NC0004405_Renewal (Application)_20190909

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ROY COOPER ty
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MICHAEL S.REGAN '., �,,. .
Secretary
LINDA CULPEPPER NORTH CAROLINA
Director Environmental Quality
September 10, 2019
Environlink, Inc.
Attn: Michael J. Myers 1
4700 Homewood Ct Ste 108
Raleigh, NC 27609
Subject: Permit Renewal
Application No. NC0004405
Cliffside Sanitary District WWTP
Rutherford County
Dear Applicant: 1
The Water Quality Permitting Section acknowledges the September 9, 2019 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. 150B-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://deq.nc.gov/permits-regulations/permit-guidance/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.
Sincerel
j4i,
Wren T edford
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
DEQ North Caro rs Department of Env ronmenta qua 2? I Dvsonof Water Resauroes
Ashev a Regor.a Offoe 12090 U.S.70 Highway I Svrarraroa, North Caro ra 28778
.. e.� /✓ 828-29e-4500

rvviaoliv
September 3, 2019
NCDEQ/DWR
Attn: Charles Weaver
NPDES Unit RECEIVED/NOUECODWR
1617 Mail Service Center
Raleigh, NC 27699-1617 SEP 0 5 2019
Water Quality n
permitting
Dear Mr.Weaver,
Please find enclosed NPDES Form 2A executed on behalf of Cliffside Sanitary District pursuant to
delegated signatory authority from Lynne Starr-Vazquez, Chairman of the Board of Directors for
Cliffside Sanitary District. Enclosed herewith is a copy of the letter delegating authority to
Envirolink, Inc. If you have questions, please contact me at [e-mail].
Sincerely,/ A
O
4149 •
. Carr McLamb,J .
Chief Operating Officer&
General Counsel
Envirolink, Inc.
Envirolink,Inc.
$(oat cfattAat in QTtllit#dtanartn ant
4700 Homewood Court,Raleigh,North Carolina 27609
252-235-4900(phone) 252-235-2132(fax)

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
CLIFFSIDE SANITARY DISTRICT, NC004405 RENEWAL BROAD
FORM
2A NPDES FORM 2A APPLICATION OVERVIEW
NPDES
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. All treatment works that have design flows
greater than or equal to 0 1 million gallons per day must complete questions B.1 through B.6
C. Certification. All applicants must complete Part C(Certification)
SUPPLEMENTAL APPLICATION INFORMATION:
D. Expanded Effluent Testing Data. A treatment works that discharges effluent to surface waters of the United States and meets
one or more of the following criteria must complete Part D(Expanded Effluent 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
3. 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).
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
3. Is otherwise required by the permitting authority to submit results of toxicity testing.
F. Industrial User Discharges and RCRA/CERCLA Wastes. A treatment works that accepts process wastewater from any
significant industrial users(Sills)or receives RCRA or CERCLA wastes must complete Part F(Industrial User Discharges
and RCRA/CERCLA 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 instructions), 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
exclusions), or
b. Contributes a process wastestream that makes up 5 percent or more of the average dry weather 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

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
CLIFFSIDE SANITARY DISTRICT, NC004405 RENEWAL BROAD
BASIC APPLICATION INFORMATION
PART A.BASIC APPLICATION INFORMATION FOR ALL APPLICANTS:
All treatment works must complete questions Al through A8 of this Basic Application Information Packet
Al. Facility Information.
Facility Name CLIFFSIDE SANITARY DISTRICT
Mailing Address P.O.BOX 122
CLIFFSIDE,NC 28024
Contact Person DAVE STRUM
Title DIRECTOR OF OPERATIONS FOR ENVIROLINK,INC.
Telephone Number 252.235-8763
Facility Address 136 HAWKINS LOOP RD.,CLIFFSIDE,NC 28024
(not P.O.Box)
A.2. Applicant Information. If the applicant is different from the above.provide the following.
Applicant Name
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.
O facility NI 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 NC0004405 PSD
UIC Other W40002379
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
CLIFFSIDE SANITARY DIST. 77 CONNECTIONS SEPARATE MUNICIPAL
Total population served 200
EPA Form 3510-2A(Rev 1-99) Replaces EPA forms 7550-6&7550-22 Page 2 of 22

