NCG110056_Long Creek WWTP Representative Status_20250122

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Division of Energy, Mineral & Land Resources FOR AGENCY USE ONLY
Date Received
^ Stormwater Program Year I Month Day
National Pollutant Discharge Elimination System ✓ 0
Environmental REPRESENTATIVE OUTFACE STATUS (ROS) "<°G�i 9t
Quality
REQUEST FORM p`
d.G
If a facility is required to sample multiple discharge locations with very similar stormwater dish—Ages Ve
permittee may petition the Director for Representative Outfall Status(ROS). DEQ may grant Rd&sentative
Outfall Status if stormwater discharges from a single outfall are representative of discharges froik multiple
outfalls. Approved ROS will reduce the number of outfalls where analytical sampling requirements apply.
If Representative Outfall Status is granted,ALL outfalls are still subject to the qualitative monitoring
requirements of the facility's permit—unless otherwise allowed by the permit(such as NCGO20000)and DEQ
approval. The approval letter from DEQ must be kept on site with the facility's Stormwater Pollution
Prevention Plan. The facility must notify DEQ in writing if any changes affect representative status.
For questions, please contact the DEQ Regional Office for your area (see page 3).
(Please print or type)
1) Enter the permit number to which this ROS request applies:
Individual Permit (or) Certificate of Coverage
N I C I S I I I I I I N I C I G 1 1 10 10 10 10
2) Facility Information:
Owner/Facility Name City of Albemarle Long Creek WWTP
Facility Contact Brandon W. Plyler
Street Address 1040 Coble Avenue
City Albemarle State NC ZIP Code 28001
County Stanly E-mail Address [e-mail]
Telephone No. 704438 5973 Fax: NA
3) List the representative outfall(s) information (attach additional sheets if necessary):
Outfall(s) 1 is representative of Outfall(s)
Outfalls' drainage areas have the same or similar activities? rfYes ❑ No
Outfalls' drainage areas contain the same or similar materials? Wes ❑ No
Outfalls have similar monitoringresults? �*la Yes ❑ No o data
Outfall(s) 2 is representative of Outfall(s)
Outfalls' drainage areas have the same or similar activities? grYes ❑ No
Outfalls' drainage areas contain the same or similar materials? 2 Yes ❑ No
Outfalls have similar monitoring results? ❑Yes ❑ No No data"
Outfall(s) 3 is representative of Outfall(s)
Outfalls' drainage areas have the same or similar activities? wfes ❑ No
Outfalls' drainage areas contain the same or similar materials? ETYes ❑ No
Outfalls have similar monitoring results? ❑Yes ❑ No ❑ No data
*Non-compliance with analytical monitoring prior to this request may prevent ROS approval. Specific
circumstances will be considered by the Regional Office responsible for review.
Page 1 of 3
SWU-ROS-2009 Last revised 12/30/2009

