NC0090263_More Information (Received)_20240806

CDG
4301 Taggart Creek Road July 30,2024
Charlotte,NC 28208
Tel[phone] Kate Shadwell
Division of Water Resources RECEIVED
NC License No.C-4973 Water Quality Permitting Section -NPDES
SC COA No.7171 1617 Mail Service Center
Raleigh,NC 27699-1617 AUG 0 6 2024
cdge.com
Subject: Local Government Review Form for NCDEQ/DWR/NPDES
Riverview Farms WWTP,Iredell County
NDPES Permit Application NC0090263
R586823001
On behalf of Waste Management Pros of the Carolinas LLC (WMP), CDG, Inc.
(CDG) is submitting this completed Local Government Review Form received
from Iredell County for NPDES Permit Application NC0090263.
Please feel free to contact Eric Swain,President of WMP or Melinda M. Greene
with CDG is you have any questions.
Sincerely,
CDG, INC.
Melin a M. Greene Meredith Brock
Project Manager Environmental Scientist
Attachment: Local Government Review Form—Iredell County
cc: Eric Swain,WMP

C D G
4301 Taggart Creek Road June 5,2024
Charlotte,NC 28208
Tel[phone] Matthew Todd,Director,Planning&Development
Iredell County
NC License No.C-4973 P.O.Box 788
SC COA No.7171 Statesville,NC 28687
cdge.com Sherry Ashley,Planning Director
City of Statesville
227 S. Center Street
Statesville,NC 28677
• Dear Mr.Todd and Ms. Ashley,
CDG,Inc. has been retained by Waste Management Pros of the Carolinas to
assist in preparing a National Pollutant Discharge Elimination System (NPDES)
permit application to provide sewerage service to a new residential development
in Iredell County. The proposed residential development will be located at 160
Brick Yard Road,Statesville,Iredell County,North Carolina.The site,known as
Riverview Farms,is described as follows:
DEVELOPMENT SUMMARY
PARCEL ID: 3792-21-7177-DB 2374 PG 1703
3792-22-0102-DB 1464 PG 1407
3792-34-3569-DB 951 PG 1027
3792-35-2304-DB 1907 PG 1841
3792-21-7177-DB 2374 PG 1703
3792-12-7478-DB 2106 PG 2451
3792-12-6777-DB 434 PG 199
3792-12-2664-DB 1151 PG 45
3792-21-1823-DB 1151 PG 43
OWNER: 1NG FAMILY PROPERTIES LLC
922 BROMLEY RD
CHARLOTTE,NC 28207
TOTAL PARCEL ACREAGE: +/-64829 ACRES
EXISTING ZONING: R-A(RESIDENTIAL AGRICULTURAL)
EXISTING USE: VACANT(WOODED)
PROPOSED STANDARDS: R-A
MINIMUM LOT AREA: 6,000 SF
MINIMUM LOT WIDTH: 50 FEET
PROVIDED LOT AREA: 6,000 SF
PROVIDED LOT WIDTH: 50 FEET
FRONT SETBACK: 17.5 FEET
SIDEYARD: 7.5 FEET
REAR SETBACK 17.5 FEET
CORNER YARD: 12.5 FEET
PROPOSED USE: SINGLE-FAMILY RESIDENTIAL

( DG
As part of the Engineering Alternatives Analysis required by the North Carolina
Department of Environmental Quality,we are requesting your input on the
application for an NPDES permit via the attached Local Government Review Form.
A copy of the NPDES Permit Application is also attached.We request that your
agency complete the Local Government Review Form and return the form signed and
notarized to us within 15 days.
If you have any questions regarding this request,please contact one of the
undersigned at(704) 394-6913.
Sincerely,
Rrtbe-Y't" L. CJf^l fu,t/. j P. E.
Melinda M. Greene,EI Robert L. Griffin,PE
Project Manager VP—NC Operations
ATTACHMENTS:
1. Local Government Review Form
2. NPDES Permit Application/EAA/Water Quality Assessment
WMPOTC—Riverview Farms
Page 2 of 2

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 govemment(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 govemment(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 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.
Name of local government �€.ck e oVA`i
(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[✓f 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[vi 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 ' •ao)-h Signa 0J2e
r
State of NO(-h CaroliAck ,County of edQ
On this 3f d day of u k aoaq,personally appeared before me,the said
name J°h'\ `.)ale) L -' 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 08—11--aaa`1/ . (Signature of Notary Public)ligAt
No ry Public(Official Seal)
BRANDI 3 KENDRICK
NOTARY PUBLIC
IREDELL COUNTY, NC
sz
EAA Guidance Document Revision:October 20 M Comm Expire
Page 1 of 1 ( —eR0 _I

DocuSign Envelope ID:65024340-5319-48C0-A119-E7C42DBA388B
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
Note: Complete this form if your facility is a MINOR new or existing publicly owned treatment works.

