Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

United States 

Environmental Protection Agency 

Office of Water 

Washington, D.C. 

EPA Form 3510-2A 

Revised <INSERT DATE> 

Water Permits Division 

Application Form 2A 

New and Existing Publicly 

Owned Treatment Works 

NPDES Permitting Program 

NPDES Proposed Application Forms for Public Docket ID No. EPA-HQ-OW-2016-

0145 & Docket ID No. EPA-HQ-OW-2016-0146. 

This document is being distributed for comment purposes only. Comments and 

suggestions regarding this draft document should be submitted through electronic 

comments to http://www.regulations.gov.

For Comment Only
Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

Paperwork Reduction Act Notice 

The U.S. Environmental Protection Agency estimates the average burden to collect information and 

complete Form 2A to average between 5 and 25 hours, depending on the number of sections the 

applicant must complete. The estimate includes time for reviewing instructions, searching existing data 

sources, gathering and maintaining the needed data, and completing and reviewing the collection of 

information. Send comments regarding the burden estimate or any other aspect of this collection of 

information to the Chief, Information Policy Branch (PM-223), U.S. Environmental Protection Agency, 

1200 Pennsylvania Avenue, NW, Washington, DC 20460 and to the Office of Information and 

Regulatory Affairs, Office of Management and Budget, 725 17th Street, NW, Washington, DC 20503, 

marked “Attention: Desk Officer for EPA.” 

For Comment Only
2A-1 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2A—GENERAL INSTRUCTIONS

Who Must Complete Form 2A? 

All new and existing publicly owned treatment works (POTWs) and 

other dischargers designated by the National Pollutant Discharge 

Elimination System (NPDES) permitting authority must complete 

Form 2A. Note that you may wish to consult the “General 

Instructions” of NPDES Application Form 1 to determine if your 

treatment works is required to submit any additional NPDES 

application forms. 

At the state level, either the U.S. Environmental Protection Agency 

(EPA) or an approved state agency operates the NPDES permit 

program. If you are located in a jurisdiction in which an EPA 

regional office administers the NPDES permit program, you should 

use Form 2A and all other applicable forms described in these 

instructions. If you are located in a jurisdiction where a state 

administers the NPDES permit program, contact the state to 

determine the forms you should complete. Often states develop 

their own application forms rather than use the federal forms. See 

http://www.epa.gov/npdes/npdes-state-program-information for a 

list of states that have approved NPDES permit programs and 

those that do not. 

Exhibit 2A–1 (see end of this section) provides contact information 

for each of EPA’s 10 regional offices. Since the content of Exhibit 

2A–1 is subject to change, consult EPA’s website for the latest 

information: http://www.epa.gov/aboutepa#regional. 

Where to File Your Completed Form 

 If you are in a jurisdiction with an approved state NPDES 

permit program, file according to the instructions on the state 

forms. 

 If you are in a jurisdiction where EPA is the NPDES permitting 

authority (i.e., the state is not an NPDES-authorized state), 

mail the completed application forms to the EPA regional office 

that covers the state in which your facility is located (see 

Exhibit 2A–1).

When to File Your Completed Form 

Form 2A must be submitted at least 180 days before your present 

NPDES permit expires or, if you are a new discharger, at least 

180 days before the date on which the discharge is to commence, 

unless the NPDES permitting authority has granted permission for a 

later date. 

Fees 

EPA does not require applicants to pay a fee for applying for 

NPDES permits. However, states that administer the NPDES permit 

program may charge fees. Consult with state officials for further 

information. 

Public Availability of Submitted Information 

EPA will make information provided on the various NPDES permit 

application forms available to the public for inspection and copying 

upon request. You may not claim any information on Form 2A (or 

related attachments) as confidential. 

You may make a claim of confidentiality for any information that you 

submit to EPA that goes beyond the information required by 

Form 2A. If you do not assert a claim of confidentiality at the time 

you submit your information to the NPDES permitting authority, 

EPA may make the information available to the public without 

further notice to you. EPA will handle claims of confidentiality in 

accordance with the Agency’s business confidentiality regulations 

at Part 2 of Title 4 of the Code of Federal Regulations (CFR). 

Completion of Forms

Form 2A is divided into six major sections. The form also contains 

five effluent monitoring tables (Tables A through E) and an 

industrial discharge information table (Table F). All of the tables are 

located at the end of Form 2A. Note that not all applicants are 

required to complete each section of the form or all of the tables. 

The questions on the form will direct you to the items and tables 

you must complete. 

Print or type in the specified areas only. If you do not have enough 

space on the form to answer a question, you may continue on 

additional sheets, as necessary, using a format consistent with the 

form. 

Provide your EPA Identification Number from the Federal Registry 

Service, NPDES Permit Number, and facility name at the top of 

each page of Form 2A and any attachments. If your facility is new 

(i.e., not yet constructed), write or type “New Facility” in the space 

provided for the EPA Identification Number and NPDES Permit 

Number. If you do not know your EPA Identification Number, 

contact your NPDES permitting authority. See Exhibit 2A–1 for 

contact information. Additionally, for Tables A through E, provide 

the applicable Outfall Number at the top of each page. 

