NC0060526_Fact Sheet_20230703

DocuSign Envelope ID: 1A010EFB-1796-4119-B642-EA52F1446086
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
Charles H. Weaver — 7/3/2023
Permit Number
NCO060526
Facility Name
Pope Industrial Park WWTP
Basin Name/Sub-basin number
03-04-02
Receiving Stream
UT Swift Creek
Stream Classification in Permit
WS-III NSW
Does permit need Daily Max NH3 limits?
No. NH3 limits are already at BAT.
Does permit need TRC limits/language?
No — already resent
Does permit have toxicity testing?
No
Does permit have Special Conditions?
Neuse nutrient conditions and several reporting
requirements
Does permit have instream monitoring?
Temperature and dissolved oxygen
Is the stream impaired on 303 d list)?
No
Any obvious compliance concerns?
Seven enforcements during the current permit
cycle as well as nine NOVs.
Any permit modifications since lastpermit?
None.
New expiration date
3/31/2028
Changes in Draft Permit
• Updated eDMR language
• Added Neuse modeling reo ener
Changes to final permit?
• None

DocuSign Envelope ID: 1A010EFB-1796-4119-B642-EA52F1446086
AFFIDAVIT OF PUBLICATION
Account #
Order Number
Identification
Order PO
Amount
Cols
Depth
19489
422569 i_
Print Legal Ad-IPL01233270 - IPLO123327
$450.35
1
46 L
Attention: Wren Thedford
DEPARTMENT OF WATER RESOURCES - RALEIGH
1617 MAIL SERVICE CENTER
RALEIGH, NC 276991617
[e-mail]
Public Notice
North Carolina Environmental Man-
agement Commission/NPDES Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Notice of Intent to Issue a NPDES
Wastewater Permit NCO060526 Pope
Industrial Park WWTP, and NCO056278
River Mill WWTP
The North Carolina Environmental
Management Commission proposes
to issue a NPDES wastewater dis-
charge permit to the person(s) listed
below. Written comments regarding
the proposed permit will be accepted
until 30 days after the publish date of
this notice. The Director of the NC Di-
vision of Water Resources (DWR) may
hold a public hearing should there be
a significant degree of public interest.
Please mail comments and/or infor-
mation requests to DWR at the above
address. Interested persons may visit
the DWR at 512 N. Salisbury Street,
Raleigh, NC 27604 to review the infor-
mation on file. Additional information
on NPDES permits and this notice may
be found on our website: https://deq.
nc.gov/public-notices-hearings,or by
calling [phone].Pope Indus-
trial Park requested renewal of permit
NC0060526/Wake County. Facility
discharges to an unnamed tributary
to Swift Creek/Neuse River Basin.
Currently, BOD5, ammonia, dissolved
oxygen, fecal coliform and total resid-
ual chlorine are water quality limited.
River Mill HOA requested renewal of
permit NC0056278/River Mill WWTP/
Wake County. Facility discharges to
the Neuse River/Neuse River
Basin. Currently fecal coliform and to-
tal residual chlorine are water quality
limited.
IPLO123327
May 18 2023
STATE OF NORTH CAROLINA
COUNTY OF WAKE, COUNTY OF DURHAM
Before the undersigned, a Notary Public of Dallas
County, Texas, duly commissioned and authorized to
administer oaths, affirmations, etc., personally
appeared Tara Pennington, who being duly sworn or
affirmed, according to law, cloth depose and say that he
or she is Accounts Receivable Specialist of the News &
Observer Publishing Company, a corporation organized
and doing business under the Laws of the State of North
Carolina, and publishing a newspaper known as The
News & Observer, Wake and State aforesaid, 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, and that as
such he or she makes this affidavit; and is familiar with
the books, files and business of said corporation and by
reference to the files of said publication the attached
advertisement for DEPARTMENT OF WATER RESOURCES -
RALEIGH was inserted in the aforesaid newspaper on
dates as follows:
1 insertion(s) published on:
05/18/23
I certify or declare) under penalty of perjury that the
foregoing is true and correct.
Ha"tw
Notary Public in and for the state of Texas, resi ing in
Dallas County
'� A' "'• STEPHANIE HATCHER
x: •- My Notary ID # 1335YAX*
E)Orss 4anuary 14, 2026
Extra charge for lost or duplicate affidavits.
Legal document please do not destroy!