DocuSign Envelope ID:65024340-5319-48C0-A119-E7C42DBA388B
NPDES Permit Number Facility Name Modified Application Form 2A
Riverview Farms WWTP Modified March 2021
Form NC Department of Environmental Quality-Application for NPDES Permit to Discharge Wastewater
NPDES MINOR SEWAGE FACILITIES(Before completing this form,please read the instructions.Failure to follow
the instructions ma result in denial of the application.
SECTION 1.BASIC APPLICATION INFORMATION FOR ALL APPLICANTS(40 CFR 122.21(j)(1)and(9))
1.1 Facility name
Riverview Farms Wastewater Treatment Plant
Mailing address(street or P.O.box)
Brickyard Rd&Hwy 70 Statesville
City or town State ZIP code
o Statesville NC 28677
Contact name(first and last) Title Phone number Email address
Eric Swain
i T
Location address(street,route number,or other specific identifier) ❑ Same as mailing address
U-
9775 BETHEL CHURCH RD
City or town State ZIP code
Midland NC 28107
1.2 Is this application for a facility that has yet to commence discharge?
❑ Yes See instructions on data submission ❑ No
requirements for new dischargers.
1.3 Is applicant different from entity listed under Item 1.1 above?
❑ Yes 0 No 4 SKIP to Item 1.4.
Applicant name
Applicant address(street or P.O.box)
0
City or town State ZIP code
co
Contact name(first and last) Title Phone number Email address
a
o_
a 1.4 Is the applicant the facility's owner,operator,or both?(Check only one response.)
❑ Owner ❑ Operator ❑r Both
1.5 To which entity should the NPDES permitting authority send correspondence?(Check only one response.)
❑ Facility El 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.)
Existing Environmental Permits
NPDES(discharges to surface RCRA(hazardous waste) UIC(underground injection
R ❑ l 9 ❑ ❑ ( 9 1
water) control)
E
2 ❑ PSD(air emissions) ❑ Nonattainment program(CM) ❑ NESHAPs(CM)
T.
rn
❑ Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section ❑ Other(specify)
wto
404)
Page 1

DocuSign Envelope ID:65024340-5319-48Co-A119-E7C42DBA388B
NPDES Permit Number Facility Name Modified Application Form 2A
Riverview Farms WWTP Modified March 2021
1.7 Provide the collection system information requested below for the treatment works.
Municipality Population Collection System Type
Served Served (indicate percentage) Ownership Status
100 %separate sanitary sewer 0 Own 0 Maintain
2 %combined storm and sanitary sewer ❑ Own ❑ Maintain
d 0 Unknown 0 Own 0 Maintain
c %separate sanitary sewer 0 Own 0 Maintain
o
.11 %combined storm and sanitary sewer 0 Own 0 Maintain
c.
0 Unknown 0 Own 0 Maintain
o %separate sanitary sewer 0 Own 0 Maintain
a
c %combined storm and sanitary sewer ❑ Own 0 Maintain
'° ❑ Unknown 0 Own 0 Maintain
m %separate sanitary sewer ❑ Own 0 Maintain
%combined storm and sanitary sewer ❑ Own 0 Maintain
tn
c 0 Unknown ❑ Own ❑ Maintain
'� Total
°' Population
c..) Served
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of
sewer line(in miles) 1o0
Z' 1.8 Is the treatment works located in Indian Country?
'o ❑ Yes D No
c 1.9 Does the facility discharge to a receiving water that flows through Indian Country?
c ❑ Yes El No
1.10 Provide design and actual flow rates in the designated spaces. Design Flow Rate
0.29 mgd
71
Annual Average Flow Rates(Actual)
vin
13 Two Years Ago Last Year This Year
c
co e mgd mgd mgd
d" Maximum Daily Flow Rates(Actual)
a Two Years Ago Last Year This Year
mgd mgd mgd
• 1.11 Provide the total number of effluent discharge points to waters of the State of North Carolina by type.
-0- Total Number of Effluent Discharge Points by Type
a o. Constructed
Treated Effluent Untreated Effluent Combined Sewer Bypasses Emergency
s T Overflows Overflows
v
cn
a 1 0 0 0 0
Page 2