FACILITY NAME AND PERMIT NUMBER: i PERMIT ACTION REQUESTED: RIVER BASIN:
CLIFFSIDE SANITARY DISTRICT, NC004405 j RENEWAL BROAD
A.5. Indian Country.
a Is the treatment works located in Indian Country?
❑ Yes U 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 1111 No
A.6. 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 121"month of'this year'°mimng no more than three months prior to this application submittal
a. Design flow rate 0.999 mgd
Two Years Ago Last Year This Year
b. Annual average daily flow rate 0.046 0.028 0.028
c Maximum daily flow rate 0.725 0.326 0.500
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.
II 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.? ❑ 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
ii. 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.? ❑ Yes II No
If yes,provide the following for each surface impoundment:
Location
Annual average daily volume discharge to surface impoundment(s) rngd
Is discharge ❑ continuous or ❑ intermittent?
c Does the treatment works land-apply treated wastewater? ❑ Yes II No
If yes,provide the following for each land application site:
Location:
Number of acres:
Annual average daily volume applied to site: mgd
Is land application 0 continuous or 0 intermittent?
d Does the treatment works discharge or transport treated or untreated wastewater to another
treatment wortcs? ❑ 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:
CLIFFSIDE SANITARY DISTRICT, NC004405 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).
If transport is by a party other than the applicant.provide.
Transporter Name N/A
Mailing Address
Contact Person
Title
Telephone Number ( )
For each treatment works that receives this discharge,provide the following:
Name N/A
Mailing Address
Contact Person
Title
Telephone Number ( )
If known,provide the NPDES permit number of the treatment works that receives this discharge
Provide the average daily flow rate from the treatment works into the receiving facility. 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:
CLIFFSIDE SANITARY DISTRICT, NC004405 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 DutfaII.
a. Outfall number 001
b. Location RUTHERFORD 28024
(City or town,if applicable) (Zip Code)
RUTHERFORD NC
(County) (State)
35 14 15 81 46 01
(Latitude) (Longitude)
c. Distance from shore(if applicable) 10 ft.
d. Depth below surface(if applicable) ft.
e Average daily flow rate 0.03 mgd
f. Does this outfall have either an intermittent or a periodic discharge'? ❑ Yes II 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 SECOND BROAD RIVER
b Name of watershed(if known) BROAD
United States Soil Conservation Service 14-digit watershed code Of known):
c. Name of State Management/River Basin(if known): BROAD RIVER BASIN
United States Geological Survey 8-digit hydrologic cataloging unit code(if known):
d. Critical low flow of receiving stream(if applicable)
acute cfs chronic cis
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

