NC0004464_application_20230807

North Carolina
Department of Environmental Quality
Division of Water Resources
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 owned treatment works.

NPDES Permit Number
Facility Name
Modified Application Form 2A
NC0004464
WOODLAND MILLS WWTP
Modified March 2021
Form
NC Department of Environmental Quality - Application for NPDES Permit to Discharge Wastewater
MINOR SEWAGE FACILITIES (Before completing this form, please read the instructions. Failure to follow
NPDES
the instructions may result in denial of the application.)
SECTION•N
INFORMATION FORr
1.1
Facility name
WOODLAND MILLS WWTP
Mailing address (street or P.O. box)
P.O. BOX 308
City or town
State
ZIP code
o
COLUMBUS
NC
28722
E
Contact name (first and last)
Title
Phone number
Email address
w
c
POLK COUNTY
[phone]
Location address (street, route number, or other specific identifier) ❑ Same as mailing address
M
LL
4021 NC HIGHWAY 108
City or town
State
ZIP code
MILLSPRING
NC
28756
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 4 SKIP to Item 1.4.
Applicant name
Applicant address (street or P.O. box)
0
.q
E
City or town
State
ZIP code
0
`c
Contact name (first and last)
Title
Phone number
Email address
n
c
a
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.)
and applicant
❑ Facility ❑✓ Applicant El
(they are one and the same)
(they
1.6
Indicate below any existing environmental permits. (Check all that apply and print or type the corresponding permit
m
number for each.
€
Existing Environmental Permits
LL
a
0 NPDES (discharges to surface
❑ RCRA (hazardous waste)
❑ UIC (underground injection
water)
control)
E
NC0004464
c
o
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
c
w
rn
❑ Ocean dumping (MPRSA)
❑ Dredge or fill (CWA Section
❑ Other (specify)
404)
Page 1

NPDES Permit Number
Facility Name
Modified Application Form 2A
NC0004464
WOODLAND MILLS WWTP
Modified March 2021
1.7
Provide the collections stem information requested below for the treatment works.
Municipality
Population
Collection System Type
Ownership Status
Served
Served
indicate percentage)
600
100 % separate sanitary sewer
O Own 0 Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
d
_
❑ Unknown
❑ Own ❑ Maintain
c
% separate sanitary sewer
❑ Own ❑ Maintain
o
% combined storm and sanitary sewer
❑ Own ❑ Maintain
3
❑ Unknown
❑ Own ❑ Maintain
a%
separate sanitary sewer
❑ Own ❑ Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
❑ Unknown
❑ Own ❑ Maintain
u
% separate sanitary sewer
❑ Own ❑ Maintain
%combined storm and sanitary sewer
❑ Own ❑ Maintain
rn
❑ Unknown
❑ Own ❑ Maintain
Total 600
°
Population
ci
Served
Separate Sanitary Sewer System
Combined Storm andSanitary
Sewer
Total percentage of each type of
too %
°
sewer line in miles)�0
2
1.8
Is the treatment works located in Indian Country?
c
'o
❑ Yes ❑� No
U
A
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.
Desi n Flow Rate
015 mgd
m
Annual Average Flow Rates Actual
Two Years Ago
Last Year
This Year
30
0.002 mgd
0.0025 mgd
0.002 mgd
LL
Maximum Daily Flow Rates Actual
Two Years Ago
Last Year
This Year
.005 mgd
0.0055 mgd
0.005 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 b T e
0
TConstructed
Combined Sewer
wr—
Treated Effluent
Untreated Effluent
Overflows
Bypasses
Emergency
Ua
Overflows
0
1
0
0
0
0
Page 2

