NC0068365_Fact Sheet_20190828 (2)

FACT SHEET FOR EXPEDITED PERMIT RENEWALS
This form must be completed by Permit Writers for all expedited permits which do not require
full Fact Sheets. Expedited permits are generally simple 100% domestics (e.g., schools, mobile
home parks, etc) that can be administratively renewed with minor changes, but can include
facilities with more complex issues (Special Conditions, 303(d) listed water, toxicity testing,
instream monitoring, compliance concerns).
Basic Information for Expedited Permit Renewals
Permit Writer / Date
Brianna Young 8/28/19
Permit Number
NCO068365
Facility Name / Facility Class
Pilot Mountain WTP / PC-1
Basin Name / Sub -basin number
Yadkin Pee -Dee / 03-07-03
Receiving Stream / HUC
Toms Creek / 0304010109
Stream Classification / Stream Segment
C / 12-72-14- 4
Does permit need Daily Maximum NH3
limits?
N/A
Does permit need TRC limits/language?
Alread resent
Does permit have toxicity testing? IWC (%) if
so
Yes; IWC = 4.9%
Does permit have Special Conditions?
No
Does permit have instream monitoring?
Yes — added upstream hardness in renewal
Is the stream impair d on 303 d list)?
No
Any obvious compliance concerns?
See below
Any permit mods since lastpermit?
None
New expiration date
2/28/2024
Comments on Draft Permit?
Yes see below)
Facility Overview:
The Pilot Mountain WTP operates a conventional WTP designed for a potable flowrate
of 1.5 MGD. The facility generates backflow with an intermittent discharge (1 day
biweekly for 2 hours). The maximum, monthly average discharge between June 2016 and
May 2019 was 0.156 MGD.
Compliance History (July 2015 — July 2019):
• Frequency violations for flow for the entire month of July 2015 — all BPJ'd
• 2 frequency violations for TSS — 1 BPJ'd, 1 has no action taken
• Passed all toxicity tests since January 2015
RPA:
The maximum monthly average flow between June 2016 and May 2019 was 0.156 MGD.
0 Copper — RP shown; Limits applied with monthly monitoring

• Fluoride — No RP; predicted max < 50% of allowable Cw; monitoring maintained
at quarterly as facility has the potential to discharge fluoride
• Zinc — No RP; predicted max < 50% of allowable Cw; monitoring maintained at
quarterly as facility has the potential to discharge zinc orthophosphate
NCG59 General Permit Eligibility (for Conventional and Greensand WTPs):
• They have passed last 12 tox tests, therefore they are eligible by tox standards
• They had limits added for copper during renewal, therefore they are not eligible
• Conclusion: They are not eligible for the NCG59
Changes from previous permit to draft:
• Updated eDMR footnote in A(1) and language in A(3)
• Updated outfall map
• Added regulatory citations
• Language on the Supplement to Permit Cover Sheet has been updated
• Components list on Supplement to Permit Cover Sheet updated based on renewal
application
• Added facility grade in A(1)
• Updated units in A(1)
• Turbidity monitoring decreased to monthly in A(1) per 2012 WTP guidance
• Limits added for copper and monitoring increased to monthly in A(1) based on
RPA
• Hardness monitoring added in A(1) per current WTP guidance
• Added "Monitor & Report" for WET testing in A(1)
• WET testing IWC changed in A(1) and A(2) based on current maximum monthly
average discharge
• Removed former footnote #2 in A(1) stating "The Town will have 18 months
from the effective date of this permit to install a continuous flow meter. Until
then instantaneous measurements can be taken with the duration of discharge to
be noted in log books and a total daily discharge reported on the DMR" as the
deadline has passed and continuous flow monitoring is now required
• Removed former footnote #4 in A(1) stating "Samples shall be collected
concurrently with WET -test samples" as this is no longer required per the 2012
WTP guidance update
• Updated TRC footnote in A(1)
• Updated toxicity language in A(2)
Changes from draft to tinal:
• None
Comments received on draft permit:

• Hannah Headrick (Aquatic tox; via email 8/9/19):
o Cover letter - Item 3 states that the outfall map has been updated. Please
explain since the coordinates of the outfall have not changed.
■ DWR Response: The map was updated with the most recent
topography. It is standard to update the map with a new
topographic image for each renewal.
o Cover letter - Item 11 states that the IWC has been updated in A. (1) and
A. (2). Please explain as this isn't seen in the text there.
Does the change in the testing concentration from 6% to 4.9% relate to
this?
■ DWR Response: The IWC is the toxicity testing concentration and
was updated based on the reasonable potential analysis (RPA) and
waste load allocation (WLA) performed with this renewal. These
take into account the maximum monthly average discharge in the
previous 36 months as well as any dilution the facility may be
getting.
o Page 4 — Why has the effluent concentration changed from 6% to 4.9%?
(The IWC language???)
■ DWR Response: The IWC was updated based on the reasonable
potential analysis (RPA) and waste load allocation (WLA)
performed with this renewal. These take into account the
maximum monthly average discharge in the previous 36 months as
well as any dilution the facility may be getting.
o Page 5 - Why has the effluent concentration changed from 6% to 4.9%?
(The IWC language???)
■ DWR Response: The IWC was updated based on the reasonable
potential analysis (RPA) and waste load allocation (WLA)
performed with this renewal. These take into account the
maximum monthly average discharge in the previous 36 months as
well as any dilution the facility may be getting.
o It appears that a statement from the ATB templates for this type of testing
is missing from the explanation of Chronic Toxicity Monitoring:
If the Permittee monitors any pollutant more frequently than required
by this permit, the results of such monitoring shall be included in the
calculation and reporting of the data submitted on the DMR and all AT
Forms submitted.
Please clarify why this statement was not included on these pages. If this
was a simple omission, please include this statement on these pages of the
permit.
■ DWR Response: We use templates for the toxicity conditions in
permits. If it was not present in the permit, it's because it's not
present in the templates we use. If this should be included, all
toxicity language templates that we use will need to be updated.

NORTH CAROLINA
BURRY COUNTY
AFFIDAVIT OF PUBLICATION
Before the undersigned, a Notary Public of said County and State, duly
commissioned, qualified and authorized by law to administer oaths,
personally appeared Sandra Hurley who being first duly
sworn, deposes and says: that he (she) is Re Tonal Publisher
(Publisher or other officer or employee authorized to make affidavit) of
ADAMS PUBLISHING GROUP, LLC, engaged in the publication of a
newspaper known as MOUNT AIRY NEWS, published, issued, and
entered as periodicals class mail in the city of Mount Airy in said County
and State; that he (she) is authorized to make this affidavit and sworn
statement; that the notice or other legal advertisement, a true copy of which
is attached hereto, was published in MOUNT AIRY NEWS on the
following dates:
1
and that the said newspaper in which such notice, paper, document or
legal advertisement was published was, at the time of each and every such
publication, a newspaper meeting all of the requirements and
qualifications of Section 1-597 of the General Statutes of North Carolina
and was a qualified newspaper within the meaning of Section 1-597 of the
General Statutes of North Carolina.
This cQ-q day of q y=�� , 2019
Signature of person making affidavit
Sworn to and subscribed before me, this Z"9 day of
!i V 2019
Notary Public
My Commission expires: January 18, 2023
FERRIS W. SIMPSON
NOTARY PUBLIC
SURRY COUNTY, N.C.
CLIPPING OF
LEGAL
ADVERTISEMENT
ATTACHED HERE
Public Notice
North Carolina Environment-
al Management
Commission/NPDES Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Notice of Intent to Issue a
NPDES
Wastewater Permit
The North Carolina Environ-
mental Management Commis-
sion proposes to issue a NP-
DES wastewater discharge
permit to the person(s) listed
below. Written comments re-
garding the proposed permit
will be accepted until 30 days
after the publish date of this
notice. The Director of the NC
Division of Water Resources
(DWR) may hold a public -hear-
ing should there be a signific-
ant degree of public interest.
Please mail comments and/or
information requests to DWR
at the above address. Inter-
ested persons may visit the
DWR at 512 N. Salisbury
Street, Raleigh, NC to review
information on file. Additional
information on NPDES per-
mits and this notice may be
found on our website:
http://deq. nc.gov/about/divi-
sions/water-resources/water-
resources-permits/wastewater-
branch/npdes-wastewater/pub-
lic-notices,or by calling (919)
707-3601. The Town of Pilot
Mountain, Surry County, has
applied to renew its NPDES
permit for the Pilot Mountain
Water Treatment Plant
(NC0068365) discharging fil-
ter -backwash wastewater to
Toms Creek in the Yadkin -Pee
Dee River Basin. This dis-
charge may affect future alloc-
ations in this portion of the re-
ceiving stream.
Publish: 07/28/2019
70025810