T
FACILITY NAME AND PERMIT NUMBER: T PERMIT ACTION REQUESTED: RIVER BASIN:
CLIFFSIDE SANITARY DISTRICT, NC004405 RENEWAL BROAD
A11. Description of Treatment
a. What level of treatment are provided? Check all that apply.
III Primary El Secondary
❑ Advanced 0 Other. Describe.
b. Indicate the following removal rates(as applicable):
Design BOD5 removal or Design CBOD5 removal %
Design SS removal %
Design P removal %
Design N removal %
Other %
c. What type of disinfection is used for the effluent from this outfall? If disinfection varies by season,please describe.
12.5%LIQUID CHLORINE
If disinfection is by chlorination is dechlorination used for this outfall? III Yes ❑ No
Does the treatment plant have post aeration? II 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 QAIQC 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) 6.7 s.u.
pH(Maximum) 8.60 s.u.
Flow Rate 0.50 MGD 0.03 MGD 365
Temperature(Winter) 6.00 C 10.00 C 26
Temperature(Summer) 28.00 C 17.00 C 26
*For pH please report a minimum and a maximum daily value
MAXIMUM DAILY AVERAGE DAILY DISCHARGE
DISCHARGE ANALYTICAL
POLLUTANT METHOD MUMDL
Conc. Units Conc. Units Number of
Samples
CONVENTIONAL AND NON CONVENTIONAL COMPOUNDS
BIOCHEMICAL OXYGEN BOD5 l 40 mg/ 10.0 mg/1 52 SM5210B I
DEMAND(Report one) CBOD5
FECAL COLIFORM 160.0 CFU 5 CFU 52 SM9222D
TOTAL SUSPENDED SOLIDS(TSS) 35.0 mg/ 20.0 mg/l 52 SM2540D
END OF PART A.
REFER TO THE APPLICATION OVERVIEW(PAGE 1) TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE
1
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:
CLIFFSIDE SANITARY DISTRICT, NC004405 RENEWAL BROAD
BASIC APPLICATION INFORMATION
PART B. ADDITIONAL APPUCATION 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.
gpd
Briefly explain any steps underway or planned to minimize inflow and infiltration.
THE FACILITY RECEIVES EXCESSIVE AMOUNTS OF INFLOW AND INFILTRATION WITH FLOWS EXCEEDING
1 MGD DURING HEAVY RAIN EVENTS.
THE DISTRICT DOES NOT HAVE THE FUNDS TO ADDRESS COLLECTION SYSTEM ISSUES.
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 outfalts from bypass piping,if applicable.
c. Each well where wastewater from the treatment plant is injected underground.
d. Wells.springs,other surface water bodies,and dnnking water wells that are: 1)within'A 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,rail,
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 redundancy in the system. Also provide a water balance showing all treatment units,including disinfection(e.g.,
chlorination and dechlorination) 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
contractor9 1. Yes D 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: ENVIROLINK, INC.
Mailing Address: 4700 HOMEWOOD COURT,SUITE 108
RALEIGH, NC 27609
Telephone Number: [phone]
Responsibilities of Contractor: ENVIROLINK IS OPERATING AS THE EMERGENCY OPERATOR AND IS CURRENTLY
NOT UNDER CONTRACT WITH THE DISTRICT.
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.
N/A
b. Indicate whether the planned improvements or implementation schedule are required by local,State,or Federal agencies.
❑ Yes ❑ No
EPA Form 3510-2A(Rev 1-09) Replaces EPA forms 7550-6&7550-22 Page 7 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION RREQUESTED: RIVER BASIN:
CLIFFSIDE SANITARY DISTRICT, NC004405 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 I I I I
-End Construction I l l I
-Begin Discharge
-Attain Operational Level I / / /
e Have appropriate permits/clearances concerning other Federal/State requirements been obtained? ❑ Yes ❑ No
Descnbe briefly-
B.6. EFFLUENT TESTING DATA(GREATER THAN 0.1 MGD ONLY).
Applicants that discharge to wators 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 QAIQC 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: 001
MAXIMUM DAILY AVERAGE DAILY DISCHARGE
DISCHARGE ANALYTICAL
POLLUTANT • MUMDL
Number of METHOD
Conc. Units Conc. Units Samples
CONVENTIONAL AND NON CONVENTIONAL COMPOUNDS
AMMONIA(as N)
CHLORINE(TOTAL 20.00 ugll 20.00 ugll 104.0
RESIDUAL,TRC)
DISSOLVED OXYGEN 10.00 mg/I 8.50 mg/I 52.0
TOTAL KJELDAHL
NITROGEN(TKN)
NITRATE PLUS NITRITE 15.00 mgll 6.90 nlgfl 2.0
NITROGEN
OIL and GREASE
PHOSPHORUS(Total) 8.50 mg/I 5.20 mg/I 2.0
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: I PERMIT ACTION REQUESTED: RIVER BASIN:
CLIFFSIDE SANITARY DISTRICT, NC004405 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:
asic Application Information packet Supplemental Application Information packet
❑ Part D(Expanded Effluent Testing Data)
❑ Part E(Toxicity Testing. Biomonitoring 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 gathering the information,the information 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 impnsonment
for knowing violations ((//������'/� / /� ( 1
Name and official title Ca ( 1_6/r I COO F-1 V/rb 110 S totnd'krGt 1 I CL.L-v
Signature (-! til /,/ om Q/A'c S)J r-� KJ11 16fi
Telephone number ( I ` ) 3 0 - 1 ( J
Date signed 1 I
Upon request of the permitting authority,you must submit any other information necessary to assure wastewater treatment practices at the treatment
works or identify appropnate 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

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USGS Quad:GIISE Chance,NC ,..r , {;a
Outfall Facility -
Latitude: 35° 13'59.2"N 35° 14' 3.8"N 4%r
Longitude: 81°45'59"W 81° 45' 54.6"W ° ' ~ ,11.. �� v, ,q .
Stream Class: WS IV North Facility Location
Subbasin:03-08-02 HUC: 03050105 Cliffside Sanitary District WWTP NC0004405
Receiving Stream: Second Broad River Rutherford County