DocuSign Envelope ID: 1A010EFB-1796-4119-B642-EA52F1446086
Weaver, Charles
From: Hayes, Mitch
Sent: Wednesday, April 26, 2023 2:10 PM
To: Weaver, Charles
Subject: RE: DRAFT permit renewal for NCO060526
Found no errors with this permit. This one is good to go Charles.
Mitch
Mitch Hayes
Environmental Specialist 1
3800 Barrett Drive
Mail Service Center 1628
Raleigh, NC 27609-1628
919.791.4261
Raleigh Regional Office
Regional Operations Section
NCDEQ — Division of Water Resources
iic DE Q:>
NORTH CAROLINA
Department of Environmental Duality
Email correspondence to and from this address is subject to the North
Carolina Public Records Law and may be disclosed to third parties.
From: Weaver, Charles <[e-mail]>
Sent: Monday, April 24, 2023 8:58 AM
To: Kinney, Maureen <[e-mail]>; Zhang, Cheng <[e-mail]>
Cc: Hayes, Mitch <[e-mail]>
Subject: DRAFT permit renewal for NCO060526
This one will go to Notice next month. Send me any comments as time permits.
Charles H. Weaver
Environmental Specialist II
Division of Water Resources
919-707-3616
charles.weaver(@ncdenr.gov
(mailing address) 1617 Mail Service Center, Raleigh, NC 27699-1617

DocuSign Envelope ID: 1A010EFB-1796-4119-B642-EA52F1446086
a„ thenrislgn ID F22FK72-4ABC-EDI 1-BA77-14C8652F4F5B
North Carolina
Department of Environmental Quality
Division of Water Resources
Print All Pages
Print Form only
Modified Application Form 2A
Revised March 2021
Modified Application
Form 2A
Minor Sewage Facilities < 0.1 MGD
and No Pretreatment Program
NPDES Permitting Program
APR 21 2023
NCDEQ/DWP/NPDES
Note: Complete this form if your facility is a MINOR new or existing publiely owned treatment works.

DocuSign Envelope ID: 1A010EFB-1796-4119-B642-EA52F1446086
Aumenns�yn ,u E22F3C?2-4ABC-ED11-8A77-14C6652F4F5B
NPDES Permit Number Facility Name Modified Application Form 2A
NCO060526 Pope Industrial Park WWTP ModifedMarch 2021
Form NC Department of Environmental Quality - Application for NPDES Permit to Discharge Wastewater
7
NPDES MINOR SEWAGE FACILITIES (Before completing this form, please read the instructions. Failure to follow
the instructions may result in denial of the aoolication.)
1 1 Facility name
Pope Industrial Park WWTP
Mailing address (street or P 0. box)
PO Box 97215
City or town State
ZIP code
Raleigh North Carolina
27624
Contact name (first and last) Title Phone number
Email address
William Lamm Operator (252) 235 490p
[e-mail]
=
Location address (street, route number, or other specific identifier) ❑ Same as mailing address
Li
5602 Fayetteville Rd
City or town
ZIP code
Raleigh
=Northna
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 14.
Applicant name
Pope Industrial Park II LTD Partnership
c
Applicant address (street or P.O. box)
ny
PO Box 97215
E
_o
City or town State
ZIP code
e
Raleigh
North Carolina
27624
Contact name (first and last) Title Phone number
Email address
C
Albert Finley General Partner [phone]
[e-mail]
1.4 Is the applicant the facility's owner, operator, or both? (Check only one response.)
0 Owner ❑ Operator ❑
Both
1.5 To which entity should the NPDES permitting authority send correspondence? (Check only one response)
❑ Facility ❑ Applicant 0
Facility and applicant
(they are one and the same)
1.6 Indicate beiow any existing environmenta! permits. (Check all that apply and print or type the corresponding
number for each.
permit
a
Existing Environmental Permits
❑ NPDES (discharges to surface ❑ RCRA (hazardous waste) ❑
UIC (underground injection
water)
NCO060526
control)
c
•�
PSD air emissions
❑ ( ) ❑ Nonattainment program (CAA) ❑
NESHAPs (CAA)
LU
e
:�,
❑ Ocean dumping (MPRSA) ❑ Dredge or fill (CWA Section ❑
Other (specify)
W
)
Page 1