DocuSign Envelope ID:65024340-5319-48C0-A119-E7C42DBA388B
NPDES Permit Number Facility Name Modified Application Form 2A
Riverview Farms WWTP Modified March 2021
Outfalls Other Than to Waters of the State of North Carolina
1.12 Does the POTW discharge wastewater to basins,ponds,or other surface impoundments that do not have outlets
for discharge to waters of the State of North Carolina?
❑ Yes ❑✓ 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 Impoundment Location and Discharge Data
Average Daily Volume Continuous or Intermittent
Location Discharged to Surface
Impoundment (check one)
❑ Continuous
gpd ❑ Intermittent
❑ Continuous
gpd 0 Intermittent
0 Continuous
gpd ❑ Intermittent
s 1.14 Is wastewater applied to land?
❑ Yes ❑ No 3 SKIP to Item 1.16.
0 1.15 Provide the land application site and discharge data requested below.
y Land Application Site and Discharge Data
Continuous or
Location Size Average Daily Volume Intermittent
a, Applied (check one)
co
-c ❑ Continuous
5 acres gpd ❑ Intermittent
L acresgpd 0 Continuous
0 Intermittent
acresgpd ❑ Continuous
❑ Intermittent
1.16 Is effluent transported to another facility for treatment prior to discharge?
❑ Yes ❑✓ No+ SKIP to Item 1.21.
0
1.17 Describe the means by which the effluent is transported(e.g.,tank truck,pipe).
1.18 Is the effluent transported by a party other than the applicant?
❑ Yes ❑ No 4 SKIP to Item 1.20.
1.19 Provide information on the transporter below.
Transporter Data
Entity name Mailing address(street or P.O.box)
City or town State ZIP code
Contact name(first and last) Title
Phone number Email address
Page 3

DocuSign Envelope ID:65024340-5319-48C0-A119-E7C42DBA388B
NPDES Permit Number Facility Name Modified Application Form 2A
Riverview Farms 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.
Receiving Facility Data
-0 Facility name Mailing address(street or P.O.box)
3
City or town State ZIP code
0
Contact name(first and last) Title
Phone number Email address
2
aNPDES number of receiving facility(if any) 0 None Average daily flow rate mgd
'c 1.21 Is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do
nnot have outlets to waters of the State of North Carolina(e.g.,underground percolation,underground injection)?
s ❑ Yes ElNo 4 SKIP to Item 1.23.
1.22 Provide information in the table below on these other disposal methods.
Information on Other Disposal Methods
o Disposal Location of Size of Annual Average Continuous or Intermittent
Method Disposal Site Disposal Site Daily Discharge (check one)
R Description Volume
acres gpd 0 Continuous
❑ Intermittent
❑ Continuous
acres gpd ❑ Intermittent
acresgpd El Continuous
0 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.
d 2 Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
A ❑ Discharges into marine waters(CWA ❑ Water quality related effluent limitation(CWA Section
to Section 301(h)) 302(b)(2))
0 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?
El Yes ❑ No 4SKIP to Section 2.
1.25 Provide location and contact information for each contractor in addition to a description of the contractor's operational
and maintenance responsibilities.
Contractor Information
Contractor 1 Contractor 2 Contractor 3
0
Contractor name
(company name)
Mailing address
(street or P.O.box)
`o City,state,and ZIP
code
Contact name(first and
last)
Phone number
Email address
Operational and
maintenance
responsibilities of
contractor
Page 4

DocuSign Envelope ID:65024340-5319-48C0-A119-E7C42DBA388B
NPDES Permit Number Facility Name Modified Application Form 2A
Riverview Farms WWTP Modified March 2021
SECTION 2.ADDITIONAL INFORMATION(40 CFR 122.21(j)(1)and(2))
c Outfalls to Waters of the State of North Carolina
c 2.1 Does the treatment works have a design flow greater than or equal to 0.1 mgd?
as
❑ Yes ❑ No+SKIP to Section 3.
c 2.2 Provide the treatment works'current average daily volume of inflow Average Daily Volume of Inflow and Infiltration
and infiltration.
gpd
Indicate the steps the facility is taking to minimize inflow and infiltration.
0
0
t 2.3 Have you attached a topographic map to this application that contains all the required information?(See instructions for
a specific requirements.)
- 15
o
0 ❑r Yes ❑ No
2.4 Have you attached a process flow diagram or schematic to this application that contains all the required information?
c E (See instructions for specific requirements.)
11. co
c ❑� 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
1.
c
E
a 2.
E
0 0
co 3.
d
CD
d
U,
4.
F) 2.6 Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
Affected Attainment of
11) Scheduled Begin End Begin
Outfalls Operational
2 Improvement Construction Construction Discharge
(from above) (list outfall (MM/DD/YYYY) (MM/DD/YYYY) (MM/DD/YYYY) Level
number) (MM/DD/YYYY)
1.
s
2.
3.
4.
2.7 Have appropriate permits/clearances concerning other federal/state requirements been obtained?Briefly explain your
response.
❑ Yes ❑ No ❑ None required or applicable
Explanation:
Page 5

