NC0069892_Renewal (Application)_20240805

EPA Identification Number NPDES Permit Number Facility Name R CN/FP
NC0069892 Andrews WTP OMB No 2040-0004
Form U.S.Environmental Protection Agency AUG 0 2 2024
1 \/EPA Application for NPDES Permit to Discharge Wastewater
NPDES • GENERAL INFORMATION NCDEQI�WR1 DES
SECTION 1.ACTIVITIES REQUIRING AN NPDES PERMIT(40 CFR 122.21(f)and(f)(1))
1.1 Applicants Not Required to Submit Form 1
Is the facility a new or existing publicly owned Is the facility a new or existing treatment works
1.1.1 1.1
.2 works? . .2 treating domestic sewage?
If yes, STOP. Do NOT complete ❑✓ No If yes, STOP. Do NOT D No
Form 1. Complete Form 2A. complete Form 1. Complete
Form 2S
1.2 Applicants Required to Submit Form 1
1.2.1 Is the facility a concentrated animal feeding 1.2.2 Is the facility an existing manufacturing,
operation or a concentrated aquatic animal commercial,mining,or silvicultural facility that is
a production facility? currently discharging process wastewater'?
❑ Yes 4 Complete Form 1 No ✓❑ Yes 4 Complete Form El No
a.. and Form 2B. 1 and Form 2C.
0 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
commenced to discharge'? discharges only nonprocess wastewater'?
d Yes . Complete Form 1 El No Yes 4 Complete Form El No
rz and Form 2D. 1 and Form 2E
°f 1.2.5 Is the facility a new or existing facility whose
' discharge is composed entirely of stormwater
a associated with industrial activity or whose
discharge is composed of both stormwater and
non-stormwater?
❑ Yes 4 Complete Form 1 ❑ No
and Form 2F
unless exempted by
40 CFR
122.26(b)(14)(x)or
b 15 .
SECTION 2.NAME,MAILING ADDRESS,AND LOCATION (40 CFR 122.21(f)(2))
2.1 Facility Name
Andrews Water Treatment Plant
• 2.2 EPA Identification Number
C.)
o NC0069892
ra 2.3 Facility Contact
tii
Name(first and last) Title Phone number
v Pete McNeely ORC [phone]
Email address
[e-mail]
2.4 Facility Mailing Address
ra Street or P.O.box
P.O.Box 1210
City or town State ZIP code
Andrews NC 28901
EPA Form 3510-1(revised 3-19) Page 1

