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Home My WebLink AboutNC0078697_Application_20230629North Carolina Department of Environmental Quality Division of Water Resources Pr►rtt All Pages Print Form t}niy Modified Application Form 2A Revised March 2021 Modified Application Form 2A Minor Sewage Facilities < 0.1 MGD and No Pretreatment Program NPDES Permitting Program Note: Complete this form if your facility is a MINOR new or existing publicly o«ned treatment works. NPDES Permit Number Fac' Name i Modified Appheatun Farm 2A I L Ar offied March 2021 Form NC Departinent of FirvifummW Quality - Application for NPDES Permit to Discharge Wastewater NPDES MIM SEWAGE FACILITIES Wore o qM% this tam, plem reed the 1rMbWm. Failure to M W the kstuc imi maynest in derma of the 7 1.1 Facility name Mailing address (street or P.O. box) ' x 4WL City or town I uxeAo State C- , ZIP code ��rl EContact name (first and last) title Phone number Email address yLjso L �pft Location address (street, route number, or other specific identifier)❑Same as mailing address 4 , maA RiueX124 City or town State ZIP code *TV�tcia 1.2 Is this application for a facility that has yet to commence discharge? Yes 4 See instructions on data submission ❑ No requirements for new dischargers. 1.3 Is applicant different from entity listed under Item 1.1 above? ❑ Yes ® No SKIP to Item 1.4. Applicant name Applicant address (street or P.O. box) 0 City or town State ZIP code c w v Contact name (first and last) Title Phone number Email address 1.4 Is the applicant the facility's owner, operator, or both? (Check only one response.) ❑ Owner ❑ Operator Both 1.5 To which entity should the NPDES permitting authority send correspondence? (Check only one response.) Facility ❑ Applicant ❑ Facility and applicant (they are one and the same) 1.6 Indicate below any existing environmental permits. (Check all that apply and print or type the corresponding permit number for each.) Existing Environmental Permits NPDES (discharges to surface 0 RCRA (hazardous waste) 10 UIC (underground injection water) control) E o ❑ Nonattainment program (CAA) NESHAPs (CAA) ❑ PSD (air emissions) y w w ❑ Dredge or fill (CWA Section Other (specify) ❑ Ocean dumping (MPRSA) 40-4) Page 1 NPDES Permit Number Facility Name Mori fled Application Form 2A Modified March 2021 1.7 Provide the collections stem information requested below for the treatment works. Municipality Population Collection System Type Served Served (indicate cent a)ownership Status % separate sanitary sewer ❑ Own ❑ Maintain % combined storm and sanitary sewer ❑ Own ❑ Maintain ❑ Unknown ❑ Own ❑ Maintain % separate sanitary sewer ❑ Own ❑ Maintain :.. % combined storm and sanitary sewer ❑ Own ❑ Maintain ❑ Unknown ❑ Own ❑ Maintain CL o % separate sanitary sewer ❑ Own ❑ Maintain % combined storm and sanitary sewer ❑ Own ❑ Maintain �— ❑ Unknown ❑ Own ❑ Maintain % separate sanitary sewer ❑ Own ❑ Maintain d% I combined storm and sanitary sewer ❑ Own ❑ Maintain c ❑ Unknown ❑ Own ❑ Maintain Total c Population u Served Separate Sanitary Sewer System Combined Storm and Sanitary Sewer Total percentage of each type of sewer line in miles % 6 f° 1.8 is the treatment works located in Indian Country? c ❑ Yes (] No C 1.9 Does the facility discharge to a receiving water that flows through Indian Country? c ❑ Yes No 1.10 Provide design and actual flow rates in the designated spaces. Design Flow Rate L C) ozb mgd , Annual Average Flow Rates Actual a Two Years Ago Last Year This Year rs c rG` mgd mgd Alck mgd _o Maximum Daily Flow Rates Actual Two Years Ago Last Year This Year Mo,_ mgd mgd fl mgd 1.11 Provide the total number of effluent discharge points to waters of the State of North Carolina by type. Total Number of Effluent Discharge Points by Type CL Constructed F Treated Effluent Untreated Effluent Combined Sewer Bypasses Emergency s ca Overflows i Oveiflows Page 2 NPDES Permit Number Facd ty Nana P Modi(ed Apphcation Faun 2A Modi%d March M1 Outfalts Other Than to Waters of the $Me of North Caro 1.12 Does the POTW discharge wastewater to basins, ponds; or other surface impoundments that do not have outlets for discharge to waters of the State of North Carolina? ❑ Yes El No 3 SKIP to Item 1.14. 