DocuSign Envelope ID:65024340-5319-48C0-A119-E7C42DBA388B
NPDES Permit Number Facility Name Modified Application Form 2A
Riverview Farms WWTP Modified March 2021
SECTION 3.INFORMATION ON EFFLUENT DISCHARGES(40 CFR 122.21(j)(3)to(5))
3.1 Provide the following information for each outfall. (Attach additional sheets if you have more than three outfalls.)
Outfall Number 001(D Outfall Number 001(( Outfall Number
State NC NC
County Iredell Iredell
0 City or town Statesville Satesville
Distance from shore ft. ft. ft.
a
Depth below surface ft. ft. ft.
Average daily flow rate mgd mgd mgd
Latitude 35° 71' 01" N 35' 70' 93" N
Longitude 81° 04' 44" W 81° 04 46" W °
3.2 Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
c ❑ Yes 0 No 4 SKIP to Item 3.4.
3.3 If so,provide the following information for each applicable outfall.
s
Outfall Number Outfall Number Outfall Number
Number of times per year
0 discharge occurs
a Average duration of each
discharge(specify units)
Average flow of each
discharge mgd mgd mgd
y Months in which discharge
occurs
3.4 Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes ❑r No 4 SKIP to Item 3.6.
3.5 Briefly describe the diffuser type at each applicable outfall.
Outfall Number Outfall Number Outfall Number
d
c ui 3 6 Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
one or more discharge points?
3 w El Yes ❑ No 4SKIP to Section 6.
Page 6

DocuSign Envelope ID:65024340-5319-48C0-A119-E7C42DBA388B
NPDES Permit Number Facility Name Modified Application Form 2A
Riverview Farms WWTP Modified March 2021
3.7 Provide the receiving water and related information(if known)for each outfall.
Outfall Number °°'°a,) Outfall Number 001(C*"1 Outfall Number
Receiving water name Unnamed Creek,Catawba Riw Catawba River,Lake Norman
Name of watershed,river,
c or stream system Catawba River,Lake Norman Catawba River,Lake Norman
U.S.Soil Conservation
Service 14-digit watershed
code
Name of state management/river basin Upper Catawba Upper Catawba
U.S.Geological Survey
8-digit hydrologic 03050101 03050101
oZ cataloging unit code
Critical low flow(acute) See EAA cfs cfs cfs
Critical low flow(chronic) See EAA 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 provided for discharges from each outfall.
Outfall Number Outfall Number Outfall Number
Highest Level of ❑ Primary ❑ Primary 0 Primary
Treatment(check all that ❑ Equivalent to 0 Equivalent to 0 Equivalent to
apply per outfall) secondary secondary secondary
El Secondary 0 Secondary 0 Secondary
❑ Advanced 0 Advanced 0 Advanced
❑ Other(specify) 0 Other(specify) 0 Other(specify)
0
0
a Design Removal Rates by
Outfall
en
d
c
BODs or CBODs
d
E
TSS
❑Not applicable ❑ Not applicable ❑Not applicable
Phosphorus % %
0 Not applicable 0 Not applicable 0 Not applicable
Nitrogen o 0 0
Other(specify) ❑Not applicable 0 Not applicable ❑Not applicable
Page 7