.}
EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0069892 Andrews WTP OMB No 2040-0004
y 2.5 Facility Location
Street, route number,or other specific identifier
Q o Dan Holland Road
�U
= = County name County code(if known)
tCherokee
o
City or town State ZIP code
z Andrews NC 28901
SECTION 3.SIC AND NAICS CODES(40 CFR 122.21(f)(3))
3.1 SIC Code(s) Description (optional)
N
0
U
3.2 NAICS Code(s) Description(optional)
221310 Water Treatment Plant
SECTION 4.OPERATOR INFORMATION (40 CFR 122.21(f)(4))
4.1 Name of Operator
Mark C.Bentley
0 4.2 Is the name you listed in Item 4.1 also the owner'?
`o ElYes ❑,r No
= 4.3 Operator Status
0
❑ Public—federal ❑ Public—state ❑ Other public(specify)
o ✓❑ Private ❑ Other(specify)
4.4 Phone Number of Operator
[phone]
= 4.5 Operator Address
Street or P.O. Box
E 279 Chestnut Street
o =
City or town State ZIP code
_
o �o Andrews NC 28901
o Email address of operator
O [e-mail]
SECTION 5.INDIAN LAND (40 CFR 122.21(f)(5))
-0 5.1 Is the facility located on Indian Land?
03
-a ❑ Yes ❑✓ No
EPA Form 3510-1(revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0069892 Andrews WTP OMB No 2040-0004
SECTION 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)
a ® NPDES(discharges to surface ❑ RCRA(hazardous wastes) ❑ UIC (underground injection of
o w water) fluids)
NC0069892
w ❑ PSD(air emissions) ❑ Nonattainment program(CAA) ❑ NESHAPs(CAA)
O.
W ❑ Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section 404) ❑ Other(specify)
SECTION 7.MAP(40 CFR 122.21(0(7))
7.1 Have you attached a topographic map containing all required information to this application?(See instructions for
specific requirements.)
✓❑ Yes ❑ No ❑ CAFO—Not Applicable(See requirements in Form 2B.)
SECTION 8. NATURE OF BUSINESS(40 CFR 122.21(f)(8))
8.1 Describe the nature of your business.
Production of potable water for the Town of Andrews.
d
C
y
co
O
SECTION 9. COOLING WATER INTAKE STRUCTURES(40 CFR 122.210)(9))
9.1 Does your facility use cooling water?
❑ Yes ❑ No 4 SKIP to Item 10.1.
a.+
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
NPDES permitting authority to determine what specific information needs to be submitted and when.)
a
4.3
U c
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
apply.Consult with your NPDES permitting authority to determine what information needs to be submitted and
when.)
Cr ❑ Fundamentally different factors(CWA ❑ Water quality related effluent limitations(CWA Section
Section 301(n)) 302(b)(2))
❑ Non-conventional pollutants (CWA ❑ Thermal discharges(CWA Section 316(a))
Section 301(c)and(g))
❑ Not applicable
EPA Form 3510-1(revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
OMB No 20400004
NC0069892 Andrews WTP
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 Permit ❑ w/attachments
O Section 2: Name, Mailing Address,and Location ❑ w/attachments
✓❑ Section 3: SIC Codes ❑ w/attachments
❑,r Section 4:Operator Information El w/attachments
Ej Section 5: Indian Land ❑ wl attachments
✓❑ Section 6: Existing Environmental Permits ❑ wl attachments
w/topographic
Section 7: Map ✓❑ map ❑
❑� w/additional attachments
o 2 Section 8: Nature of Business ❑ w/attachments
❑✓ Section 9:Cooling Water Intake Structures ❑ w/attachments
d
❑✓ Section 10:Variance Requests ❑ w/attachments
✓❑ Section 11:Checklist and Certification Statement ❑ w/attachments
•
11.2 Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision
in accordance with a system designed to assure that qualified personnel properly gather and evaluate the
information submitted. Based on my inquiry of the person or persons who manage the system, or those persons
directly responsible for gathering the information, the information submitted is.to the best of my knowledge and
belief true,accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fine and imprisonment for knowing violations.
Name(print or type first and last name) Official title
Mark C. Bentley ORC
Signatur Date signed
Arre.,4 C7 7/04°/9
EPA Form 3510-1(revised 3-19) Page 4

. . . .
- .
Permit NC0069892
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I Quad:Andrews, N C. Town of Location 41
i Subbasin:40502 1 A
' Latitude:35'12'38' ndrews WTP
Longitude:83°5012" NC0069892
) Receiving Stream UT Dan Holland Creek
(Xottk I-I. — Cherokee County
-- i
— -----
Page 7 of 7
1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0069892 Andrews Water Plant Lagoon OMB No 2040 0004
Form U.S.Environmental Protection Agency
2C "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.
c) Number Receiving Water Name Latitude Longitude
T
V
001 Unnamed Tributary to Daps 35° 12 38 N 83' 50' 12" W
ea
°
SECTION 2.LINE DRAWING (40 CFR 122.21(g)(2))
Q, 2.1 Have you attached a line drawing to this application that shows the water flow through your facility with a water
c 3 balance?(See instructions for drawing requirements. See Exhibit 2C-1 at end of instructions for example.)
J as
o 0 Yes ❑ No I
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** 001
Operations Contributing to Flow
Operation Average Flow
Backwashing Filters 0.015 mgd
c
E Flushing Clarifiers 0.010 mgd
cu
E` mgd
c
co mgd
0
rn Description Final Disposal of Solid or
(include size,flow rate through each treatment unit, Code from Liquid Wastes Other Than
a
retention time,etc.) Tabie 2C 1 by Discharge
Flocculation,Sedimentration 1-G,I-U To Andrews WWTP
Dechlorination,Disinfection(chlorine) J 2-E,2-F To Andrews WWTP
Discharge To Surface Water 4-A To Andrews WWTP
EPA Form 3510-2C(Revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0069892 Andrews Water Plant Lagoon OMB No.2040-0004
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, Table 2C-1 Liquid Wastes Other Than
retention time,etc.) by Discharge
-0
0
U
ip
**Outfall Number**
H Operations Contributing to Flow
o Operation Average Flow
a, mgd
R
> mgd
mgd
mgd
Treatment Units
Description Final Disposal of Solid or
(include size,flow rate through each treatment unit, Code from Liquid Wastes Other Than
retention time,etc.) Table 2C-1 by Discharge
3.2 Are you applying for an NPDES permit to operate a privately owned treatment works?
E w ❑ Yes ❑✓ No 4 SKIP to Section 4.
3.3 Have you attached a list that identifies each user of the treatment works?
❑ Yes No
EPA Form 3510-2C(Revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0069892 Andrews Water Plant Lagoon OMB No 20440004
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 LI No 4 SKIP to Section 5.
42 Provide information on intermittent or seasonal flows for each applicable outfall.Attach additional pages, if necessary.
Outfall O eratlon Frequency Flow Rate
P Average Average Long-Term Maximum Duration
Number (list) Da s/Week Months/Year Average Daily
d • mgd mgd days
I N
001 • mgd mgd days
LL
c .. • mgd mgd days
•. • mgd mgd days
•.ys/week months/year mgd mgd days
•. . mgd mgd days
•. . mgd mgd days
d . mgd mgd days
d . 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 4 SKIP to Section 6.
5 2 Provide the following information on applicable ELGs
ELG Category ELG Subcategory Regulatory Citation
d
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.
5.4 Provide an actual measure of daily production expressed in terms and units of applicable ELGs.
Outfall Operation,Product,or Material Quantity per Day Unit of
Number Measure
N
0
c.t
O
a
EPA Form 3510-2C(Revised 3-19) Page 3