Do not leave any response areas blank unless the form directs you 

to skip the item. If the form directs you to respond to an item that 

does not apply to your facility or activity, enter “NA” for “not 

applicable” to show that you considered the item and determined a 

response was not necessary for your facility. 

Note for New Dischargers 

Provide all information available to you at the time you 

complete Form 2A. If you do not have information to 

respond to a particular item, because your facility has 

yet to discharge, write or type “data are not available” 

next to the item on the form. Note that you are 

required to submit actual data no later than 18 months 

after your facility commences to discharge. 

The NPDES permitting authority will consider your application 

complete when it and any supplementary material are received and 

completed according to the authority’s satisfaction. The NPDES 

permitting authority will judge the completeness of any application 

independently of the status of any other permit application or permit 

for the same facility or activity. 

Definitions 

All significant terms used in Form 2A are included in the “Glossary” 

located at the end of these Instructions. 

For Comment Only
2A-2 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2A—GENERAL INSTRUCTIONS CONTINUED 

Exhibit 2A–1. Addresses of EPA Regional Contacts and Covered States 

REGION 1 

U.S. Environmental Protection Agency, Region 1 

5 Post Office Square, Suite 100, Boston, MA 02109-3912. 

Phone: (617) 918-1111, Fax: (617) 918-0101, Toll free within Region 1: 

(888) 372-7341 

Website: http://www.epa.gov/aboutepa/epa-region-1-new-england

Covered States: Connecticut, Maine, Massachusetts, New Hampshire, Rhode 

Island, and Vermont

REGION 6 

U.S. Environmental Protection Agency, Region 6 

1445 Ross Avenue, Suite 1200, Dallas, TX 75202-2733 

Phone: (214) 665-2200, Fax: (214) 665-7113, Toll free within Region 6: 

(800) 887-6063 

Website: http://www.epa.gov/aboutepa/epa-region-6-south-central

Covered States: Arkansas, Louisiana, New Mexico, Oklahoma, and Texas

REGION 2 

U.S. Environmental Protection Agency, Region 2 

290 Broadway, New York, NY 10007-1866 

Phone: (212) 637-3000, Fax: (212) 637-3526, Toll free within Region 2: 

(877) 251-4575 

Website: http://www.epa.gov/aboutepa/epa-region-2

Covered States: New Jersey, New York, Virgin Islands, and Puerto Rico

REGION 7 

U.S. Environmental Protection Agency, Region 7 

11201 Renner Boulevard, Lenexa, KS 66219 

Phone: (913) 551-7003, Toll free: (800) 223-0425 

Website: http://www.epa.gov/aboutepa/epa-region-7-midwest

Covered States: Iowa, Kansas, Missouri, and Nebraska

REGION 3 

U.S. Environmental Protection Agency, Region 3 

1650 Arch Street, Philadelphia, PA 19103-2029 

Phone: (215) 814-5000, Fax: (215) 814-5103, Toll free: (800) 438-2474 

Website: : http://www.epa.gov/aboutepa/epa-region-3-mid-atlantic

Covered States: Delaware, District of Columbia, Maryland, Pennsylvania, 

Virginia, and West Virginia

REGION 8 

U.S. Environmental Protection Agency, Region 8 

1595 Wynkoop Street, Denver, CO 80202-1129 

Phone: (303) 312-6312, Fax: (303) 312-6339, Toll free: (800) 227-8917 

Website: http://www.epa.gov/aboutepa/epa-region-8-mountains-and-plains

Covered States: Colorado, Montana, North Dakota, South Dakota, Utah, and 

Wyoming

REGION 4 

U.S. Environmental Protection Agency, Region 4 

Sam Nunn Atlanta Federal Center 

61 Forsyth Street, SW, Atlanta, GA 30303-8960 

Phone: (404) 562-9900, Fax: (404) 562-8174, Toll free: (800) 241-1754 

Website: http://www.epa.gov/aboutepa/about-epa-region-4-southeast

Covered States: Alabama, Florida, Georgia, Kentucky, Mississippi, North 

Carolina, South Carolina, and Tennessee

REGION 9 

U.S. Environmental Protection Agency, Region 9 

75 Hawthorne Street, San Francisco, CA 94105 

Phone: (415) 947-8000, Fax: (415) 947-3553, Toll free within Region 9: 

(866) EPA-WEST 

Website: http://www.epa.gov/aboutepa/epa-region-9-pacific-southwest

Covered States: Arizona, California, Hawaii, Nevada, Guam, American Samoa, 

and Trust Territories

REGION 5 

U.S. Environmental Protection Agency, Region 5 

77 West Jackson Boulevard, Chicago, IL 60604-3507 

Phone: (312) 353-2000, Fax: (312) 353-4135, Toll free within Region 5: 

(800) 621-8431 

Website: http://www.epa.gov/aboutepa/epa-region-5

Covered States: Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin

REGION 10 

U.S. Environmental Protection Agency, Region 10 

1200 Sixth Avenue, Suite 900, Seattle, WA 98101 

Phone: (206) 553-1200, Fax: (206) 553-2955, Toll free: (800) 424-4372 

Website: http://www.epa.gov/aboutepa/epa-region-10-pacific-northwest

Covered States: Alaska, Idaho, Oregon, and Washington

For Comment Only
2A-3 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2A—LINE-BY-LINE INSTRUCTIONS 

Section 1. Basic Application Information for All Applicants 

Facility Information 

Item 1.1. Enter the facility’s official or legal name. Do not use a 

colloquial name. Provide the mailing address of the facility. Next, 

give the name (first and last), title, work telephone number and 

electronic mail (email) address of the person who is thoroughly 

familiar with the operation of the facility and with the facts reported 

in this application. 