DocuSign Envelope ID:65024340-5319-48C0-A119-E7C42DBA388B
NPDES Permit Number Facility Name Modified Application Form 2A
Riverview Farms 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.
V
w
0
c.)
o Outfall Number 001 Outfall Number Outfall Number
Disinfection type
uv
w
d
Seasons used
Year round
Dechlorination used? ❑ Not applicable ❑ Not applicable ❑ Not applicable
❑ Yes ❑ Yes ❑ Yes
No ❑ No ❑ No
3.10 Have you completed monitoring for all Table A parameters and attached the results to the application package?
❑ Yes El No
3.11 Have you conducted any WET tests during the 4.5 years prior to the date of the application on any of the facility's
discharges or on any receiving water near the discharge points?
❑ Yes ❑✓ No 4 SKIP to Item 3.13.
3.12 Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
discharges by outfall number or of the receiving water near the discharge points.
Outfall Number Outfall Number Outfall Number
Acute Chronic Acute Chronic Acute Chronic
co
rn
Number of tests of discharge
= water
4,3
Number of tests of receiving
water
3.14 Does the POTW use chlorine for disinfection,use chlorine elsewhere in the treatment process,or otherwise have
reasonable potential to discharge chlorine in its effluent?
❑ Yes 4 Complete Table B,including chlorine. El No 4 Complete Table B,omitting chlorine.
3.15 Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
❑ Yes ✓❑ No
Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
3.18 attached the results to this application package?
El Yes El No additional sampling required by NPDES
permitting authority.
Page 8

DocuSign Envelope ID:65024340-5319-48C0-A119-E7C42DBA388B
NPDES Permit Number Facility Name Modified Application Form 2A
Riverview Farms 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+ 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
(MMIDDIYYYY)
c
co 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?
❑ Yes ❑ No 4 SKIP to Item 3.26.
F3.23 Describe the cause(s)of the toxicity:
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 0 Not applicable because previously submitted
information to the NPDES permittin. authorit
Page 9

DocuSign Envelope ID:65024340-5319-48C0-A119-E7C42DBA388B
NPDES Permit Number Facility Name Modified Application Form 2A
Riverview Farms WWTP Modified March 2021
SECTION 6.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
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
Ei Section 1:Basic Application
Information for All Applicants ❑ wl variance request(s) ❑ w/additional attachments
❑ Section 2:Additional ❑ w/topographic map ❑ wl process flow diagram
Information ❑ wl additional attachments
❑ wl Table A ❑ wl Table D
❑ Section 3:Information on ❑ w/Table B ❑ w/additional attachments
Effluent Discharges
❑ w/Table C
Section 4:Not Applicable
G
as
e.s Section 5:Not Applicable
❑ Section 6:Checklist and ❑ w/attachments
Certification Statement
Y 6.2 Certification Statement
/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
Eric S.Swain President
Signature Date signed
EDocuSigned by:
fYiG S. Swann,
atbuir.0e1-81-4A2.
Page 10

DocuSign Envelope ID:65024340-5319-48C0-A119-E7C42DBA388B
NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
Riverview Farms WWTP 001 Modified March 2021
TABLE A.EFFLUENT PARAMETERS FOR ALL POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant
Value Units Value Units Sam b er lest Method, (include units)
Biochemical oxygen demand
0 BODs or❑CBODs ❑ML
re.ort one ❑MDL
❑ML
Fecal coliform ❑MDL
Design flow rate
pH(minimum)
pH(maximum)
Temperature(winter)
Temperature(summer)
Total suspended solids(TSS) ❑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 11

DocuSign Envelope ID:65024340-5319-48C0-A119-E7C42DBA388B
EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
Riverview Farms WWTP 001 Modified March 2021
TABLE B.EFFLUENT PARAMETERS FOR ALL POTWS WITH A FLOW EQUAL TO OR GREATER THAN 0.1 MGD
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant
Value Units Value Units Number of Method' (include units)
Samples
Ammonia(as N) ❑ML
❑MDL
Chlorine
❑ML
(total residual,TRC)2 ❑MDL
❑ML
Dissolved oxygen 0 MDL
Nitrate/nitrite ❑ML
❑MDL
Kjeldahl nitrogen ❑ML
❑MDL
Oil and grease ❑ML
❑MDL
Phosphorus ❑ML
❑MDL
Total dissolved solids ❑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).
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

DocuSign Envelope ID:65024340-5319-48C0-A119-E7C42DBA388B
EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
Riverview Farms WWTP 001 Modified March 2021
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Methods (include units)
Value Units Value Units Samples
Metals,Cyanide,and Total Phenols
Hardness(as CaCO3) D ML
❑MDL
Antimony,total recoverable ❑ML
D MDL
Arsenic,total recoverable 0 ML
D MDL
Beryllium,total recoverable D ML
0 MDL
Cadmium,total recoverable 0 ML
❑MDL
Chromium,total recoverable D ML
❑MDL
Copper,total recoverable ❑ML
❑MDL
Lead,total recoverable D ML
0 MDL
Mercury,total recoverable 0 ML
❑MDL
Nickel,total recoverable D ML
D MDL
Selenium,total recoverable ❑ML
❑MDL
Silver,total recoverable ❑ML
❑MDL
Thallium,total recoverable 0 ML
❑MDL
Zinc,total recoverable ❑ML
❑MDL
Cyanide ❑ML
❑MDL
Total phenolic compounds D ML
❑MDL
Volatile Organic Compounds
Acrolein D ML
❑MDL
Acrylonitrile D ML
❑MDL
Benzene ❑ML
❑MDL
Bromoform ❑ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 13