•
EPA Identification i n Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0069892 Andrews Water Plant Lagoon OMB No 2040 0004
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
Brief Identification and Description of Outfalls Source(s)of
oProject (listoutfall Discharge Required Projected
number)
E
N!
_th
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 ✓❑ 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 one or more of the 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. Attach waiver request and other required information to the application.
Outfall Number Outfall Number Outfall Number
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?
El Yes ❑ No;a waiver has been requested from my NPDES
permitting authority for all pollutants at all outfalls.
�, 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 © No
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 GCIMS Fraction(s)
(Check applicable boxes.)
❑Volatile ❑Acid ❑ Base/Neutral 0 Pesticide
❑Volatile ❑Acid 0 Base/Neutral ❑Pesticide
0 Volatile El Acid ❑ Base/Neutral ❑Pesticide
EPA Form 3510-2C(Revised 3-19) Page 4

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0069892 Andrews Water Plant Lagoon OMB No 20440004
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 ❑✓ No
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 ❑ No
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
q q
indicated are"Believed Present"in your discharge?
Yes ❑ No
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
-0 then SKIP to Item 7.12.
C 7.11 Have you provided(1)quantitative data for those Sections 2 through 5,Table B,pollutants for which you have
Udetermined testing is required or(2)quantitative data or an explanation for those Sections 2 through 5,Table B,
N pollutants you have indicated are"Believed Present"in your discharge?
y ❑ Yes ❑ No
a; Table C.Certain Conventional and Non-Conventional Pollutants
2.3 7.12 Have you indicated whether pollutants are"Believed Present"or"Believed Absent"for all pollutants listed on Table C
.5 for all outfalls?
U
❑✓ Yes ❑ No
7.13 Have you completed Table C by providing(1)quantitative data for those pollutants that are limited either directly or
o indirectly in an ELG and/or(2)quantitative data or an explanation for those pollutants for which you have indicated
"Believed Present"?
❑✓ Yes ❑ No
u, Table D.Certain Hazardous Substances and Asbestos
7.14 Have you indicated whether pollutants are"Believed Present"or"Believed Absent"for all pollutants listed in Table D for
all outfalls?
❑ Yes No
7.15 Have you completed Table D by(1)describing the reasons the applicable pollutants are expected to be discharged
and(2)by providing quantitative data,if available?
❑ Yes El No
Table E.2,3,7,8-Tetrachlorodibenzo-p-Dioxin(2,3,7,8-TCDD)
7.16 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.
7.17 Have you completed Table E by reporting qualitative data for TCDD?
❑ Yes El No
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
m an intermediate or final product or byproduct?
w ❑ Yes ✓❑ No 4 SKIP to Section 9.
y 8.2 List the pollutants below.
x
0 1. 4. 7.
2. 5. 8.
N
3. 6. 9.
EPA Form 3510-2C(Revised 3-19) Page 5

