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HomeMy WebLinkAboutNC0028975_Renewal Application_20180202Water Resources ENVIRONMENTAL AYALIFY February 02, 2018 Jonathan Cannon, City Manager City of Saluda PO Box 248 Saluda, NC 28773-0248 Subject: Permit Renewal Application No. NCO028975 Saluda WWTP Polk County Dear Applicant: ROY COOPER amlw wr NUCHAEL S- REGAN secretary LLNDA CULPEPPER btBrt Dhwtar The Water Quality Permitting Section acknowledges the February 1, 2018 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. 15OB-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: //deg. nc.gov/permits-regulations/permit-g uidance/environmenta I -application -tracker If you have any additional questions about the permit, please contact the primary reviewer of the application using the links available within the Application Tracker. Sincerely, ,0 (6agn ct Wren Thedford Administrative Assistant Water Quality Permitting Section cc: Central Files w/application(ARO) ec: WQPS Laserfiche File w/application State of North Carolina I Environmental Quality I Water Resources 1617 Mail Service Center I Raleigh, North Carolma 27699-1617 919-807-6300 FACILITY NAME AND PERMIT NUMBER PERMIT ACTION REQUESTED, 1 RIVER BASIN 1 City o1 Saluda WWTP, NC0028975, Renewal Broad' FORM �,,. » Fi 2A NPD�ES FOR�IVI`2AP?P'LICrATIONORVER�/IEWn NPDES�r�r. `= - APPLICATION OVERVIEW Form 2A has been developed in a modular format and consists of a "Basic Application Information" packet and a "Supplemental Application Information" packet. The Basic Application Information packet is divided into two parts. All applicants must complete Parts A and C. Applicants with a design flow greater than or equal to 0.1 mgd must also complete Part B. Some applicants must also complete the Supplemental Application Information packet. 'The following items explain which parts of Form 2A you must complete. BASIC APPLICATION INFORMATION - A Basic Application Information for all Applicants, All applicants must complete questions A,1 through A.8, A treatment works that discharges effluent to surface waters of the United States must also answer questions A 9 through A,12 B Additional Application Information for Applicants with a Design Flow >_ 0 1 mgd Alt treatment works that have design flows greater than or equal to 0 1 million gallons per day must complete questions 13,1 through B 6 C_ Certification Alf applicants most complete Part G (Certificationij SUPPLEMENTAL APPLICATION INFORMATION D Expanded Effluent Testing Data A treatment works that discharges effluentto surface waters of the United States and meets one or more of the following criteria must complete Part D ('Expanded Eff_luerit Testing Data), 1. Has a design flow rate greater than or equal to 1mgd, 2 Is required to have a pretreatment program (or has one in place), or S. is otherwise required by the permitting authority'to provide the information, E- Toxicity Testing Data. A treatment works that meets one or more of the following criteria must complete Part E (Toxicity Testing Data) I 1 Has a design flow rate greater than or equal to 1 mgd, 2 is required to have a pretreatment program (or has one In place), or i 3, Is ofherwise required by the permitting authority to submit results ortoxicity testing F. Industrial User Discharges and RCRA/CERCLA Wastes. A treatment works that accepts process wastewater from any significant industrial users (SIUs) or .receives RCRA or CERCLA wastes must complete Part F (IndUstrral User Discharges and RCRAICE�RCLA Wastes) SIUs are defined as' 1, All industrial users subject to Categorical Pretreatment Standards under 40 Code of Federal Regulations (CFR) 403 6 and 40 CFR Chapter I, Subchapter' N (see nstructions);, and 2. Any other industrial user that, a Discharges an average of'25,000 gallons per day or more of process wastewater to the treatment works (with certain exciusions), or b. Contributes'aprocess wastestream that makes up 5 percent or more ofthe average dryweather hydraulic or organic capacity of the treatment plant,, or c, Is designated as an SIU by the control authority G, Combined Sewer Systems A treatment works that has a combined sewer system must complete Part G (Combined Sewer Systems). ALL APPLICANTS 'MUST COMPLETE PART C (CERTIFICATION) EPA Form 3510-2A (Rev 1-99) Replaces EPA forms 7550-6 &, 7550-22 Page 1 of 22 i � ,1 � ~� • a f` •" �� \`` I� %`` It ��� �� 1 ``\ � � � r` a � _ ° , f'I I . �r� JJ 1 j �, _' f r :. : � _ _ ° ='(• r14// h `' � i 7 lit ; �a' , i {` • s JD° \ e C� /��� o /sem=S, ll , 7 `f `f 1_ .