Include a complete location address for the facility if different from 

the mailing address. If the facility lacks a street name or route 

number, give the most accurate, alternative geographic information 

(e.g., section number or quarter section number from county 

records or “at intersection of Routes 425 and 22”). 

Provide the latitude and longitude to the nearest second for the 

facility. Provide associated metadata in the subsequent columns of 

the table. In the column marked “Reference Point,” indicate where 

the coordinates were collected (e.g., from the main entrance of the 

facility or the center of the facility). In the column marked “Collection 

Method Information,” indicate the following: (1) horizontal collection 

method, which is the type of method/device used to identify the 

coordinates (e.g., global positioning system or GPS device, census 

block centroid, an address, State Plane Coordinate System or 

SPCS, etc.); (2) the scale of your source map or photo if applicable 

(e.g., the proportional distance on the ground for one unit of 

measure typically expressed in ratio form such as 1:24,000); and 

(3) the horizontal reference datum (i.e., the coordinate reference 

system) to which your coordinates relate. 

GPS devices are commonly used to electronically record the 

latitude and longitude coordinates of a property. It is also possible 

to use geographic information systems (e.g., ArcView), online 

sources (e.g., Terra Server or Google Earth), or paper maps from 

trusted sources (e.g., U.S. Geological Survey or USGS) to identify 

coordinates. The online services require that you enter a property 

address, the nearest intersection, or ZIP code. The system then 

generates the coordinates. The horizontal collection method for 

such sources is “Interpolation—Satellite.” You would not report a 

source map scale if you used a GPS device or one of the online 

systems. For the horizontal reference datum, you would report one 

of the following three options: 

1. North American Datum of 1927 (NAD27): This datum was 

based on the ground survey in Europe and North America in 

the 19th century. NAD27 was the standard for many years 

because the USGS published its topographic maps in this 

datum. If you are reporting a location using a USGS 7.5-

minute map, NAD27 is your default datum. 

2. North American Datum of 1983 (NAD83): NAD83 updated 

NAD27 with current measurements using radio astronomy and 

satellite observations. When the USGS began publishing 

digital data, the NAD83 was used, which provided a more 

accurate representation of the earth’s shape and a more 

accurate depiction of the location of objects on the earth. 

3. World Geodetic System of 1984 (WGS84): This datum was 

developed from the measurements calculated in NAD83. If you 

used a GPS to calculate your latitude/longitude coordinates, 

WGS84 is the default datum. 

If you need further guidance in responding to Item 2.6, refer to 

http://www.epa.gov/geospatial/latitudelongitude-data-standard. 

Item 1.2. Indicate whether the application is for a facility that has 

not yet commenced discharge. If “yes,” be advised that you are 

required to submit actual data no later than 18 months after your 

facility commences to discharge. 

Applicant Information 

Item 1.3. Indicate if the applicant is different from the entity listed 

under Item 1.1. If so, specify the applicant name and address. 

Provide the name (first and last) of a contact, including his/her title, 

telephone number, and email address. 

Item 1.4. Indicate if the applicant is the facility’s owner, operator, or 

both. 

Item 1.5. Specify whether the NPDES permitting authority should 

send correspondence to the facility or the applicant. 

Existing Environmental Permits 

Item 1.6. Indicate all environmental permits or construction 

approvals received or applied for (including dates) under the noted 

programs. Print or type the corresponding permit number for each. 

Collection System and Population Served 

Item 1.7. Specify the municipalities served by the treatment works, 

including unincorporated connector districts. For each municipality, 

indicate the population served, the percentage of each collection 

system type if known (e.g., separate sanitary or combined storm 

and sanitary), and collection system ownership status. Finally, 

indicate the total percentage of sewer line each type comprises. 

Do not report privately owned collection systems discharging 

industrial waste to the treatment works in Item 1.7. Those facilities 

must be reported on Table F. 

Indian Country 

Item 1.8. Indicate if the POTW is located in Indian Country. 

Item 1.9. Note whether the treatment works discharges to a 

receiving stream that flows through Indian Country. 

Design and Actual Flow Rates 

Item 1.10. Provide the facility’s design flow rate in million gallons 

per day (mgd). Next, specify the facility’s actual annual average 

daily flow rate and maximum daily flow rate for each of the previous 

three years (in mgd). 

Discharge Points by Type

Item 1.11. Provide the facility’s total number of effluent discharge 

points to waters of the United States by type (e.g., treated effluent, 

untreated effluent, combined sewer overflows, bypasses, and 

constructed emergency overflows). 

