NC0035807_Renewal (Application)_20240920

STATE Q,
ROY COOPER 4,;;,
Governor, I
ELIZABETH S.BISER
Secretary
RICHARD E.ROGERS,JR. NORTH CAROLINA
Director Environmental Quality
September 23, 2024
City of Asheville
Attn: Debra Cambell, City Manager
PO Box 7148
Asheville, NC 28802-7148
Subject: Permit Renewal
Application No. NC0035807
Northfork WTP
Buncombe County
Dear Applicant:
The Water Quality Permitting Section acknowledges the September 20, 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.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.
Sincere
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
cc: Brendan Kelley, ORC
ec: WQPS Laserfiche File w/application
Q=v North Carolina Department of Environmental Quality Division of Water Resources
`►/�Jrt/ Asheville Regional Office 12090 U.S.Highway 70 I Swannanoa.North Carolina 28778
�a D • 828 296 4500

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
110054268948 NC0035807 North Fork WTP OMB No.2040-0004
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
Is the facility a new or existing publicly owned Is the facility a new or existing treatment works
1.1.1 treatment works? 1.
1.2 treating domestic sewage?
If yes,STOP.Do NOT complete 0 No If yes,STOP. Do NOT 0 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?
o1=1Yes 4 Complete Form 1 0 No 0 Yes 4 Complete Form ❑ No
a and Form 2B. 1 and Form 2C.
c 1.2.3 Is the facility a new manufacturing,commercial, 1.2.4 Is the facility a new or existing manufacturing,
cts
mining,or silvicultural facility that has not yet commercial,mining,or silvicultural facility that
.= commenced to discharge? discharges only nonprocess wastewater?
g � Yes 4 Complete Form 1 0 No Yes 4 Complete Foitn eit,No
ce and Form 2D. 1 and Form PE. CEIvED
°.. 1.2.5 Is the facility a new or existing facility whose
discharge is composed entirely of stormwater SEP 2
a associated with industrial activity or whose 2024
discharge is composed of both stormwater and
non-stormwater? NCDEQin
❑ Yes 4 Complete Form 1 0 No `NPDES
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
North Fork water Treatment Plant
2.2 EPA Identification Number
U
0 110054268948
2.3 Facility Contact
Name(first and last) Title Phone number
L
Brendan Kelley Plant Supervisor/ORC [phone]
Email address
[e-mail]
2.4 Facility Mailing Address
Street or P.O.box
3374 North Fork Left Fork Rd
City or town State ZIP code
Black Mountain NC 28711
EPA Form 3510-1(revised 3-19) Page 1
4

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
110054268948 NC0035807 North Fork Water Treatment OMB No.2040-0004
N 2.5 Facility Location
. Street, route number,or other specific identifier
Q 0 3374 North Fork Left Fork Rd
c o County name County code(if known)
Buncombe
E o City or town State ZIP code
z Black Mountain NC 28711
SECTION 3.SIC AND NAICS CODES(40 CFR 122.21(f)(3))
3.1 SIC Code(s) Description(optional)
N
a
'O
0
U
CO
U
3.2 NAICS Code(s) Description(optional)
SECTION 4.OPERATOR INFORMATION(40 CFR 122.21(f)(4))
4.1 Name of Operator
City of Asheville
4.2 Is the name you listed in Item 4.1 also the owner?
0 0 Yes ❑ No
4.3 Operator Status
❑ Public—federal ❑ Public—state 0 Other public(specify)City
❑ Private ❑ Other(specify)
4.4 Phone Number of Operator
[phone]
= 4.5 Operator Address
Street or P.O. Box
E m 3374 North fork Left Fork Rd
o g
_ w City or town State ZIP code
o o Black Mountain NC 28711
is U
a Email address of operator
0
SECTION 5.INDIAN LAND(40 CFR 122.21(f)(5))
0 5.1 Is the facility located on Indian Land?
c ❑ Yes ENo
EPA Form 3510-1(revised 3-19) Page 2
J

