NC0028975_application_20230511

FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
RIVER BASIN:
City of Saluda WWTP, NCO028975
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 13.1 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 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 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 (SIUs) 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:
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.1. Facility Information.
Facility Name City of Saluda Wastewater Treatment Facility
Mailing Address PO Box 248
Saluda, NC 28773
Contact Person Steven Orr
Title City Manager
Telephone Number [phone]
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
A.5. 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
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 121h month of "this year" occurring no more than three months prior to this application submittal.
a. Design flow rate
mgd
Two Years Ago Last Year This Year
b. Annual average daily flow rate 0.047 mqd 0.054 mqd 0.074 mqd
C. Maximum daily flow rate 0.202 mqd 0.197 mqd 0.168 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.? ® 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
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?
1
❑ Yes
mgd
R
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, NCO028975
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 [phone]
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 [phone]
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 WWTP, 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)
(Latitude)
C. Distance from shore (if applicable)
d. Depth below surface (if applicable)
e. Average daily flow rate
f. Does this outfall have either an intermittent or a periodic discharge?
If yes, provide the following information:
Number f times per year discharge occurs:
Average duration of each discharge:
Average flow per discharge:
Months in which discharge occurs:
g. Is outfall equipped with a diffuser?
(Longitude)
ft.
ft.
mgd
❑ Yes ® No (go to A.9.g.)
mgd
❑ 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 varies by season, please describe:
Sodium Hypochlorite
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 QA/QC 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
DISCHARGE
ANALYTICAL
POLLUTANT
METHOD
ML/MDL
Conc.
Units
Conc.
Units
Number of
Samples
CONVENTIONAL AND NON CONVENTIONAL COMPOUNDS
BIOCHEMICAL OXYGEN
BOD5
13
M /L
10.5
M /L
4
SM521013
2.0
DEMAND (Report one)
CBOD5
FECAL COLIFORM
10
#/100ml
2.2
#/100m
4
SM9222D
1
TOTAL SUSPENDED SOLIDS (TSS)
5
M /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 injected underground.
d. Wells, springs, other surface water bodies, and drinking water wells that are: 1) within '/4 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 redunancy 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
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: [phone]
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 0.1 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
QA/QC 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
ML/MDL
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: Biomonitoring Data)
❑ Part F (Industrial User Discharges and RCRA/CERCLA Wastes)
❑ Part G (Combined Sewer Systems)
ALL APPLICANTS MUST COMPLETE THE FOLLOWING CERTIFICATION.
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 imprisonment
for knowing violations.
Name and official title Steven Orr City Manager
4 04,4,
Signature
Telephone number ( 828-�49-2581
Date signed 5/11 /2023
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

FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
RIVER BASIN:
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 QA/QC 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 be based on at least three pollutant
scans and must be no more than four and one-half years old.
Outfall number: (Complete once for each outfall discharging effluent to waters of the United States.)
POLLUTANT
MAXIMUM DAILY DISCHARGE
AVERAGE DAILY DISCHARGE
ANALYTICAL
METHOD
ML/MDL
Conc.
Units
Mass
Units
Conc.
Units
Mass
Units
Number
of
Samples
METALS (TOTAL RECOVERABLE), CYANIDE, PHENOLS, AND HARDNESS.
ANTIMONY
ARSENIC
BERYLLIUM
CADMIUM
CHROMIUM
COPPER
LEAD
MERCURY
NICKEL
SELENIUM
SILVER
THALLIUM
ZINC
CYANIDE
TOTAL PHENOLIC
COMPOUNDS
HARDNESS (as CaCO3)
Use this space (or a separate sheet) to provide information on other metals requested by the permit writer
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22. Page 10 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.)
POLLUTANT
MAXIMUM DAILY DISCHARGE
AVERAGE DAILY DISCHARGE
ANALYTICAL
METHOD
ML/MDL
Conc.
Units
Mass
Units
Conc.
Units
Mass
Units
Number
of
Samples
VOLATILE ORGANIC COMPOUNDS
ACROLEIN
ACRYLONITRILE
BENZENE
BROMOFORM
CARBON
TETRACHLORIDE
CHLOROBENZENE
CHLORODIBROMO-
METHANE
CHLOROETHANE
2-CH LOROETHYLV I NYL
ETHER
CHLOROFORM
DICHLOROBROMO-
METHANE
1,1-DICHLOROETHANE
1,2-DICHLOROETHANE
TRANS-1,2-DICH LORO-
ETHYLENE
1,1-DICHLORO-
ETHYLENE
1,2-DICHLOROPROPANE
1,3-DICHLORO-
PROPYLENE
ETHYLBENZENE
METHYL BROMIDE
METHYL CHLORIDE
METHYLENE CHLORIDE
1,1, 2,2-TETRA-
CHLOROETHANE
TETRACHLORO-
ETHYLENE
TOLUENE
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22. Page 11 of 22