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0069892 Andrews Water Plant Lagoon OMB No 2040 0004
SECTION 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)on a receiving water in relation to your discharge?
�, ,/❑ Yes ❑ No 4 SKIP to Section 10.
9.2 Identify the tests and their Jurposes below.
Test(s) Purpose of Test(s) Submitted to NPDES Date Submitted
Permitting Authority?
0
Ceriodaphnia Chronic NPDES Permit Requires ✓❑ Yes ❑ No 03/17/2023
a) Effluent Toxicity
0
Ceriodaphnia Chronic NPDES Permit Requires ,/
Yes ❑ No 06/14/2023
Effluent Toxicity
Ceriodaphnia Chronic NPDES Permit Requires ✓❑ Yes ❑ No 09/22/2023
Effluent Toxicit
SECTION 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
Earth Environmental Services
d
;� Laboratory address 2239 Barnett Road
ea
Murphy, NC 28906
c.o
Phone number
[phone]
Pollutant(s)analyzed Toxcity,Total Suspended
Solids,Turbidity,Cu,Al,Zn,
Hardness,T.Nitrogen,T.
Phosphorous,Temperature,
pH,Low Level Total Residual
Chlorine
SECTION 11.ADDITIONAL INFORMATION(40 CFR 122.21(g)(13))
11.1 Has the NPDES permitting authority requested additional information?
❑ Yes ✓❑ No 4 SKIP to Section 12.
0
1.-; 11.2 List the information requested and attach it to this application.
`o
4.
0
2. 5.
3 6.
EPA Form 3510-2C(Revised 3-19) Page 6

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0069892 Andrews Water Plant Lagoon OMB No.2040-0004
SECTION 12.CHECKLIST 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 El privately owned treatment
works
❑✓ Section 4: Intermittent Flows ❑ w/attachments
❑✓ Section 5: Production ❑ w/attachments
wl optional additional
E] Section 6:Improvements ❑ w/attachments ❑ sheets describing any
additional pollution control
plans
❑ w/request for a waiver and ❑ w/explanation for identical
supporting information outfalls
d w/small business exemption w/other attachments
❑ request ❑
❑ Section 7: Effluent and Intake ❑ w/Table A ❑✓ w/Table B
Characteristics
0
❑✓ w/Table C ❑ w/Table D
❑ w/analytical results as an
c� w/Table E ❑ attachment
Section 8: Used or Manufactured ❑ w/attachments
Toxics
❑✓ Section 9: Biological Toxicity ❑ w/attachments
= Tests
Q Section 10:Contract Analyses ❑ w/attachments
✓❑ Section 11:Additional Information ❑ w/attachments
Section 12:Checklist and ❑ wl attachments
Certification Statement
12.2 Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly
responsible for gathering the information, the information submitted is,to the best of my knowledge and belief true,
accurate,and complete. I am aware that there are significant penalties for submitting false information, including the
possibility of fine and imprisonment for knowing violations.
Name(print or type first and last name) Official title
Mark C.Bentley ORC
Signature Date signed
4a•/•
7/96 A v
EPA Form 3510-2C(Revised 3-19) Page
L

Dan Holland
Reservoir—Raw
Water
Beaver Creek
Reservoir
Pretreatment—
Alum and Caustic Soda Injection
Clarifiers&Filter Trains
Wastewater
CLagoons _ Finished Water
Post Treatment
---2
Chlorine and Caustic Soda
-a
Unnamed
Tributary to
Dan Holland
Creek

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No.2040-0004
NC0069892 Andrews Water Plant Lagoon 1 001
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
g Monthly Average Daily Number of Number of
Present Absent Discharge Discharge Discharge Analyses Average Analyses
(required) (if available) (if available) Value
I.--' Check here if you believe all pollutants on 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.
❑ Check here if you believe all pollutants on 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 ❑ 0 Concentration
(24959-67-9)
Mass
Chlorine;total
2. ❑ ❑ Concentration uG/L 42 25 12.26 58
residual Mass
3. Color El Concentration
Mass
Concentration
4. Fecal coliform 0 ❑✓ Mass
Fluoride El Concentration
5' (16984-48-8)
Mass
6 Nitrate-nitrite 0 ❑ Concentration
Mass
Nitrogen,total El ❑ Concentration mg/L 2.6 2.6 0.435 6
7. organic(as N) Mass
Concentration
8. Oil and grease ❑ 0 Mass
Phosphorus(as Concentration mg/L 0.14 0.14 0.0617 6
9' P),total(7723-14-0) El ❑ Mass
10. Sulfate(as SO4) 0 0 Concentration
(14808-79-8) Mass
11. Sulfide(as S) El0 Concentration
Mass
EPA Form 3510-2C(Revised 3-19) Page 23