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
110054268948 NC0035807 North Fork Water Treatment OMB No.2040-0004
•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 surface ❑ RCRA(hazardous wastes) ❑ UIC(underground injection of
water) fluids)
o NC0035807
> E
w a ❑ PSD(air emissions) ❑ Nonattainment program(CM) ❑ NESHAPs(CM)
47.
❑ Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section 404) ❑ 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.)
0 Yes ❑ No ❑ 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.
North Fork Water Treatment Plant is a direct filtration water treatment plant that uses conventional treatment
processes to produce drinking water for the greater Asheville area.Source water is subject to pre-chlorination using
Sodium Hypochlorite.Coagulation/Flocculation occurs in the flocculation basins with the addition of Aliminum
cn
Sulfate.Filtration happens across 6 dual media filters that remove flocc and sediments.Additional Sodium
co Hypochlorite is added to provide post chlorination residual and CT is met in a 5 million gallon clearwell.Sodium
o Bicarbonate,Hydrofluorsilicic Acid,Zinc Orthophosphate and Caustic Soda are added as the water enters the City of
Asheville distribution system.
I Z
.ECTION 9.COOLING WATER INTAKE STRUCTURES(40 CFR 122.21(f)(9))
9.1 Does your facility use cooling water?
❑ Yes ❑ No 4 SKIP to Item 10.1.
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.)
O .Y
O f%,
U �
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 ❑ quality Water ualit related effluent limitations(CWA Section
a) ❑
Section 301(n)) 302(b)(2))
❑ Non-conventional pollutants(CWA ❑ Thermal discharges(CWA Section 316(a))
co
Section 301(c)and(g))
0 Not applicable
EPA Form 3510-1(revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
110054268948 NC0035807 North Fork Water Treatment OMB No.2040-0004
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
0 Section 1:Activities Requiring an NPDES Permit Er w/attachments
0 Section 2: Name, Mailing Address,and Location ❑ w/attachments
❑ Section 3:SIC Codes ❑ w/attachments
0 Section 4: Operator Information ❑ wl attachments
O Section 5: Indian Land ❑ wl attachments
❑ Section 6: Existing Environmental Permits [1 w/attachments
d ❑ w/topographic
❑ map ❑
CD Section 7: Map wl additional attachments
co
ElSection 8: Nature of Business ❑ wl attachments
❑ Section 9:Cooling Water Intake Structures ❑ w/attachments
❑ Section 10:Variance Requests ❑ wl attachments
N 0 Section 11:Checklist and Certification Statement ❑ w/attachments
Y
d 11.2 Certification Statement
' U
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
D,visi "1.431V��
Signature Date signed
cst ef+ -11t' 7/io1,_01Zy
EPA Form 3510-1(revised 3-19) Page 4

Ilt
Mr))
4�.d
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Public Water Supply Section
1634 Mail Service Center,Raleigh,NC
Telephone[phone]
•
ASHEVILLE,CITY OF SYSTEM NAME: ASHEVILLE CITY OF
PO BOX 7148
ASHEVILLE,NC 28802-7148 RESPONSIBLE MELTON,DAVID
PERSON: PO BOX 7148
• ASHEVILLE,NC 28802
PWS ID: NC0111010 Buncombe County
OWNER ID: 75220
2024 PERMIT TO OPERATE A PUBLIC WATER SYSTEM
POPULATION SERVED: 156,720
The above named Community or Non-Transient Non-Community Public Water Supply System is granted a
permit to operate this facility for the calendar year 2024. The permit expires at midnight on December 31,
2024.
The permit signifies that the annual fee has been paid in full and that a completed annual operating permit
application has been submitted.
All permitted community and non-transient non-community water systems shall comply with 1511 NCAC 18C,
North Carolina's Rules Governing Public Water Systems. Rule.2102(1)requires that the supplier of water
who holds a current operating permit shall inform the Department of any changes of address or transfer of
ownership within 30 days of the changes.
Payment of the 2025 operating permit fee is due by November 2,2024. Administrative Penalties will be
assessed for payments not received by December 31,2024.Renewal notices will be sent in September 2024.
Sincerely,
eaSCI-6-j°
Rebecca Sadosky,Ph.D.,Chief
Public Water Supply Section
Division of Water Resources,NCDEQ
cc: KIMBERLY BARNETT,P.E.,Regional Engineer

Permit NC0035807
QD
Part I Olin ]�rK
A. (1) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
[15A NCAC 02B.0400 et seq., 15A NCAC 02B.0500 et seq.]
Beginning with the effective date of this permit and lasting until expiration, the Permittee is
authorized to discharge treated wastewater from Outfall 001. Such discharges shall be limited
and monitored]. by the Permittee as specified below:
EFFLUENT LIMITATIONS MONITORING REQUIREMENTS
EFFLUENT CHARACTERISTICS
Parameter Code Monthly Daily Measurement Sample Sample
Average Maximum Frequency Type Location
Flow 50050 Continuous Recording Effluent
Total Suspended Solids C0530 30.0 mg/L 45.0 mg/L 2/Month Grab Effluent
Total Residual Chlorine 2 50060 28 Ng/L 2/Month Grab Effluent
>6.0 and<9.0 2/Month Grab Effluent
pH 00400 standard units
Turbidity 00070 Monitor&Report 2/Month Grab Effluent
Total Copper 01042 Monitor&Report Quarterly 3 Grab Effluent
Total Aluminum 01105 Monitor&Report Quarterly 3 Grab Effluent
Total Fluoride 00951 Monitor&Report Quarterly 3 Grab Effluent
Total Zinc 01092 Monitor&Report Quarterly 3 Grab Effluent
Total Hardness(as CaCO3) 00900 Monitor&Report Quarterly 3 Grab Effluent
Total Hardness(as CaCO3) 00900 Monitor&Report Quarterly 3 Grab Upstream
Whole Effluent Toxicity4 TGP3B Monitor&Report Quarterly Grab Effluent
Footnotes:
1. The permittee shall submit discharge monitoring reports electronically using the NC DWR's eDMR
application system [see A. (3)].
2. The Division shall consider all effluent TRC values reported below 50 µg/1 to be in compliance with
the permit. However, the Permittee shall continue to record and submit all values reported by a
North Carolina certified laboratory (including field certified), even if these values fall below 50 µg/1.
3. Parameters should be sampled in conjunction with the chronic toxicity testing.
4. Chronic Toxicity (Ceriodaphnia Pass/Fail monitoring at 22%): January, April, July& October [see A.
(2.)]
THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR VISIBLE FOAM IN OTHER THAN
TRACE AMOUNTS.
Page3of7
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North Fork WTP i������1 �11f1L�'`I l
NPDES Permit NC0035807 rr�1�,jv�/,i��Al���a�� i��
AIM"
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Facility Location >40 #`�
Receiving Stream:North Fork of the Swannanoa River scale not shown
Stream Segment:6-78-11-(13) Stream Class:C IWO
River Basin: French Broad Sub-Basin#:04-03-02 SCALE 35.66°, -82.349722°
County: Buncombe HUC:0601010506 1:24,000 USGS Quad:Montreat