Outfalls and Other Discharge or Disposal Methods 

Outfalls Other Than to Waters of the United States 

Item 1.12. Indicate whether the POTW discharges wastewater to 

basins, ponds, or other surface impoundments that do not have 

outlets for discharge to waters of the United States. If “yes,” 

For Comment Only
Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2A—LINE-BY-LINE INSTRUCTIONS CONTINUED

continue to Item 1.13. If “no,” skip to Item 1.14. 

Item 1.13. Specify the location of each surface impoundment, the 

average daily volume discharged to each surface impoundment in 

gallons per day (gpd), and whether the discharge is continuous or 

intermittent. 

Item 1.14. Indicate if the facility applies wastewater to land. If “yes,” 

continue to Item 1.15. If “no”, skip to Item 1.16. 

Item 1.15. Provide the location of each land application site; the 

size of each land application site (in acres); the average daily 

volume applied to each land application site (in gpd), and whether 

the land application is continuous or intermittent. 

Item 1.16. Note whether the facility’s effluent is transported to 

another facility for treatment prior to discharge. If “yes,” continue to 

Item 1.17. If “no,” skip to Item 1.21. 

Item 1.17. Describe the means by which the effluent is transported, 

such as by tank truck or pipe. 

Item 1.18. Specify whether the facility’s effluent is transported by a 

party other than the applicant. If “yes,” continue to Item 1.19. If “no,” 

skip to Item 1.20. 

Item 1.19. Provide the name, mailing address, contact person, 

phone number, and email address of the entity that transports the 

discharge. 

Item 1.20. Provide the name, mailing address, contact person, 

phone number, email address, NPDES permit number (if any) of the 

receiving facility. Also specify the average daily flow rate from the 

facility into the receiving facility in mgd. 

Item 1.21. Indicate if wastewater is disposed to places/structures 

(other than those already mentioned in Items 1.14 through 1.21) 

that do not have outlets to waters of the United States, such as 

underground percolation and underground injections. If “yes,” 

continue to Item 1.22. If “no,” skip to Item 1.23. 

Item 1.22. Provide a description of the disposal method, including 

the location and size of each disposal site; the annual average daily 

discharge volume (in gpd), and indication of whether disposal 

through this method is continuous or intermittent. 

Contractor Information 

Item 1.23. Indicate if any of the operational or maintenance (O&M) 

activities associated with wastewater treatment and effluent quality 

of the POTW are the responsibility of a contractor. If “yes,” continue 

to Item 1.25. If “no,” skip to Section 2. 

Item 1.24. Provide a listing of all contractors (by company name). 

For each, specify the mailing address, a contact name, telephone 

number, and email address. Also summarize the O&M 

responsibilities of each contractor. 

Section 2. Additional Information 

Outfalls to Waters of the United States 

Design Flow 

Item 2.1. Indicate whether the treatment works has a design flow 

greater than or equal to 0.1 mgd? If “yes,” continue to Item 2.2. If 

“no,” skip to Section 3. 

Inflow and Infiltration 

Item 2.2. Specify the POTW’s current average daily volume of 

inflow and infiltration (in gpd) and steps the facility is taking to 

minimize inflow and infiltration. 

Topographic Map 

Item 2.3. Prepare a topographic map (or other map if a topographic 

map is unavailable) extending at least one mile beyond property 

boundaries of the treatment plant, including all unit processes, and 

showing the following: (a) treatment plant area and unit processes; 

(b) major pipes or other structures through which wastewater enters 

the treatment plant 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 fluids 

from the treatment plant are injected underground; (d) wells, 

springs, and other surface water bodies listed in public records or 

otherwise known to the applicant within 1⁄4 mile of the treatment 

works’ property boundaries; (e) sewage sludge management 

facilities (including on-site treatment, storage, and disposal sites); 

and (f) location at which waste classified as hazardous under the 

Resource Conservation and Recovery Act (RCRA) enters the 

treatment plant by truck, rail, or dedicated pipe. 

On each map, include the map scale, a meridian arrow showing 

north, and latitude and longitude to the nearest second. On all 

maps of rivers, show the direction of the current. In tidal waters, 

show the directions of ebb and flow tides. You may develop your 

map by going to the USGS’s National Map website at 

http://nationalmap.gov/. Use the traditional 7.5-minute quadrangle 

format. If none is available, you may use a USGS 15-minute series 

map. You may also use a plat or other appropriate map. Briefly 

describe land uses in the map area (e.g., residential, commercial, 

etc.). Answer “yes” to Item 2.3 once you have completed and 

attached your topographic map to the application. 

Flow Diagram 

Item 2.4. Provide a process flow diagram or schematic showing the 

processes of the treatment plant, including all bypass piping and all 

backup power sources or redundancy in the system. This includes 

a water balance showing all treatment units, including disinfection 

(e.g., chlorination and dechlorination), and showing daily average 

flow rates at influent and discharge points, and approximate daily 

flow rates between treatment units. Also provide a narrative 

description of the diagram/schematic. Answer “yes” to Item 2.4 

once you have completed and attached your diagram to the 

application. 

Scheduled Improvements and Schedules of Implementation

Item 2.5. Indicate whether any improvements to the facility are 

scheduled. If “yes”, list and briefly describe each scheduled 

improvement and continue to Item 2.6. If “no”, skip to Section 3. 