FACILITY NAME AND PERMIT NUMBER: ! PERMIT ACTION REQUESTED: t RIVER BASIN:
I
SUPPLEMENTAL APPLICATION INFORMATION
PART D. EXPANDED EFFLUENT TESTING DATA ^`—
Refer to the directions on the cover page to determine whether this section applies to the treatment works.
Effluent Testing: 1-0 mgd and Pretreatment Works. If the treatment works has a design flow greater than or equal to 1 0 mgd or it has{or is required
to have)a pretreatment program or is otherwise required by the permitting authority to provide the data,then provide effluent testing data for the following
pollutants Provide the indicated effluent testing information and any other information 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 analyses conducted using 40 CFR Part 136 methods in addition.these data must comply with QA/QC requirements of 40 CFR Part 136 and
other appropriate QAJQC requirements for standard methods for analytes not addressed by 40 CFR Part 136 Indicate in the blank rows provided below
any data you may have on pollutants not specifically listed in this form At a minimum.effluent testing data must De based on at least three pollutant
i scans and must be no more than four and one-half years old
1
- !Complete once for each outfall discharging effluent to waters of the United States i
I MAXIMUM DAILY DISCHARGE AVERAGE DAILY DISCHARGE
r POLLUTANT I 1 I j Number I ANALYTICAL , MUMDL
Conc. I Units Mass ! Units ! Conc. 1 Units Mass ( Units
i of METHOD 1
1 -L_— -- Samples i 1
METALS
ETALS ITOTAL RECOVERABLE),CYANIDE.PHENOLS,AND HARDNESS
--.r.___ ..-T - _
ANTIMONY I i I
ARSENIC
BERYLLIUM
t
CADMIUM
I
CHROMIUM
COPPER
I
LEAD
MERCURY i
NICKEL
SELENIUM
SILVER
THALLIUM
ZINC
-------_-- ,
CYANIDE
i
TOTAL PHENOLIC
COMPOUNDS
I _
HARDNESS tas CaCO3) I I
i i I I
I I i
Use this space for a separate sheet)to provide information on other metals requested by the permit enter
EPA Form 3510.2A(Rev 1-99) Replaces EPA forms 7550-6 a 7550 22 Page 10 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: I RIVER BASIN:
Our`au nurnoer ;Complete once for each outfall discharging effluent to waters of the un,tec States
MAXIMUM DAILY DISCHARGE T AVERAGE DAILY DISCHARGE
POLLUTANT I 1 Number 1 ANALYTICAL ML/MQL
Conc. Units Mass Units Conc. ( Units Mass Units I of ! METHOD
Samples ' -I
VOLATILE ORGANIC COMPOUNDS
— — —
ACROLEIN
ACRYLONITRILE
BENZENE
BROMOFORM
CARBON
TETRACHLORIDE
CHLOROBENZENE
CHLORODIBROMO-
METHANE
CHLOROETHANE
2-CHLOROETHYLVINYL
ETHER
CHLOROFORM
DICHLOROBROMO- f I
METHANE
1.1-DICHLOROETHANE
1,2-DICHLOROETHANE
TRANS-1.2-DfCHlORO-
ETHYLENE
1,t-DICHLORO-
ETHYLENE
1.2-DICHLOROPROPANE
1.3-DICHLORO-
PROPYLENE
ETHYLBENZENE
METHYL BROMIDE J
METHYL CHLORIDE ff
METHYLENE CHLORIDE
1.1.2.2-TETRA-
CHLOROETHANE
TETRACHLORO-
ETHYLENE
j ( 1
TOLUENE �(
EPA Form 3510-2A(Rev 1-9$) Replaces EPA forms 7550-6&7550-22 Page 11 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Outfall number - (Complete once for each outfall discharging effluent to waters of the United States
MAXIMUM DAILY DISCHARGE AVERAGE DAILY DISCHARGE.,y
• POLLUTANT t l Number j ANALYTICAL MLIMDL
Conc. Units Mass i Units I Conc. Units Mass Units of METHOD
TRICHLOROETHANE
1,1.2- +{
TRICHLOROETHANE ` I
TRICHLOROETHYLENE
VINYL CHLORIDE I I
Use this space(or a separate sheet)to provide information on other volatile organic compounds requested by the permit writer
ACID-EXTRACTABLE COMPOUNDS
I � I
P-CHLORO-M-CRESOL.
1 1
2-CHLOROPHENOL
24-DICHLOROPHENOL
2.4-0IMETHVLPHENOL 1 j
4,8-DINITRO-O-CRESOL
2,4-DINITROPHENOL
l _
2-NITROPHENOL
4-NITROPHENOL
PENTACHLOROPHENOL
PHENOL
2.4.6-
TRICNLOROPHENOL I f
Use tots space(or a separate sheet)to provide informaftort on other acid-extractable compounds requested by the permit writer' {
BASE-NEUTRAL.COMPOUNDS
ACENAPHTHENE
ACENAPHTHVI-ENE
}
ANTHRACENE
BENZIDINE I
BENZO(A)ANTHRACENE
BENZO(A)PYRENE
EPA Form 35t0-2A-Rev 1.991 Replaces EPA forms 7550.6 8 7550-22 Page 12 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Outfall number (Complete once for each outfall dische ;,ftluent to waters of the united Stag
101.1111.1111,111.111 MAXIMUM DAILY DISCHARGE AVERAGE DAILY DISCHARGE T
POLLUTANT
i I Number ANALYTICAL ML/Mi7L Conc. Units Mass Units Conc. Units ! Mass I Units ! of METHOD
samples
FLUORANTHENE i I
BENZO(GHI)PERYLENE
----
BENZO(K)
FLUORANTHENE
BIS(2-CHLOROETHOXY)
METHANE
BIS(2-CHLOROETHYL)-
ETHER
BIS(2-CHLOROISO-
PROPYL)ETHER
BIS(2-ETHYLHEXYL) IIj
PHTHALATE
4-BROMOPHENYL
PHENYL ETHER
BUTYL BENZYL fi
PHTHALATE
2-CHLORO-
NAPHTHALENE
4-CHLORPHENYL
PHENYL ETHER `I
I CHRYSENE
DI-N-BUTYL PHTHALATE I -
DI-N-OCTYL PHTHALATE
OIBENZO(A,H) ! j
ANTHRACENE
1,2-OICHLOROBENZENE 9 '
1,3-DICHLOROBENZENE
1,4-DICHLOROBENZENE
3,3-DICHLORO- —
BENZIDINE f
1 � I DIETHYL PHTHALATE
4
DIMETHYL PHTHALATE
2,4-DINITROTOLUENE
( 2,8-DINITROTOLUENE
1,2-DIPHENYL- '
HYDRAZINE
EPA Form 3510-2A(Rev 1-99) Repiaces EPA forms'550.6&7550-22 Page 13 af 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: I RIVER BASIN:
Outfan r,umber Complete once for each outfall discharging effluent to waters of the United States
MAXIMUM DAILY DISCHARGE ! AVERAGE DAILY DISCHARGE
POLLUTANT I I 1 I Number { ANALYTICAL + MLIMDL
Conc. Units Mass i Units Conc. Units Mass Units 1 of I METHOD
{
1 Samples
FLUORANTHENE
FLUORENE
HEXACHLOROBENZENE
HEXACHLORO-
BUTADIENE
HEXACHLOROCYCLO-
PENTADIENE
HEXACHLOROETHANE i fI i
I
INDENO(1.2,3-CD)
PYRENE
ISOPHORONE
NAPHTHALENE
NITROBENZENE
N-NITROSODI-N-
PROPYLAMINE
N-NITROSODI-
METHYLAMINE Il I
N-NRROSODI-
PHENYLAMINE + j
PHENANTHRENE ` I
PYRENE
1,2.4- T 1
TRICHLOROBENZENE I `
Use the space(or a separate sheet)to provide information on other base-neutral compounds requested by the permit writer f 1
Use this space(or a separate sheet)to provide information on other pollutants(e S,.pesticides)requested by the perrnr writer
END OF PART D.
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 14 of 22

