. box)
City or town
State
ZIP code
Contact name (first and last)
Title
Phone number
Email address
Page 3

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO060224
Jonas Ridge WWTP
Modified March 2021
1.20
In the table below, indicate the name, address, contact information, NPDES number, and average daily flow rate of the
receiving facility.
Receivincai F cilitv Data
Facility name
Mailing address (street or P.O. box)
m
City or town
State
ZIP code
0
c.)
Contact name (first and last)
Title
0
d
Phone number
Email address
c
NPDES number of receiving facility (if any) ❑ None
Average daily flow rate mgd
a
0
1.21
Is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do
0
not have outlets to waters of the State of North Carolina (e.g., underground percolation, underground injection)?
CD
R
❑ Yes 0 No 4 SKIP to Item 1.23.
s
U
c
1.22
Provide information in the table below on these other disposal methods.
d
Information on Other Disposal Methods
o
Disposal
Location of
Size of
Annual Average
Continuous or Intermittent
Method
Disposal Site
Disposal Site
Daily Discharge
(check one)
R
Description
Volume
❑ Continuous
acres
gp d
❑ Intermittent
ElContinuous
acres
gpd
❑ Intermittent
acres
gp d
❑ Continuous
❑ Intermittent
1.23
Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)? (Check all that apply.
Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
y
❑ Discharges into marine waters (CWA ❑ Water quality related effluent limitation (CWA Section
Cr
Section 301(h)) 302(b)(2))
❑ Not applicable
1.24
Are any operational or maintenance aspects (related to wastewater treatment and effluent quality) of the treatment works
the responsibility of a contractor?
❑ Yes ❑ No +SKIP to Section 2.
1.25
Provide location and contact information for each contractor in addition to a description of the contractor's operational
and maintenance responsibilities.
Contractor Information
Contractor 1
Contractor 2
Contractor 3
o
.0
Contractor name
Water Quality Labs
com an name
E
`o
Mailing address
c
street or P.O. box
P.O. Box 1167
`o
City, state, and ZIP
Banner Elk, NC 28604
code
name (first and
Conci
last)
Paul Isenhour
Paul
Phone number
[phone]
Email address
[e-mail]
Operational and
Monitor plant, sample,
maintenance
maintain equipment, adjust
responsibilities of
chemicals, etc.
contractor
Page 4

NPDES Permit Number Facility Name Modified Application Form 2A
NCO060224 Jonas Ridge WWTP Modified March 2021
SECTION•• • •' • 1
c Outfalls to Waters of the Stabs of North Carolina
C
2.1
Does the treatment works have a design flow greater than or equal to 0.1 mgd?
o
❑ Yes ❑✓ No 4 SKIP to Section 3.
2.2
Provide the treatment works' current average daily volume of inflow
Average Daily Volume of Inflow and Infiltration
c
and infiltration.
gpd
Indicate the steps the facility is taking to minimize inflow and infiltration.
R
0
0
c
2.3
Have you attached a topographic map to this application that contains all the required information? (See instructions for
specific requirements.)
C
CD
0
❑ Yes ❑ No
r0
E
2.4
Have you attached a process flow diagram or schematic to this application that contains all the required information?
3-,
_ rn
(See instructions for specific requirements.)
o
❑ Yes ❑ No
2.5
Are improvements to the facility scheduled?
❑ Yes ❑ No 4 SKIP to Section 3.
Briefly list and describe the scheduled improvements.
0
R
1.
d
E
d
o.
2.
E
0 0
3.
d
4.
2.6
Provide scheduled or actual dates of completion for improvements.
U)
Scheduled or Actual Dates of Completion for Im rovements
E
d
>
Scheduled
Affected
Outfalls
Begin
End
Begin
Attainment of
Operational
o
ex
Improvement
(list
Construction
Construction
Discharge
Level
E
(from above)
numberber)outfall
(MM/DD/YYYY)
(MM/DD/YYYY)
(MM/DD/YYYY)
MMlDD/YYYY
m
,3
d
L
in
2.
3.
4.
2.7
Have appropriate permits/clearances concerning other federal/state requirements been obtained? Briefly explain your
response.
❑ Yes ❑ No ❑ None required or applicable
Explanation:
Page 5