DocuSign Envelope ID: 1A010EFB-1796-4119-B642-EA52F1446086
-w. henlisign Ip E22F3C72-4ABC-ED11-BA77.14CB652F4F5B
NPDES Permit Number Facility Name
Modified Application Farm 2A
NCO060526 Pop:-1 dustrial Park WWTP
Modified March 2021
1.7
Provide the collection s stem information re uested below for the treatment works.
Municipality Population Collection System Type
Served Served indicate ercenta a
Ownership Status
-a
Pope Industrial 100 100 % separate sanitary sewer
0
Own ❑ Maintain
Park 0 % combined storm and sanitary sewer
❑
Own ❑ Maintain
❑ Unknown
❑
Own ❑ Maintain
o
% separate sanitary sewer
❑
Own ❑ Maintain
o
% combined storm and sanitary sewer
❑
Own ❑ Maintain
o❑
Unknown
❑
Own ❑ Maintain
a
% separate sanitary sewer
❑
Own ❑ Maintain
% combined storm and sanitary sewer
❑
Own ❑ Maintain
m
❑ Unknown
❑
Own ❑ Maintain
y
% separate sanitary sewer
❑
Own ❑ Maintain
% combined storm and sanitary sewer
❑
Own ❑ Maintain
c
❑ unknown
ElOwn
❑ Maintain
Total
1oa
Population
Served
Separate Sanitary Sewer System
Combined Storm and
Total percentage of each type of
Sanitary Sewer
sewer line in miles 100 %
a
c
1.8
Is the treatment works located in Indian Country?
o
U
❑ Yes ❑ No
1.9
Does the facility discharge to a receiving water that flows through Indian Country?
❑ Yes 21 No
1.10
Provide design and actual flow rates in the designated spaces.
Design Flow Rate
oos mgd
t
Annual Average Flow Rates Actual
Two Years Ago Last Year
This Year
0.0042 mgd 0.0036 mgd
0.0046 mgd
oMaximum
Da ily Flow Rates IActual
Two Years Ago Last Year
This Year
0.0203 mgd 0.103 mgd
0.0123 mgd
9
m
1 11
Provide the total number of effluent discharge points to waters of the State of North Carolina by type.
Total Number of Effluent Dischar a Points b T e
CL
>%
zTreated
ro a,
ined Se
Effluent Untreated Effluent Co Overflowswer Bypasses
Constructed
Emergency
u
ma
Overflows
O
1 0 0 0
0
Page 2

DocuSign Envelope ID: 1A010EFB-1796-4119-B642-EA52F1446086
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NPDES Permit Number Facility Name Modified Appficatien Form 2A
NCD060526 Pope Industrial Park W WTP Modified March 2021
Outfalls Other Than to Waters of the State of North Carolina
: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 ❑ No 4 SKIP to Item 1.14,
1.13 Provide the location of each surface impoundment and associated discharge information in the table below
77077theck
n and Dischar a Data
olume
Location urface Continuous or Intermittent
Impoundment (check one)
❑ Continuous
gpd ❑ Intermittent
❑ Continuous
gpd ❑ Intermittent
gpd ❑ Continuous
❑ Intarmittant
1.14 Is wastewater applied to land?
❑ Yes 0
1.15 Provide the land a lication site and discharge data re
Land Aoolicatic
Location
Size
No 4 SKIP to Item 1.16.
ested below.
Site and Dischar a Data
Average Daily Volume Continuous or
Applied Intermittent
acres
acres
acres
41.17Descruijbe
efflent transported to another facility for treatment prior to discharge?
Yes �]✓ No 4 SKIP to Item 1.21.
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 ❑ No 4 SKIP to Item 1.20.
1.19 Provide information on the transporter below.
Entity name
City or town
Contact name (first and last)
Phone number
gpd ❑ Continuous
❑
Intermittent
gpd ❑
Continuous
❑
Intermittent
gpd
�[O] inuous
mittent
it Data
Maihng address (street or P.O. box)
�Stafe���ZIP�oode
Title
Email address
Page 3