FACILITY NAME AND PERMIT NUMBER: ' PERMIT ACTION REQUESTED: RIVER BASIN:
i
I
SUPPLEMENTAL APPLICATION INFORMATION
PART E. TOXICITY TESTING DATA
POTWs meeting one or more of the following criteria must provide the results of whole effluent toxicity tests for acute or chronic toxicity for each of the
facility s discharge points 1)POTWs with a design flow rate greater than or equal to 1 0 mod 2)POTWs with a pretreatment program(or those that are
required to have one under 40 CFR Part 403)•or 31 POTWs required by the permitting authority to submit data for these parameters
• At a minimum,these results must include quarterly testing for a 12-month period within the past 1 year using multiple species(minimum of two
species).or the results from four tests performed at least annually in the four and one-half years pnor to the application.provided the results
show no appreciable toxicity and testing for acute and/or chronic toxicity.depending on the range of receiving water dilution 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 OAJOC requirements of 40 CFR Part 136 and other appropriate QAJQC
requirements for standard methods for analytes not addressed by 40 CFR Part 136
• In addition.Submit the results of any other whole effluent toxicity tests from the past four and one-half years If a whole effluent toxicity test
conducted during the past four and one-half years revealed toxicity provide any information on the cause of the toxicity or any results of a
toxicity reduction evaluation if one was conducted
• If you have already submitted any of the information requested in Pan E.you need not submit it again Rather provide the information
requested in question E 4 for previously submitted information if EPA methods were not used.report the reasons for using alternate methods.
If test summaries are available that contain all of the information requested below,they may be submitted in place of Part E
If no biomonrtoring data is required do not complete Part E Refer to the Application Overview for directions or which other sections of the form to
complete
Et. Required Tests.
indicate the number of whole effluent toxicity tests conducted in the past four and one-half years
: chronic .: acute
E.2. Individual Test Data. Complete the following chart for each whole effluent toxicity test conducted in the last four and one-half years. Allow one
column per test(where each species constitutes a test) Copy this page if more than three tests are being reported
Test number Test number Test number
a Test information
Test Species&test method number
Age at initiation of test
Outfall number j
Dates sample collected 1
Date test started
Duration
b Give toxicity test methods followed.
Manual title I
Edition number and year of publication
I
Page number(s) _ I -
c Give the sample collection method(s)used For multiple grab samples indicate the number of grab samples used.
----- - ------------------
24-Hour composite
Grab 1
d. Indicate where the sample was taken in relation to disinfection, (Check all that apply for each.
Before disinfection 1
After disinfection
After dechlonnation T
i
EPA Form 3510-2A)Rev i•99i Replaces EPA forms 7550-6 8 7550-22 Page 15 of 22