Access Road
Lagoon Effluent
Containment Structures
18"Storm Drain Line
•
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elk Lagoon#t1
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0.4 ac 478,O 0 gallons
O.5ac �.�
Lagoon#1Su ILagoon i8rs
La
g Supply #2Discharge
1$ 4111'
Lagoon#3 0
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24" Lagoon#2 Sapp ly 18" 9,000,2,0 ac l Ions
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24" 'F
�r Lagoon#1 By-Pass Legooh#3 By Pass
• 24" or Lagtoon#2 By-Pass
Backwash Line Lagoon#2By-Pass
•
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Lagoon#3 By-Pass •
•
North Fork WIP Waste Lagoon Layout 811j12
IL

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
110054268948 NC0035807 North Fork Water Treatment OMB No.2040-0004
Form U.S. Environmental Protection Agency
Application for NPDES Permit to Discharge Wastewater
2C VP/EPA
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.
g Numbelr Receiving Water Name Latitude Longitude
'IT:
V
0 0 1 Noth Fork of the Swannanoa 35° 39' 36" 80° 20' 59"
R
7
0
SECTION 2.LINE DRAWING(40 CFR 122.21(g)(2))
o, 2.1 Have you attached a line drawing to this application that shows the water flow through your facility with a water
3 balance?(See instructions for drawing requirements.See Exhibit 2C-1 at end of instructions for example.)
J R
o ❑✓ Yes ❑ No
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
Filter backwash water,filter-to-waste and storm water 0.0-0.624 mgd
E'
E mgd
d
it mgd
a
c
41 mgd
3
o Treatment Units
T_
a Description Code from Final Disposal of Solid or
d (include size,flow rate through each treatment unit, Table 2C-, Liquid Wastes Other Than
a' retention time,etc.) by Discharge
Lagoon 1:0.4 ac,182,000 gal 5-C,5-Q landfill
Lagoon 2:0.5 ac,978,000 gal 5-C,5-Q landfill
Lagoon 3:2.0 ac,3,000,000 gal 5-C,5-Q landfill
EPA Form 3510-2C(Revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
110054268948 NC0035807 North Fork Water Treatment 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
-a
a)
U
m
E
H
c **Outfall Number**
fQ Operations Contributing to Flow
Operation Average Flow
a) mgd
a mgd
mgd
mgd
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
3.2 Are you applying for an NPDES permit to operate a privately owned treatment works?
n ❑ Yes ✓❑ No 4 SKIP to Section 4.
�n= 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
110054268948 NC0035807 North Fork Water Treatment OMB No.2040-0004
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 0 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
30 days/week months/year mgd mgd days
T.
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
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 ❑r No 4 SKIP to Section 6.
5.2 Provide the following information on applicable ELGs.
w ELG Category ELG Subcategory Regulatory Citation
0.
5.3 Are any of the applicable ELGs expressed in terms of production(or other measure of operation)?
❑ Yes ❑r No 4 SKIP to Section 6.
7 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
Co
co
0
0
a`
EPA Form 3510-2C(Revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
110054268948 NC0035807 North Fork Water Treatment 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
E Brief Identification and Description of Outfalls Source(s)of
o Project (list outfall Discharge Required Projected
number)
E
a
Co
R
rn
a
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 r❑ 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?
O 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
N requested and attached the results to this application package?
No;a waiver has been requested from my NPDES
❑ Yes ❑ permitting authority for all pollutants at all outfalls.
co
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.)
0 Yes 0 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 El 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 GC/MS Fraction(s)
(Check applicable boxes.)
❑Volatile 0 Acid 0 Base/Neutral 0 Pesticide
❑Volatile 0 Acid 0 Base/Neutral 0 Pesticide
❑Volatile 0 Acid 0 Base/Neutral 0 Pesticide
EPA Form 3510-2C(Revised 3-19) Page 4