NPDES Permit Number
Facility Name Modified Application Form 2A
NCO060224
Jonas Ridge WWTP Modified March 2021
SECTION•'
• ON 1 I
Provide the following information for each outfall. (Attach additional sheets if you have more than three outfalls.)
3.1
Outfall Number 001
Outfall Number
Outfall Number
State
North Carolina
County
Burke
R
w
0
p
City or town
Jonas Ridge
0
Distance from shore
Q
Depth below surface
ft.
ft.
ft.
0
Average daily flow rate
mgd
mgd
mgd
Latitude
Longitude
°
3.2
Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
R
o
❑ Yes r❑ No 4 SKIP to Item 3.4.
d
3.3
If so, provide the following information for each applicable outfall.
L
N
Outfall Number
Outfall Number
Outfall Number
0
Number of times per year
0
discharge occurs
ri
Average duration of each
`0
discharge (specify units
cAverage
flow of each
mgd
mgd
mgd
discharge
R
Months in which discharge
occurs
3.4
Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes Z No 4 SKIP to Item 3.6.
3.5
Briefly describe the diffuser type at each applicable outfall.
CL
Outfall Number
Outfall Number
Outfall Number
d
y
c
Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
1 j
3.6
one or more discharge points?
❑✓ Yes ❑ No 4SKIP to Section 6.
Page 6

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO060224
Jonas Ridge WWTP
Modified March 2021
3.7
Provide the receiving water and related information if known for each outfall.
Outfall Number 001
Outfall Number
Outfall Number
Receiving water name
Unnamed Tributary
Name of watershed, river,
Camp Creek
c
or stream system
U.S. Soil Conservation
y
Service 14-digit watershed
c
code
d
is
Name of state
management/river basin
U.S. Geological Survey
8-digit hydrologic
W
cataloging unit code
Critical low flow (acute)
cfs
cfs
cfs
Critical low flow (chronic)
cfs
cfs
cfs
Total hardness at critical
mg/L of
mg/L of
mg/L of
low flow
CaCO3
CaCO3
CaCO3
3.8
Provide the following information
describing the treatment pr vided for discharges from each outfall.
Outfall Number 001
Outfall Number
Outfall Number
Highest Level of
❑ Primary
❑ Primary
❑ Primary
Treatment (check all that
❑ Equivalent to
❑ Equivalent to
❑ Equivalent to
apply per outfall)
secondary
secondary
secondary
0 Secondary
❑ Secondary
❑ Secondary
❑ Advanced
❑ Advanced
❑ Advanced
❑ Other (specify)
❑ Other (specify)
❑ Other (specify)
c
0
a
Design Removal Rates by
Outfall
N
d
BOD5 or CBOD5
85 %
%
%
c
a�
E
TSS
85 %
%
%
© Not applicable
❑ Not applicable
❑ Not applicable
Phosphorus
%
%
%
© Not applicable
❑ Not applicable
❑ Not applicable
Nitrogen
%
%
%
Other (specify)
0 Not applicable
❑ Not applicable
❑ Not applicable
Page 7

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO060224
Jonas Ridge WWTP
Modified March 2021
3.9
Describe the type of disinfection used for the effluent from each outfall in the table below. If disinfection varies by
season, describe below.
a
m
_
0
U
=
Outfall Number 001
Outfall Number
Outfall Number
0
Disinfection type
Chlorine
U
N
d
Seasons used
All
E
Dechlorination used?
❑ Not applicable
❑ Not applicable
❑ Not applicable
0 Yes
❑ Yes
❑ Yes
❑ No
❑ No
❑ No
3.10
Have you completed monitoring for all Table A parameters and attached the results to the application package?
0 Yes ❑ No
3.11
Have you conducted any WET tests during the 4.5 years prior to the date of the application on any of the facility's
discharges or on any receiving water near the discharge points?
❑ Yes 0 No + SKIP to Item 3.13.
3.12
Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
discharges by outfall number or of the receiving water near the discharge points.
Outfall Number
Outfall Number
Outfall Number
Acute
Chronic
Acute
Chronic
Acute
Chronic
R
is
Number of tests of discharge
rn
=
water
Number of tests of receiving
water
d
w
3.14
Does the POTW use chlorine for disinfection, use chlorine elsewhere in the treatment process, or otherwise have
reasonable potential to discharge chlorine in its effluent?
0 Yes -* Complete Table B, including chlorine. ❑ No 4 Complete Table B, omitting chlorine.
3.15
Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
0 Yes ❑ No
Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
3.18
attached the results to this application package?
El Yes 0 No additional sampling required by NPDES
ermittin authority.
Page 8