FACIUTY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: TRIVER BASIN: . ..
1
Test number: Test number Test number:
e Describe the point in the treatment process at which the sample was coNected.
T
Sample was collected'
ff. For each test.include whether the test was intended to assess chronic toxicity,acute toxicity.or both
Chronic toxicity
Acute toxicity
�.—
L
g. Provide the type of test performed
Static
Static-renewal
I —
Flow-through
h Source of dilution water. If laboratory water,specify type;d receiving water.specify source
Laboratory water --- I
Receiving water -- — —'—
Type of dilution water If salt water,specify'natural'or type of artrficral sea salts or bnne used
----- - -- '-T"- --"---
Fresh water
Salt water
Give the percentage effluent used for all concentrations in the test series. I
.... ..,..,,r::.1.7,.-4'.W ,..,...,, . . /
1 1
k Parameters measured during the test. (State whether parameter meets test method specifications)
1 pH
Salinity
Temperature
Ammonia I
1
Dissolved oxygen I
r
I. Test Results
Acne!
Percent survival in 100% % % %
effluent
LCso ii
95%C.l. % % I %
Control peroent survival % % % i
Other(describe)
EPA Form 3510-2A(Rev 1-99) Replaces EPA forms 7550.6&7550-22 Page 16 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
Chronic.
NOEC °/i
IC2o 11f % 96 S
Control percent survival ! % % S
Other(descnbet
m Quality Control/Quality Assurance •
Is feference toxicant data available?
Was reference toxicant test within
acceptable bounds?
What date was reference toxicant test
run(MMIDD/YYYY)'
•
Other(describe►
E.3. Toxicity Reduction Evaluation. Is the treatment works nvolved in a Toxicity Reduction Evaluation?
❑ Yes ❑ No If yes describe
E.4. Summary of Submitted Blomonitoring Test Information. If you have submitted biomonrtoring test information or information regarding the
cause of toxicity within the past four and one-half years provide the dates the information was submitted to the permitting authority and a summary
of the results
Date submitted / / (MM/DD/YYYY)
Summary of results (see instructions)
END OF PART E.
REFER TO THE APPLICATION OVERVIEW(PAGE 1)TO DETERMINE WHICH OTHER PARTS
OF FORM 2A YOU MUST COMPLETE.
EPA Form 3510-2A(Rev t-99) Replaces EPA forms 7550 6&7550-22 •