DocuSign Envelope ID:65024340-5319-48C0-A119-E7C42DBA388B
EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
Modified March 2021
Riverview Farms WWTP 001
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method' (include units)
Value Units Value 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 0 ML
❑MDL
1,2-dichloroethane 0 ML
❑MDL
trans-1,2-dichloroethylene ❑ML
❑MDL
❑ML
1,1-dichloroethylene 0 MDL
1,2-dichloropropane ❑ML
❑MDL
1,3-dichloropropylene ❑ML
❑MDL
Ethylbenzene ❑ML
❑MDL
Methyl bromide ❑ML
0 MDL
Methyl chloride ❑ML
❑MDL
Methylene chloride ❑ML
❑MDL
1,1,2,2-tetrachloroethane ❑ML
0 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

DocuSign Envelope ID:65024340-5319-48C0-A119-E7C42DBA388B
EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
Riverview Farms WWTP 001 Modified March 2021
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Methods (include units)
Value Units Value Units Samples
❑ML
Trichloroethylene ❑MDL
Vinyl chloride ❑ML
❑MDL
Acid-Extractable Compounds
p-chloro-m-cresol ❑ML
❑MDL
❑ML
2-chlorophenol ❑MDL
2,4-dichlorophenol ❑ML
❑MDL
❑ML
2,4-dimethylphenol ❑MDL
❑ML
4,6-dinitro-o-cresol ❑MDL
❑ML
2,4-dinitrophenol ❑MDL
2-nitrophenol ❑ML
❑MDL
4-nitrophenol
❑ML
❑MDL
❑ML
Pentachlorophenol ❑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 0 ML
_ ❑MDL
Benzo(a)pyrene ❑ML
❑MDL
3,4-benzofluoranthene ❑ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 15

DocuSign Envelope ID:65024340-5319-48C0-A119-E7C42DBA388B
EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
Modified March 2021
Riverview Farms WWTP ow.
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method1 (include units)
Value Units Value 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 0 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 0 ML
❑MDL
❑ML
1,2-dichlorobenzene ❑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
0 MDL
EPA Form 3510-2A(Revised 3-19) Page 16

DocuSign Envelope ID:65024340-5319-48C0-A119-E7C42DBA388B
EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
Riverview Farms WWTP 001 Modified March 2021
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method' (include units)
Value Units Value Units Samples
1,2-diphenylhydrazine ❑ML
0 MDL
Fluoranthene 0 ML
_ ❑MDL
Fluorene 0 ML
❑MDL
❑ML
Hexachlorobenzene ❑MDL
Hexachlorobutadiene ❑ML
❑MDL
Hexachlorocyclo-pentadiene ❑ML
❑MDL
Hexachloroethane ❑ML
❑MDL
Indeno(1,2,3-cd)pyrene ❑ML
0 MDL
Isophorone ❑ML
❑MDL
Naphthalene 0 ML
0 MDL
Nitrobenzene ❑ML
❑MDL
N-nitrosodi-n-propylamine ❑ML
❑MDL
N-nitrosodimethylamine 0 ML
0 MDL
N-nitrosodiphenylamine ❑ML
0 MDL
Phenanthrene 0 ML
❑MDL
Pyrene ❑ML
❑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

DocuSign Envelope ID:65024340-5319-48C0-A119-E7C42DBA388B
NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
Modified March 2021
Riverview Farms WWTP
TABLE D.ADDITIONAL POLLUTANTS AS REQUIRED BY NPDES PERMITTING AUTHORITY
Maximum Daily Discharge Average Daily Discharge
Pollutant Analytical ML or MDL
(list) Value Units Value Units Number of Method, (include units)
Samples
ElNo additional sampling is required by NPDES permitting authority.
o ML
0 MDL
❑ML
❑MDL
❑ML
❑MDL
0 ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
0 MDL
❑ML
0 MDL
0 ML
❑MDL
❑ML
❑MDL
❑ML
0 MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or required
under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
Page 18