Freshwater RPA - 95% Probability/95% Confidence Using Metal Translators
MAXIMUM DATA POINTS = 58
Table 1. Project Information
❑ CHECK IF HQW OR ORW WQS
Facility Name
WWTP/WTP Class
NPDES Permit
Outfall
Flow, Qw (i
Receiving Stream
HUC Number
Stream Class
❑ Apply WS Hardness WQC
7Q10s (cfs)
7Q10w (cfs)
30Q2 (cfs)
QA (cfs)
1Q10s (cfs)
Effluent Hardness -------------
Upstream Hardness -------------
Combined HardnessChronic
_
Combined Hardness Acute
Data Source(s)
❑ CHECK TO APPLY MODEL
Pilot Mountain WTP
PC-1
NCO068365
001
0.156
Toms Creek
0304010109
C
4.70
3.92
25 mg/L (Avg)
25mg/L(Avg)
25mg/L
25 mg/L
---- -------
REQUIRED DATA ENTRY
Par01
Par02
Par03
Par04
Par05
Par06E
Par07
Par08
Par09
Par10
Par11
Par12
Par13
Par14
Par15
Par16
Par17
Par18
Par19
Par20
Par21
Par22
Par23
Par24
Table 2. Parameters of Concern
Name WQs Type Chronic Modifier Acute i Units
Arsenic
Aquactic Life
C
150
FW
340
ug/L
Arsenic
Human Health
Water Supply
C
10
HH/WS
N/A
ug/L
Beryllium
Aquatic Life
NC
6.5
FW
65
ug/L
Cadmium
Aquatic Life
NC
0.5899
FW
3.2396
ug/L
Chlorides
Aquatic Life
NC
230
FW
Chlorinated Phenolic Compounds
Water supply
NC
1
A
ug/L
Total Phenolic Compounds
Aquatic Life
NC
300
A
ug/L
Chromium III
Aquatic Life
NC
117.7325
FW
905.0818
ug/L
Chromium VI
Aquatic Life
NC
11
FW
16
pg/L
Chromium, Total
Aquatic Life
INC
N/A
FW
N/A
pg/L
Copper
Aquatic Life
INC
7.8806
FW
10.4720
ug/L
Cyanide
Aquatic Life
NC
5
FW
22
10
ug/L
Fluoride
Aquatic Life
INC
1,800
FW
ug/L
Lead
Aquatic Life
INC
2.9416
FW
75.4871
ug/L
Mercury
Aquatic Life
INC
12
FW
0.5
ng/L
Molybdenum
Human Health
NC
2000
HH
ug/L
Nickel
Aquatic Life
NC
37.2313
FW
335.2087
Ng/L
Nickel
Water Supply
INC
25.0000
WS
N/A
Ng/L
Selenium
Aquatic Life
INC
5
FW
56
ug/L
Silver
Aquatic Life
NC
0.06
FW
0.2964
ug/L
Zinc
Aquatic Life
NC
126.7335
FW
125.7052
ug/L
NCO068365 FW RPA, input
8/28/2019

REASONABLE POTENTIAL ANALYSIS
H1
Effluent Hardness
Date Data BDL=1/2DL Results
1 25 25 Std Dev.
2 Mean
3 C.V.
4 n
5 10th Per value
6 Average Value
7 Max. Value
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
Use "PASTE SPECIAL
Values" then "COPY"
. Maximum data
points = 58 F
1
25.0000 2
0.0000 3
1 4
25.00 mg/L 5
25.00 mg/L 6
25.00 mg/L 7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
Upstream Hardness
Date Data BDL=1/2DL Results
25 25 Std Dev.
Mean
C.V.
n
10th Per value
Average Value
Max. Value
Use"PASTE SPECIAL
Values" then "COPY"
. Maximum data
points = 58
25.0000
0.0000
1
25.00 mg/L
25.00 mg/L
25.00 mg/L
NCO068365 FW RPA, data
-3- 8/28/2019