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0069892 Andrews Water Plant Lagoon 001 OMB No.2040-0004
TABLE C.CERTAIN CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(vi))1
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant Units —� ----------- Maximum Long-Term
Believed Believed (specify) Maximum Daily Monthly Average Daily Number of Long-Term Number of
Present Absent Discharge
Discharge Discharge Analyses Average Analyses
Q ) (if available) (if available) V71ue
- ---------
Sulfite(as SO3) ❑ ❑ Concentration
12. (14265-45-3) Mass
Concentration
13. Surfactants ❑ 0
Mass
14, Aluminum;total ✓❑ ❑ Concentration uG/L 560 560 268.7 6
(7429-90-5) Mass
15. Barium,total ❑ ❑✓ Concentration
(7440-39-3) Mass
16. Boron.total ❑ ❑✓ Concentration
(7440-02-8) Mass
17. Cobalt,total ❑ ✓❑ Concentration
(7440-08-4) Mass
18. Iron,total ❑ ❑✓ Concentration
(7439-89-6) Mass
19 Magnesium,total ❑ ElConcentration
(7439-95-4) Mass
Molybdenum, Concentration 20. total CI ❑✓ _ _
Mass
(7439-98-7)
21. Manganese,total ❑ ElConcentration
(7439-96-5) Mass
22. Tin,total ❑ ❑✓ Concentration
(7440-31-5) Mass
23. Titanium,total ❑ ❑✓ Concentration
(7440-32-6) Mass
EPA Form 3510-2C(Revised 3-19) Page 24
,

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0069892 Andrews Water Plant Lagoon 001 OMB No.2040-0004
TABLE A.CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(iii))1
Effluent Intake
Waiver (Optional)
Pollutant Requested Units Maximum Maximum Long-Term
(specify) Daily Monthly Average Daily Number of Long-Term Number of
(if applicable) Discharge Discharge Discharge Analyses Average Value Analyses
(required) (if available) (if available)
0 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' (BOD6) El Mass
Chemical oxygen demand Concentration
2. (COD) ❑ Mass
Concentration
3. Total organic carbon(TOC) ❑
Mass
Concentration 10.5 mg/L 5.18 mg/L 36
4. Total suspended solids(TSS) LI
Mass
Concentration
5. Ammonia(as N) ❑
Mass
6. Flow ❑ Rate 0.13397 MGD 0.03139 MGD 546
Temperature(winter) ❑ °C °C 15 10.93 15
7.
Temperature(summer) El °C °C 25 24 13
pH(minimum) LI Standard units s.u. 6.3 6.65 58
8. —
pH(maximum) ❑ Standard units s.u. 7.2 6.65 58
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(Revised 3-19) Page 9

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No.2040-0004
NC0069892 Andrews Water Plant Lagoon 001
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
req(required) (if available) I Discharge Analyses AValuee Analyses
(if available)
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
1-1 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,total Concentration
1.1 (7440 36 0) El El El
Mass
Arsenic,total Concentration
1.2 (7440-38-2) ❑ Mass
1.3 Beryllium,total Concentration
(7440-41-7) Mass
Cadmium.total Concentration
1.4 (7440-43-9) Mass
Chromium,total Concentration
1.5 (7440-47-3) ❑ 0 Mass
Copper.total Concentration uG/L 2.0 2.0 0.135 18
1.6 (7440-50-8) Mass
Lead.total Concentration
1.7 (7439-92-1) 0 0 Mass
Mercury,total Concentration
1.8 El El El
(7439-97-6) Mass
Nickel,total Concentration
1'9 El El 0
(7440-02-0) Mass
1.10 Selenium,total Concentration
(7782-49-2) Mass
Silver,total Concentration
1.11 (7440-22-4) 0 El ElMass
EPA Form 3510-2C(Revised 3.19) Page 11

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No.2040-0004
NC0069892 Andrews Water Plant Lagoon 1 an
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v)p
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� Dischargef Average
Discharge Analyses Value
Analyses
(required) available) (if available)
Thallium,total Concentration
1.12 (7440-28-0) - Mass
Zinc.total Concentration uG/L 3.39 3.39 0.565 6
1.13 (7440-66-6) 0 El El
Mass
1.14 Cyanide,total Concentration
(57-12-5) Mass
1.15 Phenols.total 0 ID 0
Concentration
Mass
Section 2.Organic Toxic Pollutants(GC/MS Fraction—Volatile Compounds)
Acrolein Concentration
2.1 (107-02-8) � Mass
Acrylonitrile Concentration
2.2 (107-13-1) Mass
2.3 Benzene Concentration
(71-43-2) Mass
2.4 Bromoform Concentration
(75-25-2) Mass
2.5 Carbon tetrachloride CIConcentration
0 CI
(56-23-5) Mass
Chlorobenzene Concentration
2.6 (108-90-7) Mass
2.7 Chlorodibromomethane CIConcentration
(124-48-1) Mass
2.8 Chloroethane Concentration
(75-00-3) Mass
EPA Form 3510-2C(Revised 3-19) Page 12
t
L. - -