Item 2.6. For each scheduled improvement, indicate the outfall 

number of each outfall affected and the scheduled or actual dates 

of completion for the following: (a) commencement of construction, 

(b) completion of construction, (c) commencement of discharge, 

and (d) attainment of operational level. 

For Comment Only
2A-5 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2A—LINE-BY-LINE INSTRUCTIONS CONTINUED

Item 2.7. Note whether the appropriate permits/clearances 

concerning other federal/state requirements have been obtained 

and briefly explain your response. 

Section 3. Information on Effluent Discharges 

Description of Outfalls 

Item 3.1. Provide a description of each of the POTW’s wastewater 

discharge outfalls. The application form provides reporting space 

for three outfalls. If your facility has more than this number, attach 

additional sheets as necessary. 

For each outfall, provide the outfall number. Indicate the state, 

county, and city or town where each outfall is located. Note the 

distance from shore in feet and the depth below the surface in feet. 

Specify the average daily flow rate through the outfall in mgd. Also 

specify the latitude and longitude of each outfall to the nearest 

second and associated metadata (e.g., horizontal collection 

method, scale of source map or photo, if applicable, and horizontal 

reference datum). The location of each outfall (i.e., where the 

coordinates are collected) shall be the point where the discharge is 

released into a water of the United States. (See Line-By-Line 

Instructions to Item 1.1 for guidance on supplying method of 

collection information.) 

Seasonal or Periodic Discharge Data 

Item 3.2. Indicate whether any of the outfalls described under 

Item 3.1 have seasonal or periodic discharges. If “yes,” continue to 

Item 3.3. If “no”, skip to Item 3.4. 

Item 3.3. Specify the following for each applicable outfall: 

(a) number of times per year discharge occurs, (b) average duration 

of each discharge, (c) average flow of each discharge in mgd, and 

(d) months in which discharge occurs. 

Diffuser Type 

Item 3.4. Note whether any of the outfalls listed under Item 3.1 are 

equipped with a diffuser. If “yes” continue to Item 3.5. If “no,” skip to 

Item 3.6. 

Item 3.5. Briefly describe the diffuser type at each applicable 

outfall. 

Waters of the United States 

Item 3.6. Note whether the POTW discharges or plans to discharge 

wastewater to waters of the United States from one or more 

discharge points. If “yes,” continue to Item 3.7. If “no,” skip to 

Section 6. 

Receiving Water Description 

Item 3.7. Provide receiving water and related information in the 

table provided on the form (if known): (a) name of receiving water; 

(b) name of watershed / river / stream system; (c) U.S. Soil 

Conservation Service 14-digit watershed code; (d) name of state 

management / river basin; (e) USGS 8-digit hydrologic unit code 

(HUC); (f) acute critical low flow in cubic feet per second (cfs); 

(g) chronic critical low flow in cfs; and (h) total hardness of receiving 

stream at critical low flow (in milligrams per liter (mg/L) of calcium 

carbonate), if applicable. 

Treatment Description 

Item 3.8. Specify the highest level of treatment provided for 

discharges from each outfall (e.g., primary, equivalent to 

secondary, secondary, or advanced). Also indicate the following 

design removals (in percent) for the following parameters for each 

outfall: (a) biochemical oxygen demand (BOD5 or CBOD5), 

(b) suspended solids (TSS), (c) phosphorus (if applicable), 

(d) nitrogen (if applicable), and (e) any other removals that an 

advanced treatment system is designed to achieve. 

Item 3.9. Provide a description of the type(s) of disinfection used for 

wastewater discharged through each outfall. Indicate the seasons 

the disinfection type is used. Note whether the POTW dechlorinates 

if disinfection is accomplished through chlorination. Otherwise, 

check “Not Applicable.” 

Effluent Testing Data and Tables A through E 

Items 3.10 to 3.26. These items require you to collect and report 

data for the parameters and pollutants listed in Tables A through E, 

located at the end of Form 2A. The instructions for completing the 

tables are table-specific in addition to the criteria for determining 

who should complete them. 

IMPORTANT NOTE: Read the “General Instructions for Reporting, 

Sampling, and Analysis” later in these Instructions before 

completing Items 3.10 to 3.26 and Tables A through E. 

Item 3.10 and Table A. All applicants that discharge wastewater to 

waters of the U.S. must provide effluent data for Table A 

parameters. Respond “yes” to Item 3.10 when you have completed 

Table A and attached it to your application. 

Item 3.11. Answer whether the POTW has conducted any whole 

effluent toxicity (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. If “yes,” continue to Item 

3.12. If “no,” skip to Item 3.13. 

Item 3.12. For each applicable outfall, note the number of acute 

and chronic WET tests conducted since the last permit reissuance 

of the facility’s discharges or of the receiving water near the 

discharge points. 

Item 3.13. Note whether the POTW has a design flow greater than 

or equal to 0.1 mgd. If “yes,” continue to Item 3.14. If “no,” skip to 

Item 3.16. 

Item 3.14 and Table B. Answer whether the treatment works uses 

chlorine for disinfection, uses it elsewhere in the treatment process, 

or otherwise has reasonable potential to discharge chlorine in its 

effluent. If “yes,” complete Table B including chlorine. If “no,” 

complete Table B, omitting chlorine. 