REASONABLE POTENTIAL ANALYSIS
Pall
Copper
Date
Data
BDL=1/2DL
Results
1
1/6/2015
8
8
Std Dev.
2
4/7/2015
9
9
Mean
3
1/5/2016
10
10
C.V.
4
4/12/2016
18
18
n
5
7/12/2016
31
31
6
10/11/2016
28
28
Mult Factor =
7
1/10/2017
20
20
Max. Value
8
4/11/2017
272
272
Max. Fred Cw
9
7/11/2017
32
32
10
10/3/2017
17
17
11
1/9/2018
30
30
12
4/10/2018
92
92
13
7/10/2018
90
90
14
10/9/2018
22
22
15
1/15/2019
93
93
16
4/9/2019
407
407
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
Use"PASTE SPECIAL Par13
Values" then "COPY"
. Maximum data
points = 58
73.6875
1.5005
16
2.12
407.00 ug/L
862.84 ug/L
Use"PASTE SPECIAL
Fluoride Values" then "COPY"
. Maximum data
points = 58
Date
Data
BDL=1/2DL
Results
1
1/6/2015
104
104
Std Dev.
2
4/7/2015
<
100
50
Mean
3
7/7/2015
325
325
C.V.
4
10/6/2015
<
100
50
n
5
1/5/2016
<
100
50
6
4/12/2016
<
100
50
Mult Factor =
7
7/12/2016
<
100
50
Max. Value
8
10/11/2016
<
100
50
Max. Fred Cw
9
1/10/2017
206
206
10
4/11/2017
234
234
11
7/11/2017
<
100
50
12
10/3/2017
<
100
50
13
1/9/2018
<
100
50
14
4/10/2018
<
100
50
15
7/10/2018
104
104
16
10/9/2018
<
100
50
17
1/15/2019
<
100
50
18
4/9/2019
<
100
50
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
90.1667
0.8946
18
1.61
325.0 ug/L
523.3 ug/L
-4-
NCO068365 FW RPA, data
8/28/2019

REASONABLE POTENTIAL ANALYSIS
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
Use "PASTE SPECIAL
Zinc
Values" then "COPY"
. Maximum data
points = 58
Date
Data
BDL=1/2DL
Results
1/6/2015
<
10
5
Std Dev.
53.5334
4/7/2015
10
10
Mean
34.2222
7/7/2015
57
57
C.V.
1.5643
10/6/2015
26
26
n
18
1 /5/2016
<
10
5
4/12/2016
34
34
Mult Factor =
2.00
7/12/2016
47
47
Max. Value
231.0 ug/L
10/11/2016
10
10
Max. Pred Cw
462.0 ug/L
1/10/2017
<
10
5
4/11/2017
231
231
7/11/2017
<
10
5
10/3/2017
<
10
5
1 /9/2018
<
10
5
4/10/2018
15
15
7/10/2018
52
52
10/9/2018
10
10
1/15/2019
21
21
4/9/2019
73
73
-5-
NCO068365 FW RPA, data
8/28/2019

Pilot Mountain WTP - Outfall 001
NCO068365 Freshwater RPA - 95% Probability/95% Confidence Using Metal Translators Qw = 0.156 MGD
MAXIMUM
Qw (MGD) =
0.1560
1Q10S (cfs) =
3.92
7Q10S (cfs) =
4.70
7Q10W (cfs) =
NO 7Q10w DATA
30Q2 (cfs) =
NO 30Q2 DATA
Avg. Stream Flow, QA (cfs) =
NO QA DATA
Receiving Stream:
Toms Creek HUC 0304010109
DATA POINTS = 58
WWTP/WTP Class: PC-1
IWC% @ 1Q10S =
5.809986064
1WC% @ 7Q10S =
4.892953984
IWC% @ 7Q10W =
N/A
1WC% @ 30Q2 =
N/A
IW%C @ QA =
N/A
Stream Class:
C
COMBINED HARDNESS (me/L)
Acute = 25 mg/L
Chronic = 25 mg/L
PARAMETER
NC STANDARDS OR EPA CRITERIA
REASONABLE POTENTIAL RESULTS
RECOMMENDED ACTION
TYPE
a
Applied
Chronic Acute
n # Det. Max Pred Cw Allowable Cw
Standa
Acute: 180.24
RP shown - apply Monthly Monitoring with Limit
Copper
NC
7.8806 FW(7Q10s) 10.4720
ug L
16 16
862.84
_ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _
_
Chronic 161
RP shown - apply Monthly Monitoring with Limit
2 values > Allowable Cww
Acute: NO WQS
Fluoride
NC
1800 FW(7Q10s)
ug L
18 5
523.3
_ _ _ _ _ _ _ _ _ _ _
Chronic: 36,787.E
_ _ _ _ _ _ _ _ _ _ _ _ _
No RP, Predicted Max < 50% of Allowable Cw - No
No value > Allowable Cw
Monitoring required
Acute: 2,163.6
No RP, Predicted Max < 50% of Allowable Cw - No
Zinc
NC
126.7335 FW(7Q10s) 125.7052
ug/ L 18 12 462.0
Monitoring required
---------------------------------------------
Chronic: 2,590.1
No RP, Predicted Max < 50% of Allowable Cw - No
No value > Allowable Cw
Monitoring required
NCO068365 FW RPA, rpa
Page 6 of 51 8/28/2019