1.13 Provide the location of each; surface impoundment and associated discharge information in the table below. Surface Impoundment Location and Discharge Data Average Daily Volume Location Discharged to Surface i Continuous or Intermittent Impoundment one) ❑ Continuous gpd ❑ Intermittent ❑ Continuous gpd ❑ Intermittent gpd ❑ Continuous ❑ Intermittent w 1.14 Is wastewater applied to land? ❑ Yes No SKIP to Item 1.16. 1.15 Provide the land application site and discharge data requested below. Land Application Site and Discharge Data C3 o Average Daily Volume Continuous or Location Size Intermittent a, Applied check one { a acres gPd El Continuous 4 ❑ Intermittent CPacres d gpd ❑ Continuous o ❑ Intermittent R acres gpd ❑ Continuous ❑ Intermittent 1.16 Is effluent transported to another facility for treatment prior to discharge? ❑ Yes ElNo 4 SKIP to Item 121. ® 1.17 Describe the means by which the effluent is transported (e.g., tank truck, pipe). 1.18 Is the effluent transported by a party other than the applicant? ❑ Yes 0 No 4 SKIP to Item 1.20. 1.19 Provide information on the transporter below. Trans rter Data Entity name Mailing address (street or P.O. box) City or town State ZIP code Contact name (first and last) Title Phone number Email address Page 3 NPDES Permit Number Faulty Name Moddied Appke bon Form 2A Modirred March 2021 1.20 In the table below, indicate the name, address, contact information, NPDES number, and average daily flow rate of the receiving facility. Receiving Facift Data Facility name Mailing address (street or P.O. box) City or town State ZIP code fo Contact name (first and last) Tifle 0 s z Phone number Email address cc NPDES number of receiving facility (if any) None Average daily flow rate mgd C 1.21 Is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do 0 not have outlets to waters of the State of North Carolina (e.g., underground percolation, underground injection)? m v ® Yes ER No 4 SKIP to Item 1.23. 1.22 Provide information in the table below on these other disposal methods. Information on Other Disposal Methods m Disposal Method Location of Size of Annual Average Daily Discharge Continuous or Intermittent a Description Disposal Site Disposal Site Volume (check one) acres gRd ❑ Continuous ❑ Intermittent acres gp d ❑ Continuous ❑ Intermittent acres gpd ❑ Continuous ❑ Intermittent 1.23 Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)? (Check all that apply. Consult with your NPDES permitting authority to determine what information needs to be submitted and when.) C_ ® Discharges into marine waters (CWA ❑ Water quality related effluent limitation (CWA Section Section 301(h)) 302(b)(2)) Not applicable 124 Are any operational or maintenance aspects (related to wastewater treatment and effluent quality) of the treatment works the responsibility of a contractor? ❑ Yes No *SKIP to Section 2. 1.25 Provide location and contact information for each contractor in addition to a description of the contractor's operational and maintenance responsibilities. Contractor Information Contractor 1 Contractor 2 Contractor 3 Contractor name (company name Mailing address (street or P.O. box) City, state, and ZIP 75 w code oContact name (first and 0 last I Phone number Email address Operational and maintenance responsibilities of contractor Page 4 NPDES Permit Number Facft Name Modir�i Appkcation Form 2A Modified Match 2021 SECTIONADDITIONAL INFO. O,r o Outfalls to Waters of the Stile of Nat Canna 2.1 Does the treatment works have a design flow greater than or equal to 0.1 mgd? ❑ Yes ( No 4 SKIP to Section 3. 