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
110054268948 NC0035807 North Fork Water Treatment OMB No.2040-0004
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?
0 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?
0 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
indicated are`Believed Present"in your discharge?
El Yes ❑ No
7.10 Does the applicant qualify fora small business exemption under the criteria specified in the instructions?
❑ Yes 4 Note that you qualify at the top of Table B, 0 No
then SKIP to Item 7.12.
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,
pollutants you have indicated are"Believed Present"in your discharge?
0 Yes ❑ No
. Table C.Certain Conventional and Non-Conventional Pollutants
El 7.12 Have you indicated whether pollutants are"Believed Present"or"Believed Absent"for all pollutants listed on Table C
for all outfalls?
Y El Yes ❑ No
c 7.13 Have you completed Table C by providing(1)quantitative data for those pollutants that are limited either directly or
indirectly in an ELG and/or(2)quantitative data or an explanation for those pollutants for which you have indicated
CCS "Believed Present"?
0 Yes ❑ No
w 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 ❑ 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. ElNo 4 SKIP to Section 8.
7.17 Have you completed Table E by reporting qualitative data for TCDD?
❑ Yes ❑ 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
an intermediate or final product or byproduct?
w ❑ Yes ❑ No 4 SKIP to Section 9.
8.2 List the pollutants below.
P
1. Zinc 4
2. 5. 8.
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
110054268948 NC0035807 North Fork Water Treatment 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?
0 Yes ❑ No 3 SKIP to Section 10.
9.2 Identify the tests and their purposes below.
0 Test(s) Purpose of Test(s) Submitted to NPDES� Date Submitted
x Permitting Authority.
0
F" Chronic Toxicity Monitor&Report
Yes ❑ No 01/02/2024
•cn
Chronic Toxicity Monitor&Report
m ✓❑ Yes ❑ No 04/02/2024
Chronic Toxicity Monitor&Report
✓❑ Yes ❑ No 07/16/2024
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?
❑r Yes D No 3 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 Cameron Testing Services Envirochem
ti
d
Laboratory address 219 S.Steele St 6602 Windmill Way
Sanford,NC Wilimington,NC 28405
27330
cC
Phone number
[phone] [phone]
Pollutant(s)analyzed Copper,Zinc,Aluminum Fluoride
SECTION 11.ADDITIONAL INFORMATION(40 CFR 122.21(g)(13))
11.1 Has the NPDES permitting authority requested additional information?
❑ Yes ❑✓ No 3 SKIP to Section 12.
O
11.2 List the information requested and attach it to this application.
Lo
1. 4.
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
110054268948 NC0035807 North Fork Water Treatment OMB No.2040-0004
❑I-"'.
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 Elw/attachments
❑✓ Section 2:Line Drawing El w/line drawing ❑ w/additional attachments
Section 3:Average Flows and w/list of each user of
❑ Treatment ❑ w/attachments 0 privately owned treatment
works
❑ Section 4: Intermittent Flows ❑ w/attachments
❑ Section 5:Production ❑ w/attachments
w/optional additional
❑ Section 6: Improvements El w/attachments ❑ sheets describing any
additional pollution control
plans
❑ w/request for a waiver and ❑ w/explanation for identical
supporting information outfalls
_: w/small business exemption
❑ request 0 w/other attachments
ra ❑ Section 7: Effluent and Intake Elwl Table A 0w/Table B
Characteristics
Q
R; ❑✓ wl Table C ❑✓ w/Table D
v ❑r w/Table E ❑ w/analytical results as an
0 attachment
❑ Section 8:Used or Manufactured ❑ w/attachments
17, Toxics
❑ Section 9: Biological Toxicity ❑ w/attachments
a) Tests
0
ElSection 10:Contract Analyses ❑ wl attachments
❑ Section 11:Additional Information ❑ w/attachments
❑ Section 12:Checklist and ❑ w/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
N�
j)r1/�s/Q I) � �c!"
1/.//-it fri ,4 �1`i2T 222 J
Signature Date signed
/ 's- a A/ ,ef . 7/io%42 H
EPA Form 3510-2C(Revised 3-19) Page 7

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
110054268948 NC0035807 North Fork Water Treatment Plant 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
(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 45.0 mg/L 30.0 mg/L 2/Month
4. Total suspended solids(TSS) ❑✓
Mass
Concentration
5. Ammonia(as N) ❑
Mass
6. Flow ❑r Rate Continuuous
Temperature(winter) ❑ °C °C
7.
Temperature(summer) ❑ °C °C
pH(minimum) ❑✓ Standard units S.U. 6.0 2/Month
8.
pH (maximum) ✓❑ Standard units s.u. 9.0 2/month
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