FACILITY NAME AND PERMIT NUMBER:
e
PERMIT ACTION REQUESTED:
RIVER BASIN:
Outfall number: (Complete once for each outfall discharging effluent to waters of the United States.)
POLLUTANT
MAXIMUM DAILY DISCHARGE
AVERAGE DAILY DISCHARGE
ANALYTICAL
METHOD
ML/MDL
Conc.
Units
Mass
Units
Conc.
Units
Mass
Units
Number
of
Samples
TRICHLOROETHANE
1,1,2-
TRICHLOROETHANE
TRICHLOROETHYLENE
VINYL CHLORIDE
Use this space (or a separate sheet) to provide information on other volatile organic compounds requested by the permit writer
ACID -EXTRACTABLE COMPOUNDS
P-CHLORO-M-CRESOL
2-CHLOROPHENOL
2,4-DICHLOROPHENOL
2,4-DIMETHYLPHENOL
4,6-DINITRO-0-CRESOL
2,4-DINITROPHENOL
2-NITROPHENOL
4-NITROPHENOL
PENTACHLOROPHENOL
PHENOL
2,4,6-
TRICHLOROPHENOL
Use this space (or a separate sheet) to provide information on other acid -extractable compounds requested by the permit writer
BASE -NEUTRAL COMPOUNDS
ACENAPHTHENE
ACENAPHTHYLENE
ANTHRACENE
BENZIDINE
BENZO(A)ANTHRACENE
BENZO(A)PYRENE
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22. Page 12 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.)
POLLUTANT
MAXIMUM DAILY DISCHARGE
AVERAGE DAILY DISCHARGE
ANALYTICAL
METHOD
ML/MDL
Conc.
Units
Mass
Units
Conc.
Units
Mass
Units
Number
of
Samples
3,4 BENZO-
FLUORANTHENE
BENZO(GHI)PERYLENE
BENZO(K)
FLUORANTHENE
BIS (2-CHLOROETHOXY)
METHANE
BIS (2-CHLOROETHYL)-
ETHER
BIS (2-CHLOROISO-
PROPYL)ETHER
BIS (2-ETHYLHEXYL)
PHTHALATE
4-BROMOPHENYL
PHENYLETHER
BUTYL BENZYL
PHTHALATE
2-C H LO RO-
NAPHTHALENE
4-CHLORPHENYL
PHENYLETHER
CHRYSENE
DI-N-BUTYL PHTHALATE
DI-N-OCTYL PHTHALATE
DIBENZO(A,H)
ANTHRACENE
1,2-DICHLOROBENZENE
1,3-DICHLOROBENZENE
1,4-DICHLOROBENZENE
3,3-DICHLORO-
BENZIDINE
DIETHYL PHTHALATE
DIMETHYL PHTHALATE
2,4-DINITROTOLUENE
2,6-DINITROTOLUENE
1,2-DIPHENYL-
HYDRAZINE
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22. Page 13 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.)
POLLUTANT
MAXIMUM DAILY DISCHARGE
AVERAGE DAILY DISCHARGE
ANALYTICAL
METHOD
ML/MDL
Conc.
Units
Mass
Units
Conc.
Units
Mass
Units
Number
of
Samples
FLUORANTHENE
FLUORENE
HEXACHLOROBENZENE
HEXACHLORO-
BUTADIENE
HEXACHLOROCYCLO-
PENTADIENE
HEXACHLOROETHANE
INDENO(1,2,3-CD)
PYRENE
ISOPHORONE
NAPHTHALENE
NITROBENZENE
N-NITROSODI-N-
PROPYLAMINE
N-NITROSODI-
METHYLAMINE
N-NITROSODI-
PHENYLAMINE
PHENANTHRENE
PYRENE
1,2,4-
TRICHLOROBENZENE
Use this space (or a separate sheet) to provide information on other base -neutral compounds requested by the permit writer
Use this space (or a separate sheet) to provide information on other pollutants (e.g., pesticides) requested by the permit 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:
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 mgd; 2) POTWs with a pretreatment program (or those that are
required to have one under 40 CFR Part 403); or 3) 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 prior 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 QA/QC requirements of 40 CFR Part 136 and other appropriate QA/QC
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 Part E, you need not submit it again. Rather, provide the information
requested in question EA 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 biomonitoring data is required, do not complete Part E. Refer to the Application Overview for directions on which other sections of the form to
complete.
E.1. 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
Dates sample collected
Date test started
Duration
b. Give toxicity test methods followed.
Manual title
Edition number and year of publication
Page number(s)
c. Give the sample collection method(s) used. For multiple grab samples, indicate the number of grab samples used.
24-Hour composite
Grab
d. Indicate where the sample was taken in relation to disinfection. (Check all that apply for each.
Before disinfection
After disinfection
After dechlorination
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22. Page 15 of 22