0 2.2 Provide the treatment works' current average daily volume of inflow Average Daily Volume of inflow and lnfliiration and infiltration. L gPd Indicate the steps the facility is taking to minimize inflow and infiltration. a _ 3 0 _ Z 2.3 Have you attached a topographic map to this application that contains all the required information? (See instructions for specific requirements.) oz a a CL ❑ Yes ❑ No 12 r= 2.4 Have you attached a process flow diagram or schematic to this application that contains all the required information? a fa (See instructions for specific requirements.) u` o ❑ Yes ❑ No 2.5 Are improvements to the facility scheduled? ❑ Yes ❑ No 4 SKIP to Section 3. Briefly list and describe the scheduled improvements. 0 m l= 2. 0 m 3. m 4. 2.6 Provide scheduled or actual dates of completion for improvements. Scheduled or Actual Dates of Completion for lm ovements Scheduled Affected Begin End Begin Attainment of s o CL Improvement Outfalls (lnumber) ist 11 Construction Construction Discharge Operational Level (from above) (MMIDDNYYY) (MWDDNYYY) (MMl1DDNYYY) MMIDDNYYY S 3. e s c 2. 3. 4, 2.7 Have appropriate permits/clearances concerning other federalfstate requirements been obtained? Briefly explain your response. ❑ Yes ❑ No ❑ None required or applicable Explanation: Page 5 NPDES Pemit Number FacMy Name Modified Appbcation Form 2A i Wdified March 2021 3.1 Provide the following information for each outfall. (Attach additional sheets if you have more than three outfalls.) Outfall Number WWI Number Outfall Number State County e 0 City or town i o n a. Distance from shore ft. ft. ft. m Depth below surface ft, ft. ft. G Average daily flow rate mgd mgd mgd Latitude rngitude ' 61- 3.2 Do any of the outfails described under Item 3.1 have seasonal or periodic discharges? Q ❑ Yes ( No 4 SKIP to Item 3.4. 3.3 If so, provide the following information for each applicable outfall. Outfall Number Outfall Number Outfall Number n Number of times per year o discharge occurs CL Average duration of each o discharge (spec units Average flow of each m mgd mgd g mgd g 0 discharge ,n Months in which discharge occurs 3.4 Are any of the ouifalls listed under Item 3.1 equipped with a diffuser? ❑ Yes [9 No + SKIP to Item 3.6. 3.5 Briefly describe the diffuser at each applicable outfall. sa Outfall Number Outfall Number Outfall Number o 3 6 Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from m = one or more discharge points? R , 0 Yes ❑ No +SKIP to Section 6. Page 6 NPDES Permit Number Facd9�NameModified AWbcati Form 2A Modfffed March 2021 3.7 Provide the receiving water and related information if known for each outfall. Outfall Number I Outfall Number Outfall Number Receiving water name Name of watershed; river; ;� G or stream system C�u1 t� i V C a Ti U.S. Soil Conservation 10 Service 14digit watershed ID G code °r Name of state basin` "�5+/► management/river U.S. Geological Survey 8-digit hydrologic catal22ing unit code Critical low flow (acute) efs cfs cfs Critical low flow (chronic) cfs cfs cfs Total hardness at critical mg/L of mg/L of mg/L of low flow CaCO3 CaCO3 CaCO3 3.8 Provide the following information describing the treatment rovided for discharges from each outfall. Outfall Number Outfall Number Outfall Number Highest Level of 53 Primary ❑ Primary ❑ Primary Treatment (check all that ❑ Equivalent to ❑ Equivalent to ❑ Equivalent to 4 apply per outfall) secondary secondary secondary ❑ Secondary ❑ Secondary ❑ Secondary ❑ Advanced ❑ Advanced ❑ Advanced ❑ Other (specify) ❑ Other (specify) ❑ Other (specify) a a Design Removal Rates by Outfall %.616 M&*-,--) rn BODE or CBOD5 3o, p nti„ 1 % % % m E m TSS `ZCFr, i!'I % % % Not applicable ❑ Not applicable ❑ Not applicable Phosphorus % % % RI Not applicable ❑ Not applicable ❑ Not applicable Nitrogen � %%% Other (splecify) ❑ Not applicable ❑ Not applicable ❑ Not applicable t'A � 1 % % % Page 7 NPDES Permit Number Fatality Name j Modified Apphcabon Form 2A Modified March MI 3.9 Describe