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO060224
Jonas Ridge WWTP
Modified March 2021
3.19
Has the POTW conducted either (1) minimum of four quarterly WET tests for one year preceding this permit application
or (2) at least four annual WET tests in the past 4.5 years?
❑ Yes ❑ No 4 Complete tests and Table E and SKIP to
Item 3.26.
3.20
Have you previously submitted the results of the above tests to your NPDES permitting authority?
❑ Yes ❑ No 4 Provide results in Table E and SKIP to
Item 3.26.
3.21
Indicate the dates the data were submitted to your NPDES permitting authority and provide a summary of the results.
Date(s) Submitted
Summary of Results
MM/DD
m
c
c
0
R
3.22
Regardless of how you provided your WET testing data to the NPDES permitting authority, did any of the tests result in
o
toxicity?
a'
c
❑ Yes ❑ No 4 SKIP to Item 3.26.
a)
3.23
Describe the cause(s) of the toxicity:
c
d
0
w
3.24
Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes ❑ No 4 SKIP to Item 3.26.
3.25
Provide details of any toxicity reduction evaluations conducted.
3.26
Have you completed Table E for all applicable outfalls and attached the results to the application package?
❑ Yes ❑ Not applicable because previously submitted
information to the NPDES permitting authority.
Page 9

NPDES Permit Number
Facility Name Modified Application Form 2A
NCO060224
Jonas Ridge WWTP Modified March 2021
SECTION1
CERTIFICATION STATEMENT (40
6.1
In Column 1 below, mark the sections of Form 2A that you have completed and are submitting with your application. For
each section, specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note that not
all applicants are required to provide attachments.
Column 1
Column 2
Section 1: Basic Application
Informationforfor All Applicants
w/variance request(s) El w/ additional attachments
0 Section 2: Additional
0 w/ topographic map ❑ w/ process flow diagram
Information
❑ w/ additional attachments
0 w/ Table A ❑ w/ Table D
0 Section 3: Information on
✓❑ w/ Table B ❑ w/ additional attachments
c
Effluent Discharges
E
❑ w/ Table C
d
m
Cn
Section 4: Not Applicable
0
r
ca
w
Section 5: Not Applicable
d
U
o
Section 6: Checklist and
❑
El w/attachments
Certification Statement
h
ae
6.2
Certification Statement
0
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
Paul Isenhour
Laboratory Manager
Signature
Date signed
06/25/2024
Page 10

NPDES Permit Number
Facility Name
Outfall Number
NCO060224 7
Jonas Ridge WWTP
001
Modred Application Form 2A
Modified March 2021
Maximum Daily Discharge
Average Daily Discharge
Analytical
MIL or MDL
Value
Units
Number
Pollutant
Value Units
Method'
(include units)
Sampless
Biochemical oxygen demand
El ML
Ei BOD5 or ❑ CBOD5
44.7
mg/L
6.88
mg/L
156 SM-52106
2.0 mg/L O MDL
(report one
Fecal coliform
200
cfu/100mL
13.409
cfu/100mL
156 SM-9222D
cfu/100mL OML
O MDL
Design flow rate
0.0047
MGD
0.0032
MGD
156
pH (minimum)
6.2
s/u
pH (maximum)
7.9
s/u
Temperature (winter)
20
Degrees Celsius
10.23
Degrees Celsius
300
Temperature (summer)
29
Degrees Celsius
18
Degrees Celsius
420
Total suspended solids (TSS)
42
mg/L
6.74
mg/L
156 Sm-2540D
2.5 p MDL
I Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
Page 11

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NCO060224 Jonas Ridge WWTP 001 Modified March 2021
:
•' '• p
a M01101' t1 1
Maximum Daily Discharge
Average Daily Discharge
Pollutant
Analytical
ML or MDL
Number of
Value
Units
Value
Units
Method'
(include units)
Samples
Ammonia (as N)
5.2
mg/L
0.5316
mg/L
144
SM-450OF
0 MIL
0.1 mg/L O MDL
Chlorine
(total residual, TRC)z
40
u L
13.67
ug/L
312
SM-4500CLG
15 ❑ MIL
O MDL
Dissolved oxygen
12.34
mg/L
7.95
mg/L
144
SM-45000G
0 MIL
0 I7 MDL
Nitrate/nitrite
❑ MIL
❑ MDL
Kjeldahl nitrogen
❑ ML
❑ MDL
Oil and grease
❑ MIL
❑ MDL
Phosphorus
❑ MIL
❑ MDL
Total dissolved solids
❑ MIL
❑ MDL
I Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
2 Facilities that do not use chlorine for disinfection, do not use chlorine elsewhere in the treatment process, and have no reasonable potential to discharge chlorine in their effluent are not
required to report data for chlorine.
EPA Form 3510-2A (Revised 3-19) Page 12