FACILITY NAME AND PERMIT NUMBER: 1 PERMIT ACTION REQUESTED: ' RIVER BASIN:
SUPPLEMENTAL APPLICATION INFORMATION
PART F.INDUSTRIAL USER DISCHARGES AND RCRA/CERCLA WASTES
All treatment works receiving discharges from significant industrial users or which receive RCRA,CERCLA,or other remedial wastes must
complete part F.
GENERAL INFORMATION:
F.1. Pretreatment program. Does the treatment works nave,or is subject of an approved pretreatment program?
❑ Yes C No
F.2. Number of Significant Industrial Users(Sills)and Categorical Industrial Users(CIUs). Provide the number of each of the following types of
industrial users that discharge to the treatment works
a Number of non-categorical SIUs
b Number of CIUs
SIGNIFICANT INDUSTRIAL USER INFORMATION:
Supply the following Information for each SIU. It more than one SIU discharges to the treatment works,copy questions F.3 through F.8 and
provide the information requested for each SIU.
F.3. Significant Industrial User Information. Provide the name and address of each SIU discharging to the treatment works Submit additional pages
as necessary
Name
Mailing Address
F.4. Industrial Processes. Describe all the industnal processes that affect or contribute to the SIU's discharge
F 5. Principal Product(s)and Raw Material(s). Describe all of the principal processes and raw materials that affect or contnbute to the SIU•s
discharge
Principal products)
Raw matenai(s)
F.6. Flow Rate.
a. Process wastewater flow rate indicate the average daily volume of process wastewater discharge into the collection system in gallons per
day(gpd)and whether the discharge is continuous or intermittent
gpd ( continuous or - intermittent)
b Non-process wastewater flow rate Indicate the average daily volume of non-process wastewater flow discharged into the collection system
in gallons per day(gpd)and whether the discharge is continuous or intermittent.
gpd I continuous or intermittent)
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following
a Local limits Ci Yes ` No
b. Categorical pretreatment standards 0 Yes No
If subject to categorical pretreatment standards,which category and subcategory?
EPA Form 3510-2A(Rev t-e9) Replaces EPA forms 7550-6 8 7550-22 Page 18 of 22

FACIUTY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
F.B. Problems at the Treatment Works Attributed to Waste Discharge by the SIU. Has the SIU caused or contnbuted to any problems(e-g..
upsets.interference)at the treatment works in the past three years?
Yes No if yes.describe each episode
RCRA HAZARDOUS WASTE RECEIVED BY TRUCK,RAIL,OR DEDICATED PIPEUNE:
F.9. RCRA Waste. Does the treatment works receive or has it in the past three years received RCRA hazardous waste by truck,rail or dedicated pipe"
Yes ❑ No(go to F 12)
F 10 Waste transport Method by which RCRA waste is received(check all that apply)
Truck ..ram" Rail Dedicated Pipe
F.11. Waste Description. Give EPA hazardous waste number and amount(volume or mass.specify units)
EPA Hazardous Waste Number Amount units
CERCLA(SUPERFUND)WASTEWATER,RCRA REMEDIATION/CORRECTIVE ACTION
WASTEWATER,AND OTHER REMEDIAL ACTIVITY WASTEWATER:
FA2. Remediation Waste. Does the treatment works currently(or has it been notified that it will)receive waste from remedial activities"'
Yes(complete F 13 through F 15 El No
F.13. Waste Origin. Describe the site and type of facility at which the CERCLAIRCRAlor other remedial waste originates for(s excepted to origniate in
the next five years)
F.14. Pollutants. List the hazardous constituents that are received(or are expected to be received) Include data on volume and concentration,if
known (Attach additional sheets it necessary)
F.15. Waste Treatment
a. Is this waste treated(or will be treated)prior to entering the treatment works?
..--. Yes ,_I No
If yes.describe the treatment(provide information about the removal efficiency)
b. Is the discharge(or will the discharge be)continuous or intermittent — _
I Continuous ri Intermittent If intermittent,describe discharge schedule
END OF PART F.
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'S of