the type of disinfection used for the effluent from each outfall in the table below. if disinfection varies by season, describe below. m _ Z 0 Outfall Number Outfall Number Outfall Number :c � $ i Disinfection type {i O c Seasons used m E F Dechlorination used? ❑ Not applicable ❑ Not applicable ❑ Not applicable ❑ Yes ❑ Yes ❑ Yes ❑ No ❑ No ❑ No 3.10 Have you completed monitoring for all Table A parameters and attached the results to the application package? ❑ Yes ❑ No -n i(k 3.11 Have you conducted any WET tests during the 4.5 years prior to the date of the application on any of the facility's discharges or on any receiving water near the discharge points? ❑ Yes (a No 3 SKIP to Item 3.13. 3.12 Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's discharges by outfall number or of the receiving water near the discharge p2ints. Outfall Number Outfall Number Outfall Number Acute Chronic Acute Chronic Acute Chronic cc g a Number of tests of discharge m = w.. water Number of tests of receiving 12 water w 3.14 Does the POTW use chlorine for disinfection, use chlorine elsewhere in the treatment process, or otherwise have reasonable potential to discharge chlorine in its effluent? ❑ Yes 4 Complete Table B, including chlorine. [ No -* Complete Table B, omitting chlorine. 3.15 Have you completed monitoring for all applicable Table B pollutants and attached the results to this application package? ❑ Yes ❑ No la Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and 3,18 attached the results to this application package? ❑ Yes No additional sampling required by NPDES 14 permitting authority, Page 8 NPDES Permit Number -T Faddy Name Modified A Form 2A Modified March 2021 3.19 Has the POTW conducted either (1) minimum of four quarterly WET tests for one year preceding this permit application or (2) at least four annual WET tests in the past 4.5 years? ❑ Yes ❑ No 3 Complete tests and Table E and SKIP to Item 3.26. 3.20 Have you previously submitted the results of the above tests to your NPDES permitting authority? �� ❑ Yes ❑ No + Provide results in Table E and SKIP to Item 3.26. 3.21 Indicate the dates the data were submitted to our NPDES permitting authority and provide a summary of the results. Date(s)bmitted WAWNvYY Summary of Results r,6+ a w c 0 w 3.22 Regardless of how you provided your WET testing data to the NPDES permitting authority, did any of the tests result in toxicity? a' y ❑ Yes No 4 SKIP to Item 3.26. F3.23 Describe the cause(s) of the toxicity: w w 3.24 Has the treatment works conducted a toxicity reduction evaluation? ❑ Yes Z] No 4 SKIP to Item 3.26. 3.25 Provide details of any toxicity reduction evaluations conducted. 3.26 Have you completed Table E for all applicable outfalls and attached the results to the application package? ❑ Yes Not applicable because previously submitted information to the NPDES permitting authority. Page 9 NPDES Pemist Number Faaiity Name Modified Apphcabon Form 2A tuSodified March 2021 SECTION• t 6.1 In Column 1 below, mark the sections of Form 2A that you have completed and are submitting with your application. For each section, specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note that not all applicants are required to provide attachments. Column 1 Column 2 Section 1: Basic Application Information for All A licants ❑ wf variance request(s) ® w/ additional attachments Section 2: Additional LP Q w/ topographic map ❑ w/ process flow diagram Information ❑ w/ additional attachments 1 ❑ w/ Table A ❑ w/ Table D c Section 3: info on ❑ Information Discharges ❑ation w/ Table B ❑ w1 additional attachments ❑ w/ Table C Section 4: Not A PPlicable � c cc Section 5: Not Applicable m cs ❑ Section 6: Checklist and ❑ w! attachments Certification Statement 6.2 Certification Statement I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel property gather and evaluate the information submitted. 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