1
EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
110054268948 North Fork water Treatment Plant OMB No.2040-0004
NC0035807 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 Term
aily of of
Discharge ifavalablle) DisDcharge Analyses Averageischarge Value Analyses
(required)
(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
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) Mass
Arsenic,total El 0 ✓ Concentration
1.2 (7440-38-2) Mass
Beryllium,total Concentration
1.3 (7440-41-7) Mass
Cadmium,total ✓ Concentration
1.4 (7440-43-9) Mass
Chromium,total ✓ Concentration
1.5 (7440-47-3) Mass
1.6 Copper,total ❑ Concentration Quarterly
(7440-50-8) Mass
Lead,total ✓ Concentration
1.7 (7439-92-1) Mass
Mercury,total ✓ Concentration
1.8 (7439-97-6) Mass
1.9 Nickel,total ❑ 0 ✓❑ Concentration
(7440-02-0) Mass
Selenium,total ✓ Concentration
1.10 (7782 49 2) Mass
1.11 Silver,total 0 ❑ ❑ Concentration
(7440-22-4) Mass
EPA Form 3510-2C(Revised 3-19) Page 11

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
110054268948 NC0035807 North Fork water Treatment Plant 001 OMB No.2040-0004
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
D(req fired) ifavalabe) DiDharge Analyses of of
ischarge Discharge Average Analyses
(if available) _ _
Thallium,total Concentration
1.12 (7440 28 0) El El El
Mass
Zinc,total r0 Concentration Quarterly
1.13 (7440-66-6) Mass
1.14 Cyanide,total Concentration
El El 1=1
(57-12-5) Mass
1.15 Phenols,total D El El
Concentration
Mass
Section 2.Organic Toxic Pollutants(GC/MS Fraction—Volatile Compounds)
2.1 Acrolein 0 Concentration
El El
(107-02-8) Mass
Acrylonitrile Concentration
2.2 0 D E Mass
2.3 Benzene ❑ Concentration
1=1 El
(71-43-2) Mass
2 4 Bromoform ❑ Concentration
(75-25-2) Mass
Carbon tetrachloride Concentration
2.5 (56-23-5) Mass
2.6 Chlorobenzene Concentration
El 0 El
(108-90-7) Mass
2.7 Chlorodibromomethane z Concentration
(124-48-1) Mass
2.8 Chloroethane Concentration
(75-00-3) ✓ Mass
EPA Form 3510-2C(Revised 3-19) Page 12

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
110054268948 NC0035807 North Fork water Treatment Plant 001 OMB No.2040-0004
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 Maximum Maximum Long-Term Long-
(and CAS Number,if available) Required Believed Believed (specify) Daily Monthly Average Number Term Number
Present Absent
Discharge Discharge Di AverageAnalyses Average Analyses
(required) (if available) (if available) Value
2.9 2-chloroethylvinyl ether � Concentration
0 El
(110-75-8) r Mass
2.10 Chloroform(67-66-3) Concentration
Mass
2.11 Dichlorobromomethane El Concentration
(75-27-4) Mass
212 1,1-dichloroethane © Concentration
0 El
(75-34-3) Mass
1,2-dichloroethane Concentration
2.13 0(107-06-2) Mass
2.14 11-dichloroethylene 0 tEl
Concentration
(75-35-4) Mass
2.15 1,2-dichloropropane 0Concentration
El El
(78-87-5) Mass
2.16 13-dichloropropylene 0 ❑ ❑ Concentration
(542-75-6) Mass
217 Ethylbenzene 0 Concentration
El 0
(100-41-4) Mass
2.18 Methyl bromide ❑ Concentration
D El
(74-83-9) Mass
2.19 Methyl chloride 0Concentration
(74-87-3) Mass
2 20 Methylene chloride El Concentration
(75-09-2) Mass
2.21 1 1,2,2-tetrachloroethane ❑ ❑ Concentration
(79-34-5) Mass
EPA Form 3510-2C(Revised 3-19) Page 13

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
110054268948 NC0035807 North Fork water Treatment Plant 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))l
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 DisDchar of a Analyses Average Analyses
(required) (if available) (if availableValue
2 22 Tetrachloroethylene ❑ Concentration
(127-18-4) Mass
Toluene 0 Concentration
2.23 (108-88-3) ❑
Mass
2 24 1,2-trans-dichloroethylene ❑ 0Concentration
(156-60-5) Mass
2.25 1,1,1-trichloroethane ❑ Concentration
(71-55-6) Mass
2.26 1 1,2-trichloroethane El ❑ Concentration
(79-00-5) Mass
2 27 Trichloroethylene ❑ DIConcentration
(79-01-6) Mass
2 28 Vinyl chloride Concentration
0 El
(75-01-4) ✓ Mass
Section 3.Organic Toxic Pollutants(GC/MS Fraction—Acid Compounds)
3.1 2-chlorophenol 0 Concentration
0 El
(95-57-8) Mass
2,4-dichlorophenol Concentration
3.2 (120-83-2) Mass
2,4-dimethylphenol Concentration
3.3 (105-67-9) Mass
4,6-dinitro-o-cresol 0 Concentration
3.4 El 1=1
(534-52-1) Mass
3.5 2,4-dinitrophenol ❑ ❑ ❑ Concentration
(51-28-5) Mass
EPA Form 3510-2C(Revised 3-19) Page 14