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NC0060224 Jonas Ridge WWTP
Modified March 2021
•' 1 :16111116.2
Maximum Daily Discharge Average Daily Discharge
Pollutant
Analytical ML or MDL
Number of
Value Units Value Units
Method' (include units)
Samples
Metals, Cyanide, and Total Phenols
Hardness (as CaCO3)
❑ ML
❑ MDL
Antimony, total recoverable
❑ ML
❑ MDL
Arsenic, total recoverable
El ML
❑ MDL
Beryllium, total recoverable
❑ ML
❑ MDL
Cadmium, total recoverable
❑ ML
❑ MDL
Chromium, total recoverable
❑ ML
❑ MDL
Copper, total recoverable
❑ ML
❑ MDL
Lead, total recoverable
❑ ML
❑ MDL
Mercury, total recoverable
❑ ML
❑ MDL
Nickel, total recoverable
❑ ML
❑ MDL
Selenium, total recoverable
❑ ML
❑ MDL
Silver, total recoverable
El ML
❑ MDL
Thallium, total recoverable
❑ ML
❑ MDL
Zinc, total recoverable
❑ ML
❑ MDL
Cyanide
❑ ML
❑ MDL
Total phenolic compounds
❑ ML
❑ MDL
Volatile Organic Compounds
Acrolein
❑ ML
❑ MDL
Acrylonitrile
El ML
❑ MDL
Benzene
El ML
❑ MDL
Bromoform
❑ ML
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 13

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NCO060224 Jonas Ridge WWTP
Modified March 2021
Maximum Daily Discharge Average Daily Discharge
Pollutant
Analytical ML or MDL
Number of
Value Units Value Units
Method' (include units)
Samples
Carbon tetrachloride
❑ ML
❑ MDL
Chlorobenzene
❑ ML
❑ MDL
Chlorodibromomethane
❑ ML
❑ MDL
Chloroethane
❑ ML
❑ MDL
2-chloroethylvinyl ether
❑ ML
❑ MDL
Chloroform
❑ ML
❑ MDL
Dichlorobromomethane
❑ ML
❑ MDL
1,1-dichloroethane
❑ ML
❑ MDL
1,2-dichloroethane
❑ ML
❑ MDL
trans-1,2-dichloroethylene
❑ ML
❑ MDL
1,1-dichloroethylene
❑ ML
❑ MDL
1,2-dichloropropane
❑ ML
❑ MDL
1,3-dichloropropylene
❑ ML
❑ MDL
Ethylbenzene
❑ ML
❑ MDL
Methyl bromide
❑ ML
❑ MDL
Methyl chloride
❑ ML
❑ MDL
Methylene chloride
❑ ML❑
MDL
1,1,2,2-tetrachloroethane
❑ ML
❑ MDL
Tetrachloroethylene
❑ ML
❑ MDL
Toluene
❑ ML
❑ MDL
1,1,1-trichloroethane
❑ ML
❑ MDL
1,1,2-trichloroethane
❑ ML
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 14

EPA Identification Number NPDES Permit Number Facility Name Outfal Number
_F
Modified Application Form 2A
NCO060224 Jonas Ridge WWTP
Modified March 2021
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
Number of
Method' (include units)
Value Units Value Units Samples
1,77
❑ ML
❑ MDL
inyl chloride
❑ ML
❑ MDL
Acid -Extractable Compounds
p-chloro-m-cresol
❑ ML
❑ MDL
2-chlorophenol
OML
❑ MDL
2,4-dichlorophenol
0 ML
❑ MDL
2,4-d imethyl phenol
0 ML
❑ MDL
4,6-dinitro-o-cresol
❑ ML
❑ MDL
2,4-dinitrophenol
❑ ML
❑ MDL
2-nitmphenol
❑ ML
❑ MDL
4-nitmphenol
❑ ML
❑ MDL
Pentachlorophenol
❑ ML
❑ MDL
Phenol
❑ ML
❑ MDL
2,4,6-trichlorophenol
❑ ML
❑ MDL
Base -Neutral Compounds
Acenaphthene
❑ ML
❑ MDL
Acenaphthylene
❑ ML
❑ MDL
Anthracene
❑ ML
❑ MDL
Benzidine
❑ ML
❑ MDL
Benzo(a)anthracene
OML
❑ MDL
Benzo(a)pyrene
0 ML
❑ MDL
3,4-benzofluoranthene
❑ ML
❑ MDL
EPA Form 3510-2A (Revised 3-19) Page 15