FOR AGENCY USE ONLY
Division of Energy,Mineral & Land Resources Dale Received
Year Month Day
Stormwater Program AN
National Pollutant Discharge Elimination System ��
Environmental REPRESENTATIVEy
OUTFACE STATUS(R09� too
Quality REQUEST FORM If a facility is required to sample multiple discharge locations with very similar storrrR9�sc rges, the
ermittee may petition the Director or Representative Outfall Status ROS DE may "p y p f p f (ROS). Q y�c Representative
Outfall Status if Stormwater discharges from a single outfall are representative of discharjf4F from multiple
outfalls. Approved ROS will reduce the number of outfalls where analytical sampling requirements apply.
If Representative Outfall Status is granted,ALL outfalls are still subject to the qualitative monitoring
requirements of the facility's permit—unless otherwise allowed by the permit(such as NCGO20000)and DEQ
approval. The approval letter from DEQ must be kept on site with the facility's Stormwater Pollution
Prevention Plan. The facility must notify DEQ in writing if any changes affect representative status.
For questions, please contact the DEQ Regional Office for your area (see page 3).
(Please print or type)
1) Enter the permit number to which this ROS request applies:
Individual Permit (or) Certificate of Coverage
IN I C I S I I I IN I C I G 11 11 10 10 10 10
2) Facility Information:
Owner/Facility Name City of Albemarle Long Creek WWTP
Facility Contact Brandon W. Plyler
Street Address 1040 Coble Avenue
City Albemarle State NC ZIP Code 28001
County Stanly E-mail Address [e-mail]
Telephone No. 704438 5973 Fax: NA
3) List the representative outfalls) information(attach additional sheets if necessary):
Outfall(s) 4 is representative of Outfall(s)
Outfalls' drainage areas have the same or similar activities? p Yes ❑ No
Outfalls' drainage areas contain the same or similar materials? a-Yes ❑ No
Outfalls have similar monitoring results? ❑Yes ❑ No d a a
Outfall(s) 5 is representative of Outfall(s)
Outfalls' drainage areas have the same or similar activities? irfes o No
Outfalls' drainage areas contain the same or similar materials? 9'es ❑ No
Outfalls have similar monitoring results? ❑Yes /❑ No ❑ No data*
Outfall(s) is representative of Outfall(s) /!
Outfalls' drainage areas have the same or similar activities? ❑Yes ❑ No
Outfalls' drainage areas contain the same or similar materials? ❑Yes ❑ No
Outfalls have similar monitoring results? ❑Yes ❑ No ❑ No data*
*Non-compliance with analytical monitoring prior to this request may prevent ROS approval. Specific
circumstances will be considered by the Regional Office responsible for review.
Page 1 of 3
SW U-ROS-2009 Last revised 1 213 0/2 0 0 9

Representative Outfall Status Request
4) Detailed explanation about why the outfalls above should be granted Representative Status:
(Or, attach a letter or narrative to discuss this information.) For example,describe how activities and/or
materials are similar.
Request for RepresentativeOutfall is submitted due to the similar activities within the wastershed.This request combine all
representative outfalls to the stormwater pumpstation near the headworks of the facility.The discharge from this
stormwater pumpstation discharges into Little Long Creek. Activities within this watershed include:biosolids/handling
thickening,O&M of bar creen,O&M of grit removal equipment, O&M of opem flight screw pumps to lift wastewater.
Associated activities include general traffic pertaining to the O&M of the wastewater treatment plant,employee parking,
and maintainance facility.
This request Includes both qualitative and analytical monitoring.
I have found various historical stormwater maps that have 3-5 outfalls and request your approval to combine all to one
(the stormwater discharge located near the headworks of the wwtp).
5) Certification:
North Carolina General Statute 143-215.6 B(i)provides that:
Any person who knowingly makes any false statement,representation,or certification in any application,record,
report,plan,or other document filed or required to be maintained under this Article or a rule implementing this
Article;or who knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case
under this Article;or who falsifies,tampers with,or knowingly renders inaccurate any recording or monitoring device
or method required to be operated or maintained under this Article or rules of the[Environmental Management]
Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed
ten thousand dollars($10,000).
1 hereby request Representative Outfall Status for my NPDES Permit. I understand that ALL outfalls are still
subject to the qualitative monitoring requirements of the permit, unless otherwise allowed by the permit
and regional office approval. I must notify DEQ in writing if any changes to the facility or its operations
take place after ROS is granted that may affect this status. If ROS no longer applies, I understand I must
resume monitoring of all outfalls as specified in my NPDES permit.
I certify that I am familiar with the information contained in this application and that to the best of my
knowledge and belief such information is true,complete,and accurate.
Printed Name of Person Signing: prca—j '0
Title: Wastewater Treatment Plant Supervisor
/'&�14�� -�d-�.s
( rgnature of Applicant) (Date Signed)
Please note: This application for Representative Outfall Status is subject to
approval by the NCDEQ Regional Office. The Regional Office may inspect your
facility for compliance with the conditions of the permit prior to that approval.
Final Checklist for ROS Request
This application should include the following items:
s"' This completed form.
et/ Letter or narrative elaborating on the reasons why specified outfalls should be granted representative
status, unless all information can be included in Question 4.
w' Two(2)copies of a site map of the facility with the location of all outfalls clearly marked, including the
drainage areas, industrial activities,and raw materials/finished products within each drainage area.
Summary of results from monitoring conducted at the outfalls listed in Question 3.
❑ Any other supporting documentation.
Page 2of3
SWU-ROS-2009 Last revised 12/30/2009