NPDES Permit Number
Facility Name
Modified Application Form 2A
NC0004464
WOODLAND MILLS WWTP
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.
Surface III m oundment Location and Dischar a Data
Average Daily Volume
Continuous or Intermittent
Location
Discharged to Surface
(check one)
Impoundment
❑ Continuous
gpd
❑ Intermittent
❑ Continuous
gpd
❑ Intermittent
❑ Continuous
gpd
v
❑ Intermittent
s
1.14
Is wastewater applied to land?
❑ Yes No 4 SKIP to Item 1.16.
e1.15
Provide the land application site and discharge data requested below.
Land Application Site and Discharge Data
o
Average Daily Volume
Continuous or
Location
Size
Applied
Intermittent
Q,
check one
A
acres
gp d
❑ Continuous
o
❑ Intermittent
s
acres
gp d
❑ Continuous
o
ElIntermittent
acres
gp d
❑ Continuous
❑ Intermittent
N
A
1.16
Is effluent transported to another facility for treatment prior to discharge?
o
❑ Yes m No -+ SKIP to Item 1.21.
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 ❑ No 4 SKIP to Item 1.20.
1.19
Provide information on the transporter below.
Trans orter 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
Facility Name
Modified Application Form 2A
NC0004464
WOODLAND MILLS 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
receiving facility.
Receiving F cility Data
Facility name
Mailing address (street or P.O. box)
City or town
State
ZIP code
0
U
�
Contact name (first and last)
Title
0
L
u
Phone number
Email address
c
NPDES number of receiving facility (if any) ❑ None
Average daily flow rate m d
9 Y 9
m
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)?
rn
t
❑ Yes © No 4 SKIP to Item 1.23.
0
0
1.22
Provide information in the table below on these other disposal methods.
Information on Other
Disposal Methods
o
Disposal
Location of
Size of
Annual Average
Continuous or Intermittent
A
Method
Disposal Site
Dis p
Disposal Site
Dis p
Daily Discharge
(check one)
Description
Volume
acres
gpd
❑ Continuous
❑ Intermittent
0
❑ Continuous
acres
gpd
❑ Intermittent
❑ Continuous
acres
gpd
❑ 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.)
U M
3
❑ Discharges into marine waters (CWA ❑ Water quality related effluent limitation (CWA Section
Section 301(h)) 302(b)(2))
❑✓ 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?
❑ 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
R
(company name
Mailing address
c
street or P.O. box
`o
City, state, and ZIP
R
code
cContact
name (first and
U
last
Phone number
Email address
Operational and
maintenance
responsibilities of
contractor
Page 4

NPDES Permit Number Facility Name Modified Application Form 2A
NC0004464 WOODLAND MILLS WWTP Modified March 2021
o Outfalls to Waters of the State of North Carolina
2.1
Does the treatment works have a design flaw greater than or equal to 0.1 mgd?
rn
o
❑ 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 Infiltration
and infiltration.
gpd
Indicate the steps the facility is taking to minimize inflow and infiltration.
a
c
R
3
0
c
2.3
Have you attached a topographic map to this application that contains all the required information? (See instructions for
c
specific requirements.)
� R
O $-
0
❑ Yes ❑ No
E
2.4
Have you attached a process flow diagram or schematic to this application that contains all the required information?
3 I!
o
(See instructions for specific requirements.)
r` 5
❑ 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
A
1.
c
E
E
a
2.
E
`o
•v
3.
v
d
u
rn
4.
a
w
2.6
Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
aE,
Scheduled
Affected
Begin
End
Begin
Attainment of
>
o
Improvement
Outfalls
(number)
Construction
Construction
Discharge
Operational
Level
Level
(from above)
number
(MMIDD/YYYY)
(MM/DD/YYYY)
(MM/DD/YYYY)
v
a
1.
R
s
in
2.
3.
4.
2.7
Have appropriate permits/clearances concerning other federallstate requirements been obtained? Briefly explain your
response.
❑ Yes ❑ No ❑ None required or applicable
Explanation:
Page 5

NPDES Permit Number
Facility Name Modified Application Form 2A
NC0004464
WOODLAND MILLS WWTP Modified March 2021
SECTION•'
• ON DISCHARGES
3.1
Provide the following information for each curial. (Attach additional sheets if you have more than three outfalls.)
Outfall Number 001
Outfall Number
Outfall Number
State
NC
m
County
POLK
0
`o
City Of town
MILL SPRING
c
.n3
Distance from shore
o ft.
W
Depth below surface
2 ft,
ft.
ft.
W
0
Average daily flow rate
.002 mgd
mgd
mgd
Latitude
35° 11 40r' NEI
Longitude
ez id of va49
"
3.2
Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
I
o
❑ Yes ❑ No 4 SKIP to Item 3.4.
d
3.3
If so, provide the following information for each applicable ouffall.
Outfall Number_
Outfall Number_
Outfall Number_
0
v
Number of times per year
s
discharge occurs
a
Average duration of each
`o
discharge (specify units
Average flow of each
mgd
mgd
mgd
w
discharge
A
in
Months in which discharge
occurs
3.4
Are any of the ouffalls listed under Item 3.1 equipped with a diffuser?
❑ Yes ❑� No 4 SKIP to Item 3.6.
3.5
Briefly describe the diffuser t pe at each applicable ouffall.
Outfall Number_
Outfall Number_
Outfall Number_
`m
0
viThe
treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina fro
more discharge points?
Yes ❑ No +SKIP to Section 6.
Page 6