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Modred Application Form 2A
NCO06O224 Jonas Ridge WWTP
Modified March 2021
Maximum Daily Discharge Average Daily Discharge
Pollutant
Analytical ML or MDL
Number of
Value Units Value Units
Method' (include units)
Samples
Benzo(ghi)perylene
❑ ML
❑ MDL
Benzo(k)fluoranthene
❑ ML
❑ MDL
Bis (2-chloroethoxy) methane
❑ ML
❑ MDL
Bis (2-chloroethyl) ether
❑ ML
❑ MDL
Bis (2-chloroisopropyl) ether
❑ ML
❑ MDL
Bis (2-ethylhexyl) phthalate
❑ ML
❑ MDL
4-bromophenyl phenyl ether
❑ ML
❑ MDL
Butyl benzyl phthalate
❑ ML
❑ MDL
2-chloronaphthalene
❑ ML
❑ MDL
4-chlorophenyl phenyl ether
❑ ML
❑ MDL
Chrysene
❑ ML
❑ MDL
di-n-butyl phthalate
❑ ML❑
MDL
di-n-octyl phthalate
❑ ML
❑ MDL
Dibenzo(a,h)anthracene
❑ ML
❑ MDL
1,2-dichlorobenzene
❑ ML
❑ MDL
1,3-dichlorobenzene
❑ ML
❑ MDL
1,4-dichlorobenzene
❑ ML
❑ MDL
3,3-dichlorobenzidine
❑ ML
❑ MDL
Diethyl phthalate
❑ ML
❑ MDL
Dimethyl phthalate
❑ ML
❑ MDL
2,4-dinitrotoluene
❑ ML
❑ MDL
2,6 dinitrotoluene
❑ ML❑
MDL
EPA Form 3510-2A (Revised 3-19) Page 16

EPA Identification Number NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NCO06O224 Jonas Ridge WWTP
Modified March 2021
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
Pollutant Number of
Method' (include units)
Value Units Value Units Samples
ML
1,2-diphenylhydrazine
o MDL
❑ ML
Fluoranthene
❑ MDL
❑ ML
Fluorene
❑ MDL
El ML
Hexachlorobenzene
❑ MDL
Hexachlorobutadiene
❑ ML
❑ MDL
OML
Hexachlorocydo-pentadiene
❑ MDL
❑ ML
Hexachloroethane
❑ MDL
OML
Indeno(1,2,3-cd)pyrene
❑ MDL
El ML
Isophorone
❑ MDL
11 ML
Naphthalene
❑ MDL
El ML
Nitrobenzene
❑ MDL
11 ML
N-nitrosodi-n-propylamine
❑ MDL
N-nitrosodimethylamine
El ML
❑ MDL
N-nitrosodiphenylamine
0 ML
❑ MDL
❑ ML
Phenanthrene
❑ MDL
1-1 ML
Pyrene
❑ MDL
1,2,4-trichlorobenzene
❑ ML
❑ MDL
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 3510-2A (Revised 3-19) Page 17

NPDES Permit Number Facility Name Outfall Number
Modified Application Form 2A
NCO060224 Jonas Ridge WWTP
Modified March 2021
lot 16 IMS •'
Maximum Dail Discharge Average Dail Discharge
Pollutant
Analytical ML or MDL
Numbers
gist) Value Units Value Units
Method' (include units)
Samples
❑ No additional sampling is required by NPDES permitting authority.
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
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).
Page 18

DocuSWn Envelope ID: E986326C-4884-4EC6-9F4D-23D47991D8E4
Jonas Ridge Properties, LLC
Jonas Ridge Adult Care Facility WWTP
NPDES Permit NCO060224
Receiving Stream: UT to Camp Creek Stream Class: C;Tr
Stream Segment: 1 I-29-15 Sub -Basin #: 03-08-30
River Basin: Catawba HUC: 030501010301
County: Burke
115.000.000
•9,.-
1:24,000 il I

North Carolina
Department of Environmental Quality Modified Application Form 2A
Division of Water Resources Revised March 2021
Modified Application
Form 2A
Minor Sewage Facilities < 0.1 MGD
and No Pretreatment Program
NPDES Permitting Program
RECEIVED
INC
pEQl[)\VRINp0ES
Note: Complete this form if your facility is a MINOR new or existing publicly owned treatment works.