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
110054268948 NC0035807 North Fork water Treatment Plant 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))l
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)
3.6 2-nitrophenol ❑ ❑ Concentration
(88-75-5) Mass
4-nitrophenol Concentration
3.7 (100-02-7) El ❑ El
3.8 p-chloro-m-cresol El ❑ ❑ Concentration
(59-50-7) Mass
3.9 Pentachlorophenol ❑ ❑ ❑ Concentration
(87-86-5) Mass
Phenol Concentration
3.10 (108-95-2) ❑ El El
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
Acenaphthylene Concentration
4.2 (208-96-8) ❑ ❑ ❑ Mass
Anthracene r Concentration
4.3 (120-12-7) El El El
Benzidine Concentration
4.4 (92 87 5) ❑ ❑ ❑ Mass
4.5 Benzo(a)anthracene El ❑ ❑ Concentration
(56-55-3) Mass
4.6 Benzo(a)pyrene ❑ ❑ Concentration
r
(50-32-8) Mass
EPA Form 3510-2C(Revised 3-19) Page 15

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
110054268948 NC0035807 North Fork water Treatment Plant 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))'
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 AverageValue Analyses
(required) (if available)
(if available)
4.7 3 4-benzofluoranthene Concentration
(205-99-2) ✓ Mass
Benzo(ghi)perylene 2 Concentration
4.8 (191-24-2) Mass
4.9 Benzo(k)fluoranthene � Concentration
(207-08-9) ✓ Mass
4.10 Bis(2-chloroethoxy)methane z Concentration
(111-91-1) Mass
Bis(2-chloroethyl)ether z Concentration
4.11 (111-44-4) Mass
4.12 Bis(2-chloroisopropyl)ether z Concentration
(102-80-1) Mass
4.13 Bis(2-ethylhexyl)phthalate � Concentration
El 0
(117-81-7) ✓ Mass
4.14 4-bromophenyl phenyl ether z Concentration
(101-55-3) Mass
4.15 Butyl benzyl phthalate Ei Concentration
(85-68-7) Mass
4.16 2-chloronaphthalene z Concentration
(91-58-7) Mass
4-chlorophenyl phenyl ether 0 Concentration
4.17 (7005-72-3) Mass
Chrysene ✓ Concentration
4.18 (218-01-9) Mass
4.19 Dibenzo(a,h)anthracene � Concentration
(53-70-3) ✓ Mass
EPA Form 3510-2C(Revised 3-19) Page 16

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
110054268948 NC0035807 North Fork water Treatment Plant 001 OMB No.2040-0004
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 Termof
Discharge Discharge DisDcharaily ge Analyses Average Analyses
(required) (if available) (if available) Value
4.20 12-dichlorobenzene Concentration
(95-50-1) ✓ Mass
4.21 1,3-dichlorobenzene Concentration
(541-73-1) ✓ Mass
4.22 1 4-dichlorobenzene Concentration
(106-46-7) Mass
4.23 3,3-dichlorobenzidine Concentration
(91-94-1) Mass
4.24 Diethyl phthalate Concentration
(84-66-2) Mass
Dimethyl phthalate Concentration
4.25 (131-11-3) Mass
4.26 Di-n-butyl phthalate ElConcentration
(84-74-2) Mass
4.27 2,4-dinitrotoluene Concentration
(121-14-2) ✓ Mass
4.28 2,6-dinitrotoluene Concentration
(606-20-2) Mass
4.29 Di-n-octyl phthalate ✓ Concentration
(117-84-0) Mass
4.30 1,2-Diphenylhydrazine Concentration
(as azobenzene)(122-66-7) Mass
4.31 Fluoranthene Concentration
(206-44-0) ✓ Mass
4.32 Fluorene Concentration
0 0
(86-73-7) ✓ Mass
EPA Form 3510-2C(Revised 3-19) Page 17

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
110054268948 NC0035807 North Fork water Treatment Plant 001 OMB No.2040-0004
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)
Hexachlorobenzene Concentration
4.33 (118-74-1) Mass
4.34 Hexachlorobutadiene Concentration
El 1=1
(87-68-3) r Mass
4.35 Hexachlorocyclopentadiene Concentration
(77-47-4) ✓ Mass
4.36 Hexachloroethane ❑ Concentration
(67-72-1) ✓ Mass
4.37 Indeno(1,2,3-cd)pyrene El Concentration
l
(193-39-5) ✓ Mass
4.38 Isophorone Concentration
r
(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
El El El
(621-64-7) Mass
4.43 N-nitrosodiphenylamine Concentration
1=I El El
(86-30-6) Mass
4.44 Phenanthrene Concentration
El 1=1 r
(85-01-8) Mass
Pyrene Concentration
4.45 (129-00-0) Mass
EPA Form 3510-2C(Revised 3-19) Page 18