FACILITY NAME AND PERMIT NUMBER:
PERMIT ACTION REQUESTED:
RIVER BASIN:
Test number: Test number: Test number:
e. Describe the point in the treatment process at which the sample was collected.
Sample was collected:
f. For each test, include whether the test was intended to assess chronic toxicity, acute toxicity, or both
Chronic toxicity
Acute toxicity
g. Provide the type of test performed.
Static
Static -renewal
Flow -through
h. Source of dilution water. If laboratory water, specify type; if receiving water, specify source.
Laboratory water
Receiving water
i. Type of dilution water. If saltwater, specify "natural' or type of artificial sea salts or brine used.
Fresh water
Salt water
j. Give the percentage effluent used for all concentrations in the test series.
k. Parameters measured during the test. (State whether parameter meets test method specifications)
pH
Salinity
Temperature
Ammonia
Dissolved oxygen
I. Test Results.
Acute:
Percent survival in 100%
effluent
LC5o
95% C.I.
%
%
%
Control percent survival
%
%
%
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:
e
PERMIT ACTION REQUESTED:
RIVER BASIN:
Chronic:
NOEC
%
%
%
IC25
%
%
%
Control percent survival
%
%
%
Other (describe)
m. Quality Control/Quality Assurance.
Is reference toxicant data available?
Was reference toxicant test within
acceptable bounds?
What date was reference toxicant test
run (MM/DD/YYYY)?
/
Other (describe)
E.3. Toxicity Reduction Evaluation. Is the treatment works involved in a Toxicity Reduction Evaluation?
❑ Yes ❑ No If yes, describe:
EA. Summary of Submitted Biomonitoring Test Information. If you have submitted biomonitoring 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. 1-99). Replaces EPA forms 7550-6 & 7550-22. Page 17 of 22

FACILITY NAME AND PERMIT NUMBER:
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 have, or is subject ot, an approved pretreatment program?
❑ Yes ❑ No
F.2. Number of Significant Industrial Users (SIUs) 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. If 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:
FA. Industrial Processes. Describe all the industrial 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 contribute to the SIU's
discharge.
Principal product(s):
Raw material(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 ( continuous or intermittent)
F.7. Pretreatment Standards. Indicate whether the SIU is subject to the following:
a. Local limits ❑ Yes ❑ No
b. Categorical pretreatment standards ❑ Yes ❑ No
If subject to categorical pretreatment standards, which category and subcategory?
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22. Page 18 of 22

FACILITY NAME AND PERMIT NUMBER:
I
PERMIT ACTION REQUESTED:
RIVER BASIN:
F.8. Problems at the Treatment Works Attributed to Waste Discharge by the SIU. Has the SIU caused or contributed 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 PIPELINE:
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 ❑ 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:
F.12. 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.) ❑ No
F.13. Waste Origin. Describe the site and type of facility at which the CERCLA/RCRA/or other remedial waste originates (or is 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 if necessary.)
F.15. Waste Treatment.
a. Is this waste treated (or will be treated) prior to entering the treatment works?
❑ Yes ❑ No
If yes, describe the treatment (provide information about the removal efficiency):
b. Is the discharge (or will the discharge be) continuous or intermittent?
❑ Continuous ❑ 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 19 of 22

FACILITY NAME AND PERMIT NUMBER:
I
PERMIT ACTION REQUESTED:
RIVER BASIN:
SUPPLEMENTAL APPLICATION INFORMATION
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 and endangered species potentially affected by CSOs.
G.2. System Diagram. Provide a diagram, either in the map provided in GA 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, if applicable) (Zip Code)
(County) (State)
(Latitude) (Longitude)
C. Distance from shore (if applicable) ft.
d. Depth below surface (if applicable) ft.
e. Which of the following were monitored during the last year for this CSO?
❑ Rainfall ❑ CSO pollutant concentrations ❑ CSO frequency
❑ CSO flow volume ❑ Receiving water quality
f. How many storm events were monitored during the last year?
GA. 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 (❑ actual or ❑ approx.)
EPA Form 3510-2A (Rev. 1-99). Replaces EPA forms 7550-6 & 7550-22. Page 20 of 22

FACILITY NAME AND PERMIT NUMBER:
I
PERMIT ACTION REQUESTED:
RIVER BASIN:
C. Give the average volume per CSO event.
million gallons (❑ actual or ❑ approx.)
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 Soil Conservation Service 14-digit watershed code (if known):
C. Name of State Management/River Basin:
United States Geological Survey 8-digit hydrologic cataloging unit code (if 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 advisories, 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 21 of 22

Additional information, if provided, will appear on the following pages.
NPDES FORM 2A Additional Information