� �.- J� o o �.� +V%` 4 I(� !c y ,. (�',\ ! i -=�Jl�(r/ !•� __ o�_�_ � �\\J/ e! i `-^\•r/ :���%,yr�j�.•i�- // :mss YfjU1 w • `° VF% I1 + \ (�U�Lf7 Jy \� , f--��\` : "� f •% /�� ', }f lUft I. • { • ,\ .: •\\\y �i / J I �� lli�^r p ` i��,j-r9 v, ;`l\� = "' `-o / . `A ,�Q .:+^l 1' •\��•� %� -`'i p f� J r) C/- � ^',\� i =_s `�l I,� ;�� `;�°�\ ' ° "f 1� a / •\�\' '° °l{,f ��rd rte`. -� 1 t - l! \ , t` � og I� 1 'i `` , i • • �.1`\ \ hlt °lnri'f �. / r- `-- / `1 � ' �'/r r `' - _. ' \ J Ji �'� --✓ � \ '� � � e 'J '� // :. `i LJ � ,�' ' .J /,�; � 'yam; %' ---, i ( 1 _ V. l r ` „ �•' ; !' ° 'V — t,=-t-,rj /� �! c • r' ) � � 7+` .-� - J � r./ 1 �.! � �! i ;( , � �J I J ', I) `}' ^ ;�� •\ : •°� \ '` _ � � of :: a \:1° \ ` � I t t'• / / �(' \ � i f. !�_- ,�, � f!•! • : \ -�, _.,� s �/ % l r $J i ilk"�t 4, 1 /. + , V %�' - -:�--� _ a� _- -✓ 1 ; • ^a\ 1 l� �y� �ir� /: / (° °l f °ih ti` % .-' / i \I • ;J' �— -�� 1 hili= ` 'SInIL�QROFBtD ��\ Jt''�„� ti . , �\--. • l ` o fl ,I�� ��_ \vY' l rf 11�Y._ _� \\ iy. .r' i r� _ - \ jr \N ,,, - i W, \_ a-\lt• l t ( '\\ „ Q • ;�• /~ li r r . � _ /� gid\ - Ni,►.�, °'' • /,�t �• �;' -� -r- a _,,, , - ' DISCHARGE POINT '� ; �';�,r' il� I ..� 11 1 l�'c��,' !!r%i' ' /� � 1 -_.J1!'� • '��`� � `', ` / � /�/1\' rl�` �'�`'�' -� !l(",`� \-•` -, !/, j% /�a It %• '_�"_d�` \ L�sI !I \ n`\1�,-�J r � �\ f � i\1 •/ii �`�_%� ��`^ l � i`,`- C_�"���- \` � ./' 'r�' 1� �\ \`I(� � t l\ t\1 �'-o i it �-�I t 1 • 1l �J —.: ��"-.,�.. ('!I �j`'�1 \� ,' \-7 („'•"`''�- �'� t %(%� 1 1 �It�: `l J` - \\'\ ��At —/�.' ��°=''1 4� '`.,-r=�- �•`�' lir!%- - C-' i; - : I• 'i ,) _'= ,`'' { J( l \, \ � �� �/!, > _ '} ! % ; 1 ' �! (`' - i • � -���•, �. \,-. � '\CJI' I,- , i � �j' !� _. ` �;, I q ',. `sti�,,` � `%1; �• i ' ,/!'%f � ! �!: ��5 J ��•` 1�� y`i �,r� S -= �,,i"'�.^ �`���"� �I E-),�-r` , rj�r _" �'• \ �\ ,Sj,�) 7 f i ` I r / • l `\ �l ' Y t •K1 1 V '\' f �\ j 't r rIJV(�I ; f/ Y \. .\Y'1 City of Saluda Facility City of Saluda WWTP Location x County. Polk Stream Class C (not to Scale) Receiving Stream- Joel's Creek Sub-Basin: 03-08-06 Latitude, 35° 13'50" Grid/Quad. ONE (Saluda) Longitu82`20'37" HUC# 03050105 de. jlj��r� f�IPP3ES PerlYti�: �C����g75 FACILITY NAME AND PERMIT NUMBER- PERMIT ACTION REQUESTED: RIVER BASIN: City of Saluda WWTP, NCO028975 Renewal Broad BASIC APPLICATION INFORMATION PART A. BASIC APPLICATION INFORMATION FOR ALL APPLICANTS. All treatment works must complete questions A 1 through A.8 of this Basic Application Information Packet A.I. Facility Information. Facility Name City of Saluda Wastewater Treatment Facility Mailing Address PO Box 248 Saluda, NC 28773 Contact Person Jon Cannon Title City Manager Telephone Number (828) 749-2581 Facility Address 619 Pearson Falls Road (not P O Box) Saluda, NC 28773 A.2. Applicant Information If the applicant is different from the above, provide the following Applicant Name Same as above Mailing Address Contact Person Title Telephone Number ( ) Is the applicant the owner or operator (or both) of the treatment works? ® owner ❑ operator Indicate whether correspondence regarding this permit should be directed to the facility or the applicant ❑ facility ® applicant A 3. Existing Environmental Permits. Provide the permit number of any existing environmental permits that have been issued to the treatment works (include state -issued permits) NPDES NCO028975 PSD UIC Other RCRA Other A.4 Collection System Information Provide information on municipalities and areas served by the facility Provide the name and population of each entity and, if known, provide information on