DocuSign Envelope ID: 1A010EFB-1796-4119-B642-EA52F1446086
autneniisign is E22F3C72-4ABC-ed1 T-BA77-74CB652W5B
NPDES Permit Number Facility Name Modified Application Form 2A
NCOD60526 LPope Industrial Park WWTP Modified March 2021
1.20 In the table below, indicate the name: address, contact information. NPDES number. and average daily flow rate of the
receivin facifit .
Receivin Facilit Data
Facility name Mailing address (street or P.O. box)
'o
City or town State ZIP code
U
Contact name (first and last) Title
O
Phone number Email address
o
NPDES number of receiving facility (if any) ❑ None
_C
Average daily flow rate mgd
1.21
Is the wastewater disposed of fn a manner other than those already mentioned in Items 1.14 through 1.21 that do
not have outlets to waters of the State of North Carolina (e.g., underground percolation, underground injection)?
s
❑ Yes ❑ No 4 SKIP to Item 1.23.
0
1 22
Provide information in the table below on these other disposal methods.
Information on Other Dis osal Methods
o
c
Disposal Location of Size of Annual Average
Method Daily Discharge Continuous or Intermittent
Disposal
Descri tion Site Disposal Site Volume (check one)
o
❑ Continuous
acres gpd
❑ Intermittent
acres gpd ❑ Continuous
❑ Intermittent
acres gpd ❑ Continuous
1.23
❑ Intermittent
Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)? (Check all that apply.
v
Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
,RCr
❑ Discharges into marine waters (CWA ❑ Water quality related effluent limitation (CWA Section
Section 301(h)) 302(b)(2))
0 Not applicable
1.24
Are any operational or maintenance aspects (related to wastewater treatment and effluent quality) of the treatment works
the responsibility of a contractor?
0 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
o
Contractor name
Ecom
an name
Envirolink, Inc.
`o
Mailing address
street or P.O. box
4700 Homewood Ct., Suite 108
`o
City, state, and ZIP
code
Ralefgh, NC 27609
25-
Contact name (first and
0
last
Aaron Gold
Phone number
(2S2) 235-4900
Email address
[e-mail]
Operational and
Daily/weekly/monthly
maintenance
operational duties and
responsibilities of
contractor
equipment preventive
Page 4

DocuSign Envelope ID: 1A010EFB-1796-4119-B642-EA52F1446086
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NPNFS Permit Number Facility Name
NCO06OS26 Pope Industrial Park WWTP
Outfalls to Waters of the State of North Carolina
2.1PDes treatment works have a design Flow greater than or equal to al mgd?
es [� No 4 SKIP to Section 3.
2.2he treatment works' current average daily volumation.
Indicate the steps the facility is taking to minimize inflow and infiltration
Modified Application Form 2A
Modified March 2021
Volume of Inflow and Infiltration
gpd
2.3 1 I Lave you attached a topographic map to this application that contains all the required information? (See instructions for
specific requirements.)
❑ Yes ❑ No
2.4 Have you attached a process flow diagram or schematic to this appiication that contains ail the required information?
4(See instructions for specific requirements J
❑ Yes ❑ No
2.5 Are improvements to the facility scheduled?
❑ Yes ❑ No 4 SKIP to Section 3.
Briefly list and describe the scheduled improvements.
1.
2.
3.
4
2.6 j Provide scheduled or actual dates of completion for improvements
Scheduled or Actual Dates of Com letion for Im rovements
Scheduled
Affected
OutIts
Begin
End
i
Begin
Attainment of
Improvement
(list ouffafl
Construction
Construction
Disch g a
Operational
(from above)
number
MMlDD
( NYYY)
(MMIDDIYYYY)
(MMIDDIYYYY)
Level
MMIDDIYY
1.
2,
9
4.
2.7 Nave appropriate permits/clearances concerning other federallstate requirements been obtained? Briefly explain your
response.
❑ Yes ❑ No ❑ None required or applicable
Explanation:
Page 5