NPDES Permit Number
Facility Name
Modified Application Form 2A
NC0004464
WOODLAND MILLS WWTP
Modified March 2021
3.7
Provide the receiving water and related information if known for each outfall.
Outfall Number wi
Outfall Number
Outfall Number
Receiving water name
SOUTH BRANCH
Name of watershed, river,
c
or stream system
BROAD RIVER BRP
c
U.S. Soil Conservation
Service 14-digit watershed
03050105150010
o
code
A
Name of state
rn
management/river basin
BROAD
U.S. Geological Survey
8-digit hydrologic
03050105
cataloging unit code
Critical low flow (acute)
cfs
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 provided for discharges from each outfall.
Outfall Number 00
Outfall Number
Outfall Number
Highest Level of
0 Primary
❑ Primary
❑ Primary
Treatment (check all that
❑ Equivalent to
❑ Equivalent to
❑ Equivalent to
apply per outfall)
secondary
secondary
secondary
❑ Secondary
❑ Secondary
❑ Secondary
❑ Advanced
❑ Advanced
❑ Advanced
❑ Other (specify)
❑ Other (specify)
❑ Other (specify)
0
0
S
Design Removal Rates by
Outfall
m
m
BOD5 or CBOD5
85 %
%
%
c
m
E
TSS
85 %
%
%
r
© Not applicable
❑ Not applicable
❑ Not applicable
Phosphorus
%
%
o
/o
0 Not applicable
❑ Not applicable
❑ Not applicable
Nitrogen
/o o
a /a
o
/o
Other (specify)
111 Not applicable
❑ Not applicable
❑ Not applicable
%
%
%
Page 7

NPDES Permit Number
Facility Name
Modified Application Form 2A
NC0004464
WOODLAND MILLS WWTP
Modified March 2021
3.9
Describe the type of disinfection used for the effluent from each outfall in the table below. If disinfection vanes by
season, describe below.
a
d
c
c
0
U
o
Outfall Number 001
Outfall Number
Outfall Number
Disinfection type
CHLORINE
U
N
N
0
Seasons used
ALL
w
E
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
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 © 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
discharges by outfall number or of the receiving water near the discharge poin .
Outfall Number_
Outfall Number_
Outfall Number_
Acute
TChronic
Acute
Chronic
Acute
Chronic
N
Number of tests of discharge
water
FNumber
of tests of receiving
water
d
Uj
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 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

NPDES Permit Number
Facility Name
Modified Application Form 2A
NC0004464
WOODLAND MILLS WWTP
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?
El Yes ❑ No 4 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?
4 Provide results in Table E and SKIP to
El Yes El
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) Submitted
Summary of Results
MWDD
a
d
I c
c
0
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?
❑ Yes ❑ No 4 SKIP to Item 3.26.
3,23
Describe the cause(s) of the toxicity:
c
m
w
3.24
Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes ❑ 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 Permit Number Facility Name Modified Application Form 2A
NC0004464 WOODLAND MILLS WWTP Modified 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 Applicants
❑ w/ variance request(s) El w/ additional attachments
121 Section 2: Additional
El w/ topographic map El w/ process flow diagram
Information
❑ w/ additional attachments
© w/ Table A ❑ w/ Table D
© Section 3: Information on
❑ w/ Table B ❑ w/ additional attachments
Effluent Discharges
E
❑ wi Table C
d
R
Section 4: Not Applicable
0
�e
Section 5: Not Applicable
d
U
Section 6: Checklist and
©
© w/ attachments
Certification Statement
x
6.2
Certification Statement
0
d
1 certify under penalty of law that this document and all attachments were prepared under my direction orsupervision 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. I am aware that there are significant penalties for submitting false information, including the possibility of fine
and imprisonment for knowing violations.
Name (print or tyt n last name)
Official title
C6u-n+y Mana er
Si nature
�
Date signed
5 Jv��
-7 13 I I 2-3
Page 10

NPDES Pena Number Faulity Name Oudaa Number Modifietl Appkafion Form2
NC0004464 WOODUIN D M ILLS WWTP Wdfied Mich 2021
Maximum Daily Discharge
Average Daily Discharge
Pollutant
Analytical MLor MDL
Value
Units
Value
Units
Method' (include units)
Aleser
Samples
Sam les
Biochemical oxygen demand
o BOD5 or ❑ CBODs
23.6
MG/L
12.57
MG/L
52 5210-B C1 ML
e or one
❑ MDL
Fecal collform
140
CFU/100ML
5
CFU/IOOML
52 9222-D 10ML
❑ MDL
Design flow rate
.005
MGD
.002
MGD
365
pH (minimum)
6.0
su
pH (maximum)
z2
sU
Temperature (winter)
14.71
C
16.32
C
130
Temperature(summer)
24.6
C
18.2
C
131
Total suspended solids (TSS)
19.24
MG/L
12.8
MG/L
52 2540-D
❑MDL
' Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
Page 11

NPDEs Peh a Number Faulity Name Ouaat Number Mad6.d Application Fear 2A
NC0004464 WOODLAND MILLS WWiP MWed March 2021
TABLED. ADDITIONAL POLLUTANTS
AS REQUIRED BY NPDESAUTHORITY
Maximum Daily Discharge I Avem eDafl Dischar e
Pollutant
Analytical ML or MDL
Value
Units Value
Units
Number of
01A
Method' (indudeunits)
Sample
❑� No additional sampling is required by NPDES permitting authority.
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
' Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or required
under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
Page 18