the type of collection system (combined vs separate) and its ownership (municipal, private, etc) Name Population Served Type of Collection System Ownership City of Saluda 1000 Separate Municipal Total population served 1000 EPA Form 3510-2A (Rev 1-99) Replaces EPA forms 7550-6 & 7550-22 Page 2 of 22 FACILITY NAME AND PERMIT NUMBER. PERMIT ACTION REQUESTED: RIVER BASIN: City of Saluda WWTP, NCO028975 Renewal Broad AS Indian Country. a Is the treatment works located in Indian Country? ❑ Yes ® No b Does the treatment works discharge to a receiving water that is either in Indian Country or that is upstream from (and eventually flows through) Indian Country? ❑ Yes ® No AS. Flow Indicate the design flow rate of the treatment plant (i e , the wastewater flow rate that the plant was built to handle) Also provide the average daily flow rate and maximum daily flow rate for each of the last three years Each year's data must be based on a 12 -month time period with the 12th month of "this year" occurnng no more than three months prior to this application submittal a Design flow rate 0 1 mgd Two Years Ago Last Year This Year b Annual average daily flow rate 0 053 mqd 0.045 mqd 0.041 mqd c Maximum daily flow rate 0 27 mqd 0.134 mqd 0.159 mqd A 7. Collection System Indicate the type(s) of collection system(s) used by the treatment plant Check all that apply Also estimate the percent contribution (by miles) of each ® Separate sanitary sewer 100 % ❑ Combined storm and sanitary sewer % A 8 Discharges and Other Disposal Methods a Does the treatment works discharge effluent to waters of the U S o ® Yes ❑ No If yes, list how many of each of the following types of discharge points the treatment works uses I Discharges of treated effluent li Discharges of untreated or partially treated effluent iii Combined sewer overflow points IV Constructed emergency overflows (prior to the headworks) V Other b Does the treatment works discharge effluent to basins, ponds, or other surface impoundments that do not have outlets for discharge to waters of the U S 9 ❑ Yes If yes, provide the following for each surface impoundment Location Annual average daily volume discharge to surface impoundment(s) Is discharge ❑ continuous or ❑ intermittent? c Does the treatment works land -apply treated wastewater? If yes, provide the following for each land application site d Location Number of acres Annual average daily volume applied to site Is land application ❑ continuous or ❑ intermittent? Does the treatment works discharge or transport treated or untreated wastewater to another treatment works? 100% 2 No mgd ❑ Yes ® No mgd ® Yes ❑ No EPA Form 3510-2A (Rev 1-99) Replaces EPA forms 7550-6 & 7550-22 Page 3 of 22 FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN: City of Saluda WWTP, NC0028975__J Renewal Broad If yes, describe the mean(s) by which the wastewater from the treatment works is discharged or transported to the other treatment works (e g , tank truck, pipe) Tank Truck If transport is by a party other than the applicant, provide Transporter Name Mike's Septic Tank Service, Inc Mailing Address PO Box 968 Leicester, NC 28748 Contact Person Mike Lusk Title Owner Telephone Number (828) 253-2612 For each treatment works that receives this discharge, provide the following Name City of Brevard Mailing Address 95 West Main Street Brevard, NC 28712 Contact Person Emory Owen Title ORC Telephone Number (828) 883-8461 If known, provide the NPDES permit number of the treatment works that receives this discharge NCO060534 Provide the average daily flow rate from the treatment works into the receiving facility <0 0001 mgd e Does the treatment works discharge or dispose of its wastewater in a manner not included in A 8 through A 8 d above (e g , underground percolation, well injection) ❑ Yes ® No If yes, provide the following for each disposal method Description of method (including location and size of site(s) if applicable) Annual daily volume disposed by this method Is disposal through this method ❑ continuous or ❑ intermittent? EPA Form 