Representative Outfall Status Request
Mail the entire package to:
NCDEQ DEMLR at the appropriate Regional Office (See map and
addresses below)
Notes
The submission of this document does not guarantee Representative Outfall Status (ROS)will be granted as
requested. Analytical monitoring as per your current permit must be continued,at all outfalls, until written
approval of this request is granted by DEQ. Non-compliance with analytical monitoring prior to this request
may prevent ROS approval. Specific circumstances will be considered by the Regional Office responsible for
review.
For questions, please contact the DEQ Regional Office for your area.
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Asheville Regional Office
2090 U.S. Highway 70
Swannanoa, NC 28778 Washington Regional Office
943 Washington Square Mall
Phone [phone] Washington, NC 27889
FAX [phone]
Phone [phone]
Fayetteville Regional Office FAX [phone]
Systel Building,
225 Green St., Suite 714 Wilmington Regional Office
Fayetteville, NC 28301-5094 127 Cardinal Drive Extension
Wilmington, NC 28405
Phone [phone]
FAX [phone] Phone [phone]
FAX [phone]
Mooresville Regional Office
610 East Center Ave. Winston-Salem Regional Office
Mooresville, NC 28115 585 Waughtown Street
Winston-Salem, NC 27107
Phone [phone] Phone [phone]
FAX [phone] Water Quality Main FAX [phone]
Raleigh Regional Office Central Office
1628 Mail Service Center 1612 Mail Service Center
Raleigh, NC 27699-1628 Raleigh, NC 27699-1612
Phone [phone] Phone [phone]
FAX [phone] FAX [phone]
Page 3 of 3
SWU-ROS-2009 Last revised 12/30/2009

Raw Materials/Chemicals stored at The City of Albemarle Long Creek Wastewater Treatment Plant
• Average approximately 2,000 gallons of diesel fuel is stored in the tanks(double walled)of 4
generators. Approximately 400-500 gallons are stored in each of our 4 generators on site.
Referencing the attached map,there is a generator within each Stormwater discharge point
watershed except stormwater discharge point S. Approximately,150 gallons are stored in the
diesel driven pump in the watershed of discharge point 4.
• A maximum capacity of 6500 gallons of 38-42%Sodium Bisulfite in stored in an above ground
tank within the watershed of stormwater discharge point 4.
• Approximately 1000 gallons of 25%Sodium Hydroxide is located in the building with the
watershed of stormwater discharge point 4. The floor drains within this building are piped to
in influent lift station and discharged to the WWTP.
• A maximum of 30 gallons of gasoline are stored in lawnmowers and gas cans inside of a
building at the WWTP. This building is not within the watershed of any of the stormwater
discharge points on the map.

Town of Albemarle
SPPP Location Map
Stormwater Discharge Point 1
recut It ��' `l" 35' 19'28"N -- 80' 12'57"W
P Stormwater Discharge Point 2
-/—� • } ��'''� i __.`��_ ���`l-`_} ;� 35' 19'13"N — 80' 13'05"W
...
/� • .�k�, � !�_, � �-, - - . ® Stormwater Discharge Point 3
35"20'04"N — 80" 12'41"W
�� ,� �♦ �} Stormwater Discharge Point 4
35' 19'21"N — 80' 12'54"W
Stormwater Discharge Point 5
35'19'25"N — 80' 12'58"W
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•' LOCATION MAP MAP I

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SPPP Location Map
Stormwater Discharge Point 1
rec�y ' gyp. ! ,\�, . '-a! • 35" 19'28"N -- 809 12'57"W
x o((j 7 Stormwater Discharge Point 2
.�• • j 1 \��Bd`�' ,� ��' ��` ) 350 19' 13"N -- 80° 13'05"W
Stormwater Discharge Point 3
35"20'04"N - 80° 12'41"W
Stormwater Discharge Point 4
35' 19'21"N - 80` 12'54"W
Stormwater Discharge Point 5
35° 19'25"N -- 8W 12'58"W
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•' LOCATION MAP MAP 1