NH3/TRC WLA Calculations
Facility: Pilot Mountain WTP
PermitNo. NC0068365
Prepared By: Brianna Young
Enter Design Flow (MGD): 0.156
Enter s7Q10 (cfs): 4.7
Enter w7Q10 cfs : 0
Total Residual Chlorine (TRC)
Daily Maximum Limit (ug/1)
Ammonia (Summer)
Monthly Average Limit (mg NH3-N/1)
s7Q10 (CFS)
4.7
s7Q10 (CFS)
4.7
DESIGN FLOW (MGD)
0.156
DESIGN FLOW (MGD)
0.156
DESIGN FLOW (CFS)
0.2418
DESIGN FLOW (CFS)
0.2418
STREAM STD (UG/L)
17.0
STREAM STD (MG/L)
1.0
Upstream Bkgd (ug/1)
0
Upstream Bkgd (mg/1)
0.22
IWC (%)
4.89
IWC (%)
4.89
Allowable Conc. (ug/1)
347
Allowable Conc. (mg/1)
16.2
Ammonia (Winter)
Monthly Average Limit (mg NH3-N/1)
Fecal Coliform
w7Q10 (CFS)
0
Monthly Average Limit:
200/100ml DESIGN FLOW (MGD)
0.156
(If DF >331; Monitor)
DESIGN FLOW (CFS)
0.2418
(If DF<331; Limit)
STREAM STD (MG/L)
1.8
Dilution Factor (DF)
20.44 Upstream Bkgd (mg/1)
0.22
IWC (%)
100.00
Allowable Conc. (mg/1)
1.8
Total Residual Chlorine
1. Cap Daily Max limit at 28 ug/I to protect for acute toxicity
Ammonia (as NH3-N)
1. If Allowable Conc > 35 mg/I, Monitor Only
2. Monthly Avg limit x 3 = Weekly Avg limit (Municipals)
3. Monthly Avg limit x 5 = Daily Max limit (Non-Munis)
If the allowable ammonia concentration is > 35 mg/L, no limit shall be imposed
Fecal Coliform
1. Monthly Avg limit x 2 = 400/100 ml = Weekly Avg limit (Municipals) = Daily Max limit (Non -Muni)