3510-2A (Rev 1-99) Replaces EPA forms 7550-6 & 7550-22 Page 4 of 22 FACILITY NAME AND PERMIT NUMBER. PERMIT ACTION REQUESTED. RIVER BASIN. City of Saluda WV\(TP, NCO028975 Renewal Broad WASTEWATER DISCHARGES: If you answered "Yes" to question A.8.a, complete questions A.9 through A 12 once for each outfall (including bypass points) through which effluent is discharged. Do not include information on combined sewer overflows in this section. If you answered "No" to question A 8.a, go to Part B, "Additional Application Information for Applicants with a Design Flow Greater than or Equal to 0.1 mgd." A.9. Description of Outfall. a Outfall number 001 b Location 619 Pearson Falls Road, Saluda, 28773 (City or town, if applicable) (Zip Code) Polk NC (County) (State) EPA Form 3510-2A (Rev 1-99) Replaces EPA forms 7550-6 & 7550-22 Page 5 of 22 (Latitude) (Longitude) c Distance from shore (if applicable) ft d Depth below surface (if applicable) ft e Average daily flow rate mgd f Does this outfall have either an intermittent or a periodic discharge? ❑ Yes ® No (go to A 9 g ) If yes, provide the following information Number f times per year discharge occurs Average duration of each discharge Average flow per discharge mgd Months in which discharge occurs g Is outfall equipped with a diffuser? ❑ Yes ® No A.10. Description of Receiving Waters a Name of receiving water Joel's Creek b Name of watershed (if known) Broad River United States Soil Conservation Service 14 -digit watershed code (if known) c Name of State Management/River Basin (if known) Broad United States Geological Survey 8 -digit hydrologic cataloging unit code (if known) d Critical low flow of receiving stream (if applicable) acute cfs chronic cfs e Total hardness of receiving stream at critical low flow (if applicable) mg/I of CaCO3 EPA Form 3510-2A (Rev 1-99) Replaces EPA forms 7550-6 & 7550-22 Page 5 of 22 FACILITY NAME AND PERMIT NUMBER- PERMIT ACTION REQUESTED: RIVER BASIN: City of Saluda WWTP, NCO028975 Renewal Broad A 11. Description of Treatment a What level of treatment are provided? Check all that apply ® Primary ® Secondary ❑ Advanced ❑ Other Describe b Indicate the following removal rates (as applicable) Design BOD5 removal or Design CBOD5 removal 85 % Design SS removal 85 % Design P removal % Design N removal % Other % c What type of disinfection is used for the effluent from this outfall? If disinfection vanes by season, please describe Sodium Hvpochlonte If disinfection is by chlorination is dechlorination used for this outfall? ® Yes ❑ No Does the treatment plant have post aeration? ® Yes ❑ No A.12. Effluent Testing Information. All Applicants that discharge to waters of the US must provide effluent testing data for the following parameters Provide the indicated effluent testing required by the permitting authority for each outfall through which effluent is discharged. Do not include information on combined sewer overflows in this section. All information reported must be based on data collected through analysis conducted using 40 CFR Part 136 methods. In addition, this data must comply with QA/QC requirements of 40 CFR Part 136 and other appropriate QAIQC requirements for standard methods for analytes not addressed by 40 CFR Part 136. At a minimum, effluent testing data must be based on at least three samples and must be no more than four and one-half years apart. Outfall number 001 MAXIMUM DAILY VALUE AVERAGE DAILY VALUE PARAMETER Value Units Value Units Number of Samples pH (Minimum) 6.0 s u pH (Maximum) 9.0 S u Flow Rate 0.1 mgd Temperature (Winter) NO Limit Temperature (Summer) NO Limit * For pH please report a minimum and a maximum daily value MAXIMUM DAILY AVERAGE DAILY DISCHARGE POLLUTANT DISCHARGE ANALYTICAL MUMDL Conc. Units Conc. Units Number of METHODSamples CONVENTIONAL AND NON CONVENTIONAL COMPOUNDS BIOCHEMICAL OXYGEN BOD5 13 Mg/L 10.5 Mg/L 4 SM521013 2.0 DEMAND (Report one) CBOD5 FECAL COLIFORM 10 #/100ml 2.2 #1100m 4 SM9222D 1 TOTAL SUSPENDED SOLIDS (TSS) 5 Mg/L 5 Mg/L 4 SM2540D 5.0 END OF PART A. REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS OF FORM 2A YOU MUST COMPLETE EPA Form 3510-2A (Rev 1-99) Replaces EPA forms 7550-6 & 7550-22 Page 6 of 22 FACILITY NAME AND PERMIT NUMBER PERMIT ACTION REQUESTED. RIVER BASIN' City of Saluda WWTP, NCO028975 Renewal Broad BASIC APPLICATION INFORMATION PART B. ADDITIONAL APPLICATION INFORMATION FOR APPLICANTS WITH A DESIGN FLOW GREATER THAN OR EQUAL TO 0.1 MGD (100,000 gallons per day). All applicants with a design flow rate >_ 0 1 mgd must answer questions B.1 through B.6. All others go to Part C (Certification) B.1 Inflow and Infiltration. Estimate the average number of gallons per day that flow into the treatment works from inflow and/or infiltration unknown gpd Briefly explain any steps underway or planned to minimize inflow and infiltration Monitor pump station run times, camera approximately 10% of sewer mains per year, visual Inspection of mains and manholes during rain events B.2. Topographic Map. Attach to this application a topographic map of the area extending at least one mile beyond facility property boundaries This map must show the outline of the facility and the following information (You may submit more than one map if one map does not show the entire area ) a The area surrounding the treatment plant, including all unit processes b The major pipes or other structures through which wastewater enters the treatment works and the pipes or other structures through which treated wastewater is discharged from the treatment plant Include outfalls from bypass piping, if applicable c Each well where wastewater from the treatment plant is infected underground d Wells, springs, other surface water bodies, and drinking water wells that are 1) within'% mile of the property boundaries of the treatment works, and 2) listed in public record or otherwise known to the applicant e Any areas where the sewage sludge produced by the treatment works is stored, treated, or disposed f If the treatment works receives waste that is classified as hazardous under the Resource Conservation and Recovery Act (RCRA) by truck, rad, or special pipe, show on the map where the hazardous waste enters the treatment works and where it is treated, stored, and/or disposed B.3. Process Flow Diagram or Schematic. Provide a diagram showing the processes of the treatment plant, including all bypass piping and all backup power sources or redunancy in the system Also provide a water balance showing all treatment units, including disinfection (e g , chlorination and dechlonnation) The water balance must show daily average flow rates at influent and discharge points and approximate daily flow rates between treatment units Include a brief narrative description of the diagram B.4 Operation/Maintenance Performed by Contractor(s). Are any operational or maintenance aspects (related to wastewater treatment and effluent quality) of the treatment works the responsibility of a contractor? ® Yes ❑ No If yes, list the name, address, telephone number, and status of each contractor and describe the contractor's responsibilities (attach additional pages if necessary) Name KACE Environmental, Inc. Mailing Address 2905 Wood Road Mooresboro, NC 28114 Telephone Number (828) 657-1810 Responsibilities of Contractor Provide ORC for plant B.5 Scheduled improvements and Schedules of Implementation. Provide information on any uncompleted implementation schedule or uncompleted plans for improvements that will affect the wastewater treatment, effluent quality, or design capacity of the treatment works If the treatment works has several different implementation schedules or is planning several improvements, submit separate responses to question B 5 for each (if none, go to question B 6 ) a List the outfall number (assigned in question A 9) for each outfall that is covered by this implementation schedule 001 None b Indicate whether the planned improvements or implementation schedule are required by local, State, or Federal agencies ❑ Yes ® No EPA Form 3510-2A (Rev 1-99) Replaces EPA forms 7550-6 & 7550-22 Page 7 