Item 3.15. Answer “yes” when you have completed monitoring for 

all applicable Table B parameters and attached the results to your 

application. 

Item 3.16 and Screen for Tables C through E. Indicate whether 

one or more of the following conditions apply to your POTW: 

 The facility has a design flow ≥ 1 mgd. 

For Comment Only
Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2A—LINE-BY-LINE INSTRUCTIONS CONTINUED

 The POTW has an approved pretreatment program or is 

required to develop such a program. 

 The NPDES permitting authority has notified the facility that it 

must sample for the parameters in Table C, sample for 

additional parameters (Table D), or submit the results of WET 

tests for acute or chronic toxicity for each of the facility’s 

discharge outfalls (Table E). 

If “yes,” continue to Item 3.17. If “no,” skip to Section 4. 

Item 3.17 and Table C. Answer “yes” to indicate you have 

completed monitoring for all applicable Table C pollutants and 

attached the results to your application package. 

Item 3.18 and Table D. Answer “yes” to indicate you have 

completed monitoring for applicable Table D pollutants required by 

your NPDES permitting authority and attached the results to your 

application package, or “no” if the NPDES permitting authority has 

not required additional sampling for the pollutants in Table D. 

Item 3.19 and Additional Screen for Table E. Answer whether the 

POTW conducted either (a) a minimum of four quarterly WET tests 

for one year preceding this permit application or (b) at least four 

annual WET tests in the past 4.5 years. If “yes,” continue to Item 

3.20. If “no,” complete tests and Table E and then skip to Item 3.26. 

Item 3.20 and Additional Screen for Table E. Report whether you 

have previously submitted the results of the WET tests indicated in 

Item 3.19 to your NPDES permitting authority? If “yes,” continue to 

Item 3.21. If “no,” provide the results in Table E and skip to Item 

3.26. 

Item 3.21. Report the dates the testing data were submitted to your 

NPDES permitting authority and provide a summary of the results. 

Item 3.22. Regardless of how you may have provided the results of 

previously conducted WET analyses to your NPDES permitting 

authority, indicate if any of the tests resulted in toxicity? If “yes,” 

continue to Item 3.23. If “no,” skip to Item 3.26. 

Item 3.23. Describe the cause(s) of toxicity. 

Item 3.24. Indicate if the POTW has conducted a Toxicity 

Reduction Evaluation. If “yes,” continue to Item 3.25. If “no,” skip to 

Item 3.26. 

Item 3.25. Provide details of any Toxicity Reduction Evaluations 

performed. 

Item 3.26. Answer “yes” when you have completed Table E for all 

applicable outfalls and attached the results to the application 

package, or answer “no” if the item is not applicable because you 

previously submitted WET data to your NPDES permitting authority. 

Section 4. Industrial Discharges, Table F, and Hazardous 

Wastes 

Item 4.1. Indicate if the POTW receives discharges from significant 

industrial users (SIUs) or categorical industrial users (CIUs). If 

“yes,” continue to Item 4.2. If “no,” skip to Item 4.5. 

SIUs are defined as: 

1. All industrial users subject to categorical pretreatment 

standards under 40 CFR 403.6 and 40 CFR Chapter I, 

Subchapter N (CIUs); and 

2. Any other industrial user per 40 CFR 403.3 that: 

a. Discharges an average of 25,000 gpd 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. 

Item 4.2. Indicate the number of SIUs and CIUs that discharge to 

the POTW. 

Item 4.3. Answer whether the POTW has an approved 

pretreatment program, which is defined at 40 CFR 403.3 as a 

program administered by a POTW that meets the criteria 

established in 40 CFR 403.8 and 403.9 and that has been 

approved by the NPDES permitting authority. 

Item 4.4. Answer whether you have submitted either of the 

following to the NPDES permitting authority that contains 

information substantially identical to that required in Table F: (a) a 

pretreatment program annual report submitted within one year of 

the application or (b) a pretreatment program. If “yes,” continue to 

Item 4.5. If “no,” skip to Item 4.6. 

Item 4.5. Identify the title and date of the pretreatment program 

annual report or pretreatment program referenced in Item 4.4 and 

skip to Item 4.7. 

Item 4.6 and Table F. Complete Table F by providing the following 

information for each SIU and CIU that discharges to the POTW: 

(a) name and mailing address; (b) description of all industrial 

processes that affect or contribute to each SIU’s and CIU’s 

discharge and the SIC or NAICS code(s), if available; (c) a list of 

the principal products and raw materials that affect or contribute to 

the SIU’s/CIU’s respective discharges; (d) average daily volume of 

wastewater discharged by each SIU/CIU, indicating the amount 

attributable to process flow and non-process flow; (e) whether the 

SIU or CIU is subject to local limits; (f) whether the SIU is subject to 

categorical standards and the categories / subcategories under 

which the SIU/CIU is subject; and (g) whether any upsets or pass 

through interferences have occurred at the POTW that can be 

attributed to the SIU or CIU in the past 4.5 years. Answer “yes” to 

Item 4.6 when you have completed and attached Table F to the 

application package. 