DocuSign Envelope ID: 1A010EFB-1796-4119-B642-EA52F1446086
A�MCIInsigr ID E22F3C7224ABC-EDI1-BA17-14CB652F4F58
L::NPDES Permit Number Facility Name Modified Appiica6on Form 2A
NC0060626 Pvpe Industrial Park WW7P Modified March 2021
• •- •
3.1 Provide the following information for each outfail. (Attach additional sheets if you have more than three outfalls.)
Outfalf Number 001 Outfall Number Outfaff Number
State North Carolina
County wake
City or town Raleigh
0
c
Q
Distance from shore 0 ft ft ft
Depth below surface
Average daily flow rate .008 mgd mgd mgd
Latitude 35' 42' 23"
Longitude 7g° 39 55„ a o
3.2 Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
c ❑ Yes El No 4 SKIP to Item 3.4.
3.3 If so, provide the following information for each applicable outfall.
U
Outfall Number Outfall Number Outfall Number
Number of times per year
discharge occurs
a Average duration of each
o discharge s eci units
Average flow of each
R dischar e mgd mgd mgd
v, Months in which discharge
occurs
3.4 Are any of the outfals listed under Item 3.1 equipped with a diffuser?
❑ Yes ❑ No 4 SKIP to Item 3.6,
d 3.5 Briefl describe the diffuser t eat each applicable outfall
a
d
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
� one or more discharge points?
3 ❑ Yes ❑ No 4SKIP to Section 6.
Page 6

DocuSign Envelope ID: 1A010EFB-1796-4119-B642-EA52F1446086
�uthennsigrQ E22F3C724ABC-E©I1-BA77-14C8652F4F5B
NPOES Permit Number
Facility Name
Modified Application Form 2A
NC0060526 Pope Industrial Park WWTP
Modified March 2021
3 7 Provide the receivin water and related information if known for each outfafl.
Outfall Number 001
Outfall Number
Outfall Number
Receiving water name
UT to Swift Creek
Name of watershed, river,
c
o
or stream system
Neuse River
Q
U.S. Soil Conservaticn
Service 14-digit watershed
03020201110020
o
code
Name of state
management/river basin
NC DEQ/Neuse River Basin
}
U.S. Geological Survey
8-digit hydrologic
03020201
W
catalo2ing unit code
Critical iow flow (acute)
unknown cfs
ofs
cfs
Critical low flow (chronic)
Unknown cfs
cfs
cfs
Total hardness at critical
mg/L of
mg/L of
mg/L of
low flow
unknown CaCO3
CaCO3
CaCOs
3.8 Provide the followin information describing the treatment
rovided for dischar es from each putfall.
Outfall Number 001
Outfall Number
Outfall Number
Highest Level of
0 Primary
❑ Primary
❑ Primary
Treatment (check all that
R Equivalent to
❑ Equivalent to
❑ Equivalent to
apply per outfalf )
secondary
secondary
secondary
❑ Secondary
❑ Secondary
❑ Secondary
❑ Advanced
❑ Advanced
❑ Advanced
❑ Other (specify)
❑ Other (specify)
❑ Other (specify)
0
Q
Design Removal Rates by
Outfall
001
w
BOD5 or C80Ds
°
so /°
%
%
E
TSS
so %
Phosphorus
0 Nat applicable
ElNot applicable
❑ Not applicable
Nitrogen
® Not applicable
ElNot applicable
ElNot applicable
%
Other (specify)
0 Not applicable
❑ Not applicable
❑ Not applicable
Page 7