of 22 FACILITY NAME AND PERMIT NUMBER PERMIT ACTION REQUESTED RIVER BASIN City of Saluda WWTP, NCO028975 Renewal Broad C If the answer to B 5 b is "Yes," briefly describe, including new maximum daily inflow rate (if applicable) d Provide dates imposed by any compliance schedule or any actual dates of completion for the implementation steps listed below, as applicable For improvements planned independently of local, State, or Federal agencies, indicate planned or actual completion dates, as applicable Indicate dates as accurately as possible Schedule Actual Completion Implementation Stage MM/DD/YYYY MM/DD/YYYY - Begin Construction - End Construction - Begin Discharge - Attain Operational Level e Have appropriate permits/clearances concerning other Federal/State requirements been obtained? ❑ Yes ❑ No Describe briefly B 6 EFFLUENT TESTING DATA (GREATER THAN 01 MGD ONLY) Applicants that discharge to waters of the US must provide effluent testing data for the following parameters. Provide the indicated effluent testing required by the permitting authority for each outfall through which effluent is discharged Do not include information on combine sewer overflows in this section All information reported must be based on data collected through analysis conducted using 40 CFR Part 136 methods In addition, this data must comply with QA/QC requirements of 40 CFR Part 136 and other appropriate QAIQC requirements for standard methods for analytes not addressed by 40 CFR Part 136 At a minimum effluent testing data must be based on at least three pollutant scans and must be no more than four and on -half years old. Outfall Number MAXIMUM DAILY AVERAGE DAILY DISCHARGE DISCHARGE ANALYTICAL POLLUTANT METHOD ML1iVIDL Conc. Units Conc Units Number of Samples CONVENTIONAL AND NON CONVENTIONAL COMPOUNDS AMMONIA (as N) CHLORINE (TOTAL RESIDUAL, TRC) DISSOLVED OXYGEN TOTAL KJELDAHL NITROGEN (TKN) NITRATE PLUS NITRITE NITROGEN OIL and GREASE PHOSPHORUS (Total) TOTAL DISSOLVED SOLIDS (TDS) OTHER END OF PART B. REFER TO THE APPLICATION OVERVIEW (PAGE 1) TO DETERMINE WHICH OTHER PARTS OF FORM 2A YOU MUST COMPLETE EPA Form 3510-2A (Rev 1-99) Replaces EPA forms 7550-6 & 7550-22 Page 8 of 22 FACILITY NAME AND PERMIT NUMBER PERMIT ACTION REQUESTED. RIVER BASIN: City of Saluda WWTP, NCO028975 Renewal Broad BASIC APPLICATION INFORMATION PART C CERTIFICATION All applicants must complete the Certification Section. Refer to instructions to determine who is an officer for the purposes of this certification. All applicants must complete all applicable sections of Form 2A, as explained in the Application Overview Indicate below which parts of Form 2A you have completed and are submitting. By signing this certification statement, applicants confirm that they have reviewed Form 2A and have completed all sections that apply to the facility for which this application is submitted. Indicate which parts of Form 2A you have completed and are submitting: ® Basic Application Information packet Supplemental Application Information packet ❑ Part D (Expanded Effluent Testing Data) ❑ Part E (Toxicity Testing Biomonitonng Data) ❑ Part F (Industrial User Discharges and RCRA/CERCLA Wastes) ❑ Part G (Combined Sewer Systems) ALL APPLICANTS MUST COMPLETE THE FOLLOWING CERTIFICATION 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 gathenng the information, the information is, to the best of my knowledge and belief, true, accurate, and complete I am awa=thatthfialties ubmitting false information, including the possibility of fine and imprisonment for knowing violations iiael Name and official titlet� ILIO EZ Signature Telephone number jQZ�) -7 Date signed 1 ^^ S Upon request of the permitting authority, you must submit any other information necessary to assure wastewater treatment practices at the treatment works or identify appropriate permitting requirements SEND COMPLETED FORMS TO: NCDENR/ DWQ Attn: NPDES Unit 1617 Mail Service Center Raleigh, North Carolina 27699-1617 EPA Form 3510-2A (Rev 1-99) Replaces EPA forms 7550-6 & 7550-22 Page 9 of 22