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
110054268948 NC0035807 North Fork water Treatment Plant 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))'
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)
1,2,4-trichlorobenzene Concentration
4.46 (120-82-1) ❑ ❑ ❑
Mass
Section 5.Organic Toxic Pollutants(GC/MS Fraction—Pesticides)
5.1 Aldrin ❑ ❑ ❑ Concentration
(309-00-2) Mass
a-BHC ci Concentration
5.2 (319-84-6) El El
R-BHC z Concentration
5.3 (319-85-7) El ElMass
y-BHC 0 Concentration
5.4 (58 89 9) ❑ ❑ Mass
5-BHC z Concentration
5.5 (319-86-8) ❑ 0 Mass
5.6 Chlordane ❑ ❑ ❑ Concentration
(57-74-9) Mass
5.7 4,4'-DDT ❑ ❑ ❑ Concentration
(50-29-3) Mass
4 4'-DDE Concentration
5.8 (72-55-9) ❑ ❑ ❑ Mass
5.9 4 4'-DDD El ❑ ❑r Concentration
(72-54-8) Mass
5.10 Dieldrin ❑ 0
❑ Concentration
(60-57-1) Mass
5.11 a-endosulfan El ❑ ❑ Concentration
(115-29-7) Mass
EPA Form 3510-2C(Revised 3-19) Page 19

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
110054268948 NC0035807 North Fork water Treatment Plant 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))l
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 Dail of Term of
uDischarge ifavalabe)ischarg De ischarge Analyses AValuee Analyses
(if available)
5.12 R-endosulfan El 0
❑ Concentration
(115-29-7) Mass
Endosulfan sulfate Concentration
5.13 (1031-07-8) El ❑ El
Mass
Endrin Concentration
5.14 (72 20 8) El 0 ❑ Mass
Endrin aldehyde Concentration
5.15 (7421-93-4) El 0 Mass
5.16 Heptachlor El 0
❑ Concentration
(76-44-8) Mass
Heptachlor epoxide Concentration
5.17 (1024-57-3) ❑ ❑ 0
Mass
PCB-1242 Concentration
5.18 (53469-21-9) 0 0 0
Mass
PCB-1254 Concentration
5.19 (11097-69-1) 0 0 0
Mass
PCB-1221 - Concentration
5.20 (11104-28-2) 0 0 0 Mass
PCB-1232 Concentration
5.21 (11141-16-5) ❑ 0 0
Mass
PCB-1248 Concentration
5.22 (12672-29-6) ❑ ❑ El
Mass
PCB-1260 Concentration
5.23 (11096-82-5) 0 0 0 Mass
PCB-1016 Concentration
5.24 (12674-11-2) ❑ ❑ ID
Mass
EPA Form 3510-2C(Revised 3-19) Page 20

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
110054268948 NC0035807 North Fork water Treatment Plant 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))'
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 Dailyof Term of
Discharge Discharge Discharge Analyses AAverage Analyses
(required) (if available) Value
(if available)
Toxaphene Concentration
5.25 (8001-35-2) 0 0 0 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(Revised 3-19) Page 21

1 EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
110054268948 NC0035807 North Fork water Treatment Plant 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 Long-Term
Monthly Average Daily Number of Number of
Present Absent Discharge Discharge Discharge Analyses Average Analyses
(required) Value
(if available) (if available)
© 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 Concentration 50 ug/L 2/Month
2. residual ❑ ❑ Mass
3. Color ❑ ill Concentration
Mass
Concentration
4. Fecal coliform ❑ 0 Mass
5 Fluoride ❑ ElConcentration Quarterly
(16984-48-8) Mass
Concentration
6 Nitrate-nitrite ❑ 0 Mass
Nitrogen,total Concentration
T organic(as N) ❑ Mass
Concentration
8. Oil and grease ❑ 0 Mass
9 Phosphorus(as ❑ ❑ Concentration
P),total(7723-14-0) Mass
10. Sulfate(as SO4) ❑ ❑ Concentration
(14808-79-8) Mass
11. Sulfide(as S) ❑ 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
110054268948 NC0035807 North Fork water Treatment Plant 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 DailyLong-Term
Present Absent Discharge Monthly Average Daily Number of Average Number of
Discharge Discharge Analyses Analyses
(required) Value
(if available) (if available)
12. Sulfite(as SO3) ❑ 0 Concentration
(14265-45-3) Mass
Concentration
13. Surfactants 0 0 Mass
14. Aluminum,total 0 0 Concentration Quarterly
(7429-90-5) Mass
15. Barium,total 0 ❑ Concentration
(7440-39-3) Mass
16. Boron,total 0 ❑ Concentration
(7440-42-8) Mass
17. Cobalt,total ❑ ❑ Concentration
(7440-48-4) Mass
18 Iron,total ❑ ❑ Concentration
(7439-89-6) Mass
Magnesium,total ✓ Concentration
19. (7439-95-4) ❑
Mass
Molybdenum, Concentration
20. total ❑ E Mass
(7439-98-7)
21. Manganese,total ❑ 0 Concentration
(7439-96-5) Mass
22. Tin,total 0 ❑ Concentration
(7440-31-5) Mass
23. Titanium,total 0 0 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
110054268948 NC0035807 North Fork water Treatment Plant 001 OMB No.2040-0004
TABLE C.CERTAIN CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(vi))l
Presence or Absence
(check one) Effluent Intake
(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
Alpha,total CIConcentration
Mass
Beta,total CIConcentration
Mass
Radium,total CI 0 Concentration
Mass
Radium 226,total CI 0 Concentration
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(Revised 3-19) Page 25