Whole Effluent Toxicity Testing and Self Monitoring Summary
Thomasville -Hamby
Creek WWTP
NCO024112/001
County: Davidson
Ceri7dPF
Begin:
8/1/2009
Chr lim: 90%
NonComp:
SINGLE
J
F
M
A
M
2015
Pass
Pass
Pass
Pass >100(P)
2016
>100
Pass
Pass
2017
-
Pass
Pass
2018
-
Pass
>100(P)
Pass
2019
>100
Pass
Town of Burnsville WTP
NCO075965/001
County: Yancey
Ceri48PF
Begin:
5/1/2016
Ceri48PF Monit. @ 9
NonComp:
J
F
M
A
M
2016
Pass
Pass
2017
Pass
Pass
2018
Pass
Pass
2019
Pass
-
Pass
Town of Cary - Cary/Apex WTP
NCO081591/001
County: Wake
Ceri7dPF
Begin:
8/1/2011
Chr Monit:
90%
NonComp:
J
F
M
A
M
2015
Pass
Pass
2016
Pass
Pass
2017
Pass
Pass
2018
Pass
Pass
2019
Pass
-
Pass
Town of Highlands WTP
NCO032778/001
County: Macon
Ceri7dPF
Begin:
5/1/2018
Chr Monit:
7%
NonComp:
J
F
M
A
M
2015
Pass
2016
Pass
2017
Pass
2018
Pass
2019
Pass
Town of Pilot Mountain WTP
NCO068365/001
County: Surry
Ceri7dPF
Begin:
7/1/2014
Chr Monit:
6%
NonComp:
J
F
M
A
M
2015
Pass
Pass
2016
Pass
Pass
2017
Pass
Pass
2018
Pass
Pass
2019
Pass
Pass
Region: WSRO
7Q10: 0.43
J J
Pass Pass
Region: ARO
7Q10:
J J
Pass
Pass
Pass
Region: RRO
7Q10:
J
Region: ARO
7Q10:
J
Pass
Pass
Pass
Pass
Region: WSRO
7Q10:
J
J
Pass
Pass
Pass
Pass
J
Basin: YAD07
Feb May Aug Nov
PF: 4.0 IWC:
94 Freq: Q
A
S O
Pass
Pass
Pass >100(P)
Pass >100(P)
Pass
Basin: FRB06
Jan Apr Jul Oct
PF: IWC:
Freq: Q
A
S O
Pa
Pa:
Pa:
Basin: CPF05
Jan Apr Jul Oct
PF: IWC:
Freq: Q
A
S O
Pa:
Pa:
Pa
Pa
Basin: TRB01
Mar Jun Sep Dec
PF: IWC:
Freq: Q
A
S O
Pass -
Pass
Pass
Pass
Basin: YAD03
PF: IWC:
J A
Pass
Pass
Pass
Pass
SOC JOC:
N
Fail
Pass
Pass
Fail
SOC JOC:
N
SOC JOC:
N
SOC JOC:
N
Jan Apr Jul Oct SOC JOC:
Freq: Q
S O N
Pass
Pass
Pass
Pass
D
>100
>100
L
C
D
Pass
Pass
Pass
Pass
L
Leeend: P= Fathead minnow (Pimphales promelas). H=No Flow (facility is active). s = Split test between Certified Labs Page 111 of 125

MONITORING REPORT(MR) VIOLATIONS for: Report Date: 07/05/19 Page: 1 of 3
Permit: nc0068365 MRs Between 7 - 2015 and 7 - 2019 Region: % Violation Category% Program Category:
Facility Name: % Param Name % County: % Subbasin:% Violation Action: %
Major Minor:
i
PERMIT: NCO068365 FACILITY: Town of Pilot Mountain - Pilot Mountain WTP COUNTY: Surry REGION: Winston-Salem
Monitoring Violation
MONITORING VIOLATION UNIT OF CALCULATED %
REPORT OUTFALL LOCATION PARAMETER DATE FREQUENCY MEASURE LIMIT VALUE Over VIOLATION TYPE VIOLATION ACTION
07 -2015 001 Effluent Flow, in conduit or thru 07/01/15 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
07 -2015 001 Effluent Flow, in conduit or thru 07/02/15 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
07 -2015 001 Effluent Flow, in conduit or thru 07/03/15 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
07 - 2015 001 Effluent Flow, in conduit or thru 07/04/15 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
07 - 2015 001 Effluent Flow, in conduit or thru 07/05/15 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
07 - 2015 001 Effluent Flow, in conduit or thru 07/06/15 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
07 _ 2015 001 Effluent Flow, in conduit or thru 07/08/15 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
07 - 2015 001 Effluent Flow, in conduit or thru 07/09/15 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
07 _ 2015 001 Effluent Flow, in conduit or thru 07/10/15 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
07 - 2015 001 Effluent Flow, in conduit or thru 07/11/15 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
07 - 2015 001 Effluent Flow, in conduit or thru 07/12/15 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
07 _ 2015 001 Effluent Flow, in conduit or thru 07/13/15 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
07 - 2015 001 Effluent Flow, in conduit or thru 07/14/15 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
07 _ 2015 001 Effluent Flow, in conduit or thru 07/15/15 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
07 - 2015 001 Effluent Flow, in conduit or thru 07/16/15 Continuous mgd Frequency Violation No Action, BPJ
treatment plant