DocuSign Envelope ID: 1A010EFB-1796-4119-B642-EA52F1446086
Aurnan[rs+gn to B22F3C72-4ABC-ED11-8A77-14C8652F4F5B
NPDES Permit NumberI Facility Name Modified Appficalian Form 2A
NCO060526 Pope Industrial Park WWTP Modified March2021
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.
ti
m
.c
0
U
o Outfall Number oat Outfall Number Outfall Number
Q- Disinfection type
Chlorination
m
G
Seasons used all
d
E
�a
Dechlorination used? ❑ Not appiicable ❑ Not a Iicable
Ap ❑ Not applicable
0 Yes ❑ Yes ❑ Yes
❑ No ❑ No ❑ No
3.10 Have you completed monitoring for ail Table A parameters and attached the results to the application package?
0 Yes ❑ No
3.11 Have you conducted any WET tests during the 4.5 years prior to the date of the applicatfon on any of the facility's
discharges or on any receiving water near the discharge points?
❑ Yes ❑ No 4 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
dischar es by outfall number or of the receiving water near the discharge poirts.
Outfall Number I Outfall Number Outfall Number
2 Acute Chronic Acute Chronic Acute Chronic
C Number of tests of discharge
cm
= water
FNumber of tests of receiving
water
a�
ui
3.14 1 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?
0 Yes 4 Complete Table B, including chlorine. ❑ No 4 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
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
permitting authority.
Page 8

DocuSign Envelope ID: 1A010EFB-1796-4119-B642-EA52F1446086
uth,mssgn+6 F22F3C72-4ABC-EDI1-BA77-14CB552F4F58
NPDES Permit Number Facility Name Modified Application Form 2A
NCO060526 Pope Industrial Paris WWTP Modffied March 2021
3.19 Has the PQTW 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 4 Complete tests and Table E and SKIP to
Item 3.26.
:3.2:0 Have you previously submitted the results of the above tests to your NPDES permitting authority?
❑ Yes ❑ No 4 Provide results in Table E and SKIP to
Item 3.26.
3.21 Indicate the dates the data were submitted to our NPDES permittingauthorityand provide a summaryof the results.
Dafe{s) Sut�mitted
MM/DD/YYYY! Summary of Results
0
U
2 3.22 Regardless of how you provided your WET testing data to the NPDES permitting authority, did any of the tests result in
o toxicity?
CO
❑ Yes ❑ No -* SKIP to Item 3.26.
F 3.23 Describe the cause(s) of the toxicity:
� I w
3.24 Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes ❑ No 4 SKIP to Item 3.26.
3.25 Provide detaiis of any toxicity reduction evaluations conducted.
3.26 Have you compieted 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 authorit
Page 9

DocuSign Envelope ID: lA010EFB-1796-4119-B642-EA52F1446086
duihenUsign ID. E22F3G72-4ABC-ECJ1 f-6A77-14C8652F4F58
NPDES Permit Number Facility Name I Modified Application Form 2A
NCO060526 I Pope Industrial Park WWTP Modified March 2021
6.1 In Column 1 below, mark the sections of Form 2A that you have completed and are submitting with your applica
each tion. For
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 Applicants ❑ w/ variance request(s) ❑ wl additional attachments
❑ Section 2: Additional ❑ wl topographic map ❑ wl process flow diagram
Information ❑ wl additional attachments
❑ wl Table A ❑ wl Table D
Section 3: Information on ❑
❑ Effluent Discharges 'u1 Table B ❑ wl additional attachments
d ❑ wl Table C
2
Section 4: Not Applicable
0
U
1C
Section 5: Not Applicable
m
U
❑ Section 6: Checklist and
..
Certification Statement ❑ wl attachments
e
6,2 Certification Statement
m
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 submitted is, to the best of my knowledge and belief, true, accurate, and
complete. / am aware that there are significant penalties for submitting false information, including the possibility of fine
and imprisonment for knowing violations.
Name (print or type first and last name) Official title
Albert Finley General Partner
Signature a�1hPf11, Date signed
e F;hley 03/06/23
REGEIVED"
APR 21 2023
N ' [) 0/r)WRINPDES
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