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
110054268948 NC0035807 North Fork Water Treatment Plant 001 OMB No.2040-0004
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 ❑ 0
2. Acetaldehyde ❑ 12
3. Allyl alcohol ❑ 0
4. Allyl chloride ❑ 0
5. Amyl acetate ❑ 0
6. Aniline ❑ 0
7. Benzonitrile ❑ 0
8. Benzyl chloride ❑ 0
9. Butyl acetate ❑ 0
10. Butylamine ❑ 0
11. Captan ❑ 0
12. Carbaryl ❑ 0
13. Carbofuran ❑ 0
14. Carbon disulfide ❑ El
15. Chlorpyrifos ❑ 0
16. Coumaphos ❑ 0
17. Cresol ❑ 0
18. Crotonaldehyde ❑ 0
19. Cyclohexane ❑ 0
EPA Form 3510-2C(Revised 3-19) Page 27

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
110054268948 NC0035807 North Fork Water Treatment Plant 001 OMB No.2040-0004
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 12221(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) ❑ 0
21. Diazinon ❑ 0
22. Dicamba ❑ 0
23. Dichlobenil 0 0
24. Dichlone 0 0
25. 2,2-dichloropropionic acid ❑ 0
26. Dichlorvos ❑ 0
27. Diethyl amine ❑ 0
28. Dimethyl amine ❑ 0
29. Dintrobenzene ❑ 0
30. Diquat ❑ 0
31. Disulfoton ❑ 0
32. Diuron ❑ 0
33. Epichlorohydrin ❑ 0
34. Ethion 0 0
35. Ethylene diamine ❑ 0
36. Ethylene dibromide ❑ 0
37. Formaldehyde 0 0
38. Furfural ❑ 0
EPA Form 3510-2C(Revised 3-19) Page 28

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
110054268948 NC0035807 North Fork Water Treatment Plant 001 OMB No.2040-0004
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
39. Guthion ❑ 0
40. Isoprene ❑ 0
41. Isopropanolamine ❑ 0
42. Kelthane 0 ❑✓
43. Kepone 0 0
44. Malathion ❑ 0
45. Mercaptodimethur 0 0
46. Methoxychlor 0 ❑✓
47. Methyl mercaptan 0 0
48. Methyl methacrylate 0 0
49. Methyl parathion 0 0
50. Mevinphos 0 0
51. Mexacarbate ❑ 0
52. Monoethyl amine 0 0
53. Monomethyl amine 0 0
54. Naled ❑ El
55. Naphthenic acid 0 0
56. Nitrotoluene 0 0
57. Parathion 0 0
EPA Form 3510-2C(Revised 3-19) Page 29

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
110054268948 NC0035807 North Fork Water Treatment Plant 001 OMB No.2040-0004
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 122.21(g)(7)(vii)p
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 ❑ El
61. Propylene oxide ❑ ❑✓62. Pyrethrins ❑ El
63. Quinoline ❑ ❑✓
64. Resorcinol ❑ 0
65. Strontium ❑ ❑r
66. Strychnine ❑ ❑✓
67. Styrene ❑ ❑�
68. 2,4 5-T(2,4,5-trichlorophenoxyacetic ❑ ❑
acid)
69. TDE(tetrachlorodiphenyl ethane) ❑ 0
70. 2,4,5-TP[2-(2,4,5-trichlorophenoxy) ❑ 0
propanoic acid]
71. Trichlorofon ❑ 0
72. Triethanolamine ❑ ❑✓
73. Triethylamine ❑ ❑r
74. Trimethylamine ❑ ❑✓
75. Uranium ❑
76. Vanadium ❑ ❑r
EPA Form 3510-2C(Revised 3-19) Page 30

7
EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
110054268948 NC0035807 North Fork Water Treatment Plant 001 OMB No.2040-0004
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 12221(g)(7)(vii))l
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 ❑ 0
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 31

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
110054268948 NC0035807 North Fork Water Treatment Plant OMB No.2040-0004
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 ❑ El
EPA Form 3510-2C(Revised 3-19) gc 33