MONITORING REPORT(MR) VIOLATIONS for:
Permit: nc0068365 MRs Between 7 - 2015 and 7 - 2019 Region: %
Facility Name: % Param Name % County: %
Major Minor: %
Report Date: 07/05/19 Page: 2 of 3
Violation Category:% Program Category: %
Subbasin:% IN
Violation Action:
PERMIT: NCO068365
FACILITY: Town of Pilot Mountain -Pilot Mountain WTP
COUNTY: Surry REGION: Winston-Salem
Monitoring Violation
MONITORING
VIOLATION
UNIT OF
CALCULATED
REPORT
OUTFALL
LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE
LIMIT VALUE Over VIOLATION TYPE
VIOLATION ACTION
07 -2015
001
Effluent
Flow, in conduit or thru
07/17/15
Continuous
mgd
Frequency Violation
No Action, BPJ
treatment plant
07 _2015
001
Effluent
Flow, in conduit or thru
07/18/15
Continuous
mgd
Frequency Violation
No Action, BPJ
treatment plant
07 -2015
001
Effluent
Flow, in conduit or thru
07/19/15
Continuous
mgd
Frequency Violation
No Action, BPJ
treatment plant
07 - 2015
001
Effluent
Flow, in conduit or thru
07/20/15
Continuous
mgd
Frequency Violation
No Action, BPJ
treatment plant
07 - 2015
001
Effluent
Flow, in conduit or thru
07/21/15
Continuous
mgd
Frequency Violation
No Action, BPJ
treatment plant
07 - 2015
001
Effluent
Flow, in conduit or thru
07/22/15
Continuous
mgd
Frequency Violation
No Action, BPJ
treatment plant
07 - 2015
001
Effluent
Flow, in conduit or thru
07/23/15
Continuous
mgd
Frequency Violation
No Action, BPJ
treatment plant
07 - 2015
001
Effluent
Flow, in conduit or thru
07/24/15
Continuous
mgd
Frequency Violation
No Action, BPJ
treatment plant
07 - 2015
001
Effluent
Flow, in conduit or thru
07/25/15
Continuous
mgd
Frequency Violation
No Action, BPJ
treatment plant
07 - 2015
001
Effluent
Flow, in conduit or thru
07/26/15
Continuous
mgd
Frequency Violation
No Action, BPJ
treatment plant
07 - 2015
001
Effluent
Flow, in conduit or thru
07/27/15
Continuous
mgd
Frequency Violation
No Action, BPJ
treatment plant
07 - 2015
001
Effluent
Flow, in conduit or thru
07/28/15
Continuous
mgd
Frequency Violation
No Action, BPJ
treatment plant
07 - 2015
001
Effluent
Flow, in conduit or thru
07/29/15
Continuous
mgd
Frequency Violation
No Action, BPJ
treatment plant
07 - 2015
001
Effluent
Flow, in conduit or thru
07/30/15
Continuous
mgd
Frequency Violation
No Action, BPJ
treatment plant
07 - 2015
001
Effluent
Flow, in conduit or thru
07/31/15
Continuous
mgd
Frequency Violation
No Action, BPJ
treatment plant
10 - 2015
001
Effluent
Solids, Total Suspended -
10/31/15
2 X month
mg/I
Frequency Violation
No Action, BPJ
Concentration

MONITORING REPORT(MR) VIOLATIONS for:
Permit: nc0068365 MRs Between 7 - 2015 and 7 - 2019 Region: %
Facility Name: % Param Name % County: %
Major Minor: %
Report Date: 07/05/19 Page: 3 of 3
Violation Category:% Program Category: %
Subbasin:% IN
Violation Action:
PERMIT: NCO068365 FACILITY: Town of Pilot Mountain -Pilot Mountain WTP COUNTY: Surry REGION: Winston-Salem
Monitoring Violation
MONITORING VIOLATION UNIT OF CALCULATED
REPORT OUTFALL LOCATION PARAMETER DATE FREQUENCY MEASURE LIMIT VALUE Over VIOLATION TYPE VIOLATION ACTION
05 -2019 001 Effluent Solids, Total Suspended - 05/31/19 2 X month mg/I Frequency Violation None
Concentration