Note: SIUs and CIUs include users that haul industrial waste to the 

POTW by truck or rail. Information for these users must be provided 

in Table F. 

 

For Comment Only
Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

General Instructions for Reporting, Sampling, and Analysis 

IMPORTANT NOTICE: Read these instructions prior to completing 

Tables A through E and Section 3 of Form 2A. 

General Items 

Complete the applicable tables for each outfall at your facility. Be 

sure to note the EPA Identification Number, NPDES Permit 

Number, facility name, and applicable outfall number at the top of 

each page of the tables and any associated attachments. 

You may report some or all of the required data by attaching 

separate sheets of paper instead of completing Tables A through E 

for each of your outfalls so long as the sheets contain all of the 

required information and are similar in format to Tables A through 

E. For example, you may be able to print a report in a compatible 

format from the data system used in your analysis of metals 

completed under Table C. 

Reporting of Effluent Data 

Where effluent data are requested, do not provide information on 

CSOs. The latter information is requested instead under Section 5 

of Form 2A. 

Provide data for each outfall through which effluent is discharged. 

When an applicant has two or more outfalls with substantially 

identical effluents, the NPDES permitting authority may allow the 

applicant to test only one outfall and report that quantitative data as 

applying to the substantially identical outfall. If the permitting 

authority grants your request, attach a separate sheet to the 

application form identifying the outfall tested and describing why the 

other outfall(s) are substantially identical. 

At a minimum, effluent testing data must be based on at least three 

samples taken within 4.5 years prior to the date of the permit 

application. Samples must be representative of the seasonal 

variation in the discharge from each outfall. Existing data may be 

used, if available, in lieu of sampling done solely for the purpose of 

this application. 

All existing data for pollutants specified in Tables A through D that 

is collected within 4.5 years of the application must be included in 

the pollutant data summary that you submit. If, however, you 

sampled for a specific pollutant on a monthly or more frequent 

basis, it is only necessary, for such pollutant, to summarize all data 

collected within 1 year of the application. 

Except as specified below, all required quantitative data shall be 

collected in accordance with sufficiently sensitive analytical 

methods approved under 40 CFR part 136 or required under 

40 CFR chapter I, subchapter N or O. A method is “sufficiently 

sensitive” when: 

(1) The method minimum level (ML) is at or below the level of the 

applicable water quality criterion for the measured pollutant or 

pollutant parameter; 

(2) The method ML is above the water quality criterion, but the 

amount of the pollutant or pollutant parameter in the facility’s 

discharge is high enough that the method detects and quantifies 

the level of the pollutant or pollutant parameter in the discharge. 

(3) The method has the lowest ML of the analytical methods 

approved under 40 CFR part 136 or required under 40 CFR 

chapter I, subchapter N or O for the measured pollutant or 

pollutant parameter. 

Consistent with 40 CFR part 136, you may provide matrix or 

sample specific MLs rather than the published levels. Further, 

where you can demonstrate that, despite a good faith effort to use 

a method that would otherwise meet the definition of “sufficiently 

sensitive”, the analytical results are not consistent with the quality 

assurance (QA) / quality control (QC) specifications for that 

method, then the NPDES permitting authority may determine that 

the method is not performing adequately and the NPDES 

permitting authority should select a different method from the 

remaining EPA-approved methods that is sufficiently sensitive 

consistent with 40 CFR 122.21(e)(3)(i). Where no other EPAapproved methods exist, you must select a method consistent with 

40 CFR 122.21(e)(3)(ii). 

When there is no analytical method that has been approved under 

40 CFR part 136, required under 40 CFR chapter I, subchapter N 

or O, and is not otherwise required by the NPDES permitting 

authority, you may use any suitable method but shall provide a 

description of the method. When selecting a suitable method, other 

factors such as a method’s precision, accuracy, or resolution, may 

be considered when assessing the performance of the method. 

Effluent monitoring data must comply with the 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). 

Clearly specify the units of measure on Tables A through E for each 

parameter / pollutant analyzed. Values should be reported as 

concentration or mass, with the exception of flow, temperature, pH, 

color, and fecal coliform organisms, unless otherwise requested or 

required by the NPDES permitting authority. Flow, temperature, pH, 

color, and fecal coliform organisms must be reported as mgd, 

degrees Celsius (°C), standard units, color units, and most 

probable number per 100 milliliters (MPN/100 mL), respectively. 

Use the following abbreviations in the columns requiring “units” in 

Tables A through D. 

Concentration Mass 

ppm = parts per million lbs = pounds 

mg/L = milligrams per liter ton = Tons (English tons) 

ppb = parts per billion mg = milligrams 

μg/L = micrograms per liter g = grams 

MPN = most probable number kg = kilograms 

per 100 milliliters T = tonnes (metric tons)

Grab samples must be used for pH, temperature, cyanide, total 

phenols, residual chlorine, oil and grease, fecal coliform (including 

E. coli), and volatile organic chemicals. For all other pollutants, 24-

hour composite samples must be used. For a composite sample, 

only one analysis of the composite of aliquots is required. 