FACILITY NAME AND PERMIT NUMBER: ; PERMIT ACTION REQUESTED: ' RIVER BASIN:
SUPPLEMENTAL APPLICATION INFORMATION 1
PART G. COMBINED SEWER SYSTEMS
If the treatment works has a combined sewer system,complete Part G.
G.1. System Map. Provide a map indicating the following. (may be included with Basic Application Information)
a All CSO discharge points
b Sensitive use areas potentially affected by CSOs(e g.beaches.drinking water supplies shellfish beds.sensitive aquatic ecosystems and
outstanding natural resource waters)
c Waters that support threatened ana endangered species potentially affected by CSOs
G.2. System Diagram. Provide a diagram.either in the map provided in G 1 or on a separate drawing of the combined sewer collection system that
includes the following information
a. Location of major sewer trunk lines both combined and separate sanitary
b Locations of points where separate sanitary sewers feed into the combined sewer system
C. Locations of in-line and off-line storage structures
d Locations of flow-regulating devices
e Locations of pump stations
CSO OUTFALLS:
Complete questions G.3 through G.6 once for each CSO discharge point.
G.3. Description of Outfall.
a Outfall number
b Location
(City or town.rf applicable) (Zip Code;
(County) (State)
(Latitude) (Longitude)
C Distance from shore(if applicable) ft
d Depth below surface(rf applicable ft
e. Which of the following were monitored during the last year for this CSO'7
Rainfall 7: CSO pollutant concentrations CSO frequency
CSO flow volume Receiving water quality
f How many storm events were monitored during the last year?
G.4. CSO Events.
a Give the number of CSO events in the last year
events (_ actual or approx.,
b Give the average duration per CSO event.
Hours (LJ actual or EL,approx l
EPA Form 3510-2A;Rev 1-99) Replaces EPA forms 7550-6&7550-22 Page 20 of 22

FACILITY NAME AND PERMIT NUMBER: PERMIT ACTION REQUESTED: RIVER BASIN:
c. Give the average volume per CSO event
million gallons;_:actual or!_j approx i
d Give the minimum rainfall that caused a CSO event in the last year
inches of rainfall
G.S. Description of Receiving Waters.
a Name of receiving water
b Name of watershed/river/stream system
United State Sod Conservation Service to-digit watershed code(if known)
C. Name of State Management/River Basin
United States Geological Survey 8-digit hydrologic cataloging unit code Of known)
G.6. CSO Operations.
Describe any known water quality impacts on the receiving water caused by this CSO(e g permanent or intermittent beach closings permanent or
intermittent shell fish bed closings fish kills fish advrsones other recreational loss,or violation of any applicable State water quality standard)
•
END OF PART G.
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 2?of 22

Lynne Starr-Vasquez
P.O. Box 627
Cliffside,N.C.
28024
August 12, 2019
To whom it may concern:
This communication is in regards to the NPDES Permit Number, for operations at Cliffside Sanitary
District.The current board members,Johnny White, Brad Poynter,and myself Lynne Starr-Vasquez grant
authorization for signatures to obtain the needed permits to continue operations at the Cliffside Sanitary
District.
Please be advised,effective August 15,2019 the board members of the Cliffside Sanitary District will
leave their volunteer positions.At that time there will be no one to assume responsibilities for the
operations of the facility.Also be advised that neither board member will be responsible and/or delegate
any signatures of authority after the said date.
By notice of this letter,we the board members of the Cliffside Sanitary District delegate signature
authority to:
EnviroLink(WasteWater Management)
4700 HomeWood Circle, Suite 108
Raleigh,North Carolina
27609
Please be advised,the contact person between EnviroLink and the Cliffside Sanitary District has been and
continues to be:
John Mullis
Business and Relationship Manager
Cell [phone]
[e-mail]
www.envirolinkinc.com
The purpose of our delegating signature is to allow EnviroLink WasterWater Management to maintain
monitoring reports and apply for permit applications, which is needed to continue the operations at
Cliffside Sanitary District, as required by the State of North Carolina and the Local Government
Commission within the State of North Carolina.
Joh ny White- Board Me, ber Brad Poynter- Board Member
Lynne Starr-Vasquez-Chairman of the Board