NPDES PERMIT APPLICATION - SHORT FORM C - WTP
For discharges associated with water treatment plants
Mail the complete application to:
N. C. Department of Environment and Natural Resources
Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit Number INCO068365
If you are completing this form in computer use the TAB key or the up - down arrows to move from one
field to the next. To check the boxes, click your mouse on top of the box. Otherwise, please print or type.
1. Contact Information:
Owner Name
Facility Name
Mailing Address
City
State / Zip Code
Telephone Number
Fax Number
e-mail Address
Michael Boaz
Pilot Mountain WTP
124 West Main Street
Pilot Mountain
NC 27041
336-368-2247
mboaz@pilotmountainnc. org
2. Location of facility producing discharge:
Check here if same as above ❑
Street Address or State Road
City
State / Zip Code
County
953 West Hwy 52 Bypass
Pilot Mountain
NC 27041
Surry
3. Operator Information:
Name of the firm, consultant or other entity that operates the facility. (Note that this is not referring to the
Operator in Responsible Charge or ORC)
Name Town of Pilot Mountain
Mailing Address 124 West Main Street
City Pilot Mountain
State / Zip Code NC 27041
Telephone Number [phone]
Fax Number ( )
4. Ownership Status:
Federal ❑ State ❑ Private ❑ Public

NPDES PERMIT APPLICATION - SHORT FORM C - WTP
For discharges associated with water treatment plants
S. Type of treatment plant:
® Conventional (Includes coagulation, flocculation, and sedimentation, usually followed by
filtration and disinfection)
❑ Ion Exchange (Sodium Cycle Cationic ion exchange)
❑ Green Sand Filter (No sodium recharge)
❑ Membrane Technology (RO, nanofiltration)
Check here if the treatment process also uses a water softener ❑
6. Description of source water(s) (i.e. groundwater, surface water)
Surface Water
7. Describe the treatment process(es) for the raw water:
Raw water is pumped to flocculation basin where aluminum sulfate is added for
coagulation, the water then flows thru the sedimentation basin where soda ash is added.
The water then flows thru 2 rapid sand filters, after filtration fluoride, Zinc -
orthophosphate and chlorine is added, the water is then discharged into the clear well for
pumping into the system.
8. Describe the wastewater and the treatment process(es) for wastewater generated by the
facility:
2 Sand drying beds.
9. Number of separate discharge points: 1
Outfall Identification number(s) 001
10. Frequency of discharge
Continuous ❑
If intermittent:
Days per week discharge occurs: 1 day biweekly
11. Plant design potable flowrate 1.5 MGD
Backwash or reject flow .010 MGD
Intermittent ❑
Duration: 2 Hours biweekly
12. Name of receiving stream(s) (Provide a map showing the exact location of each outfall, including
latitude and longitude):
Toms Creek
13. Please list all water treatment additives, including cleaning chemicals or disinfection
treatments, that have the potential to be discharged.
Alum / aluminum sulfate Yes X No

NPDES PERMIT APPLICATION - SHORT FORM C - WTP
For discharges associated with water treatment plants
Iron sulfate / ferrous sulfate Yes No X
Fluoride Yes X No
Ammonia nitrogen / Chloramines Yes No X
Zinc -orthophosphate or sweetwater CP1236 Yes X No
List any other additives below:
Soda Ash
Chlorine
14. Is this facility located on Indian country? (check one)
Yes ❑
m
15. Additional Information:
Provide a schematic of flow through the facility, include flow volumes at all points in
the water treatment process. The plan should show the point[s] of addition for
chemicals and all discharges routed to an outfall [including stormwater].
Solids Handling Plan: Alum sludge from the sand drying beds is hauled to the Surry
County Landfill.
16. NEW Applicants
Information needed in addition to items 1-15:
New applicants are highly encouraged to contact a permit coordinator with the
NCDENR Customer Service Center.
Was the Customer Service Center contacted? ❑ Yes ❑ No
Analyses of source water collected
Engineering Alternative Analysis
Discharges from Ion Exchange and Reverse Osmosis plants shall be evaluated using a
water quality model.
17. Applicant Certification
I certify that I am familiar with the information contained in the application and that to the
best of my knowledge and belief such information is true, complete, and accurate.
Michael Boaz City Manager
Printed name of Person Signing Title
Signature of
Date
North Carolina General Statute 143-215.6 (b)(2) provides that: Any person who knowingly makes any false statement representation, or certification in any application,
record, report, plan, or other document files or required to be maintained under Article 21 or regulations of the Environmental Management Commission implementing that
Article, or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under Article 21
or regulations of the Environmental Management Commission implementing that Article, shall be guilty of a misdemeanor punishable by a fine not to exceed $25,000, or by

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