For Comment Only
Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

General Instructions for Reporting, Sampling, and Analysis Continued 

The effluent monitoring data provided must include at least the 

following for each parameter: (1) the maximum daily discharge 

based upon actual sample values, (2) average daily discharge for 

all samples and the number of samples used to obtain this value, 

(3) the analytical method used, and (4) the threshold level (i.e., 

method detection limit, minimum level, or other designated method 

endpoints) for the analytical method used. 

Metals must be reported as “total recoverable metal”, unless all 

approved analytical methods for the metal inherently measure only 

its dissolved form (e.g., hexavalent chromium) or otherwise directed 

by the NPDES permitting authority. 

Note to New Dischargers. Provide all information available to you 

at the time you complete Form 2A. If you do not have information to 

respond to a particular item, because your facility has yet to 

discharge, write or type “data are not available” next to the item on 

the form. Note that you are required to submit actual data no later 

than 18 months after your facility commences discharge. 

Sampling 

The collection of samples for the reported analyses should be 

supervised by a person experienced in performing sampling of 

domestic wastewater. You may contact your NPDES permitting 

authority for detailed guidance on sampling techniques and for 

answers to specific questions. See Exhibit 2A–1 for contact 

information. Any specific requirements contained in the analytical 

methods must be followed, including factors related to sample 

containers, sample preservation, holding times, and the collection 

of duplicate samples. 

The time when you sample should be representative of your 

normal operation, to the extent feasible, with your treatment 

system operating properly with no system upsets. Samples should 

be collected from the center of the flow channel, where turbulence 

is at a maximum, at a site specified in your present NPDES permit, 

or at any site adequate for the collection of a representative 

sample. 

Additional Requirements for Table E, Whole Effluent Toxicity 

Testing 

Each applicant required to perform WET testing must provide 

results of a minimum of four quarterly tests for a year, from the year 

preceding the permit application or the results from four tests 

performed at least annually in the 4.5 year period prior to the 

application, provided the results show no appreciable toxicity using 

a safety factor determined by the NPDES permitting authority. 

Applicants must conduct tests with multiple species (no less than 

two species; e.g., fish, invertebrate, plant) and test for acute or 

chronic toxicity, depending on the range of receiving water dilution. 

See 40 CFR 122.21(j)(5)(v) for further details. 

Whole effluent toxicity testing must be conducted using methods 

approved under 40 CFR part 136. West Coast facilities in 

Washington, Oregon, California, Alaska, Hawaii, and the Pacific 

Territories are exempted from 40 CFR part 136 chronic methods 

and must use alternative guidance as directed by the NPDES 

permitting authority. 

For Comment Only
2A-9 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2A—LINE-BY-LINE INSTRUCTIONS CONTINUED

Section 4. Industrial Discharges, Table F, and Hazardous 

Wastes Continued 

Item 4.7. Indicate if the POTW receives or has been notified that it 

will receive by truck, rail, or dedicated pipe any wastes that are 

regulated as Resource Conservation and Recovery Act (RCRA) 

hazardous wastes pursuant to 40 CFR Part 261. If “yes,” continue 

to Item 4.8. If “no,” skip to Item 4.9. 

Item 4.8. For each hazardous waste received, provide the 

hazardous waste number, the method by which the waste is 

received (e.g., by truck, dedicated pipe, rail, etc.), and the amount 

of waste received annually (specify units). 

Item 4.9. Answer whether the POTW receives, or has been notified 

that it will receive, wastewaters that originate from remedial 

activities, including those undertaken pursuant to Comprehensive 

Environmental Response, Compensation, and Liability Act 

(CERCLA) and sections 3004(u) or 3008(h) of RCRA. If “yes,” 

continue to Item 4.10. If “no,” skip to Section 5. 

Item 4.10. Answer whether the POTW receives (or expects to 

receive) less than 15 kilograms per month of non-acute hazardous 

wastes as specified at 40 CFR 261.30(d) and 261.33(e). If “yes,” 

skip to Section 5. If “no,” continue to Item 4.11. 

Item 4.11. In an attachment to the application, provide an 

identification and description of the site(s) or facility(ies) at which 

the wastewater originates; the identities of the wastewater’s 

hazardous constituents, and the extent of treatment, if any, the 

wastewater receives or will receive before entering the POTW. 

Answer “yes” to Item 4.11 when you have completed and attached 

the information to the application package. 

Section 5. Combined Sewer Overflows 

CSO Map and Diagram 

Item 5.1. Indicate if the treatment works has a combined sewer 

system. If “yes,” continue to Item 5.2. If “no”, skip to Section 6. 

Item 5.2. Attach a CSO system map to the application. The map 

should indicate: (a) all CSO discharge points; (b) sensitive use 

areas potentially affected by CSOs (beaches, drinking water 

supplies, shellfish beds, sensitive aquatic ecosystems, and 

outstanding national resource waters); and (c) waters supporting 

threatened and endangered species potentially affected by CSOs. 

Answer “yes” to Item 5.2 when you have completed and attached 

the map to the application package. 

Item 5.3. Prepare a diagram of the CSO collection system. The 

diagram should show the following: (a) the location of major sewer 

trunk lines, both combined and separate sanitary; (b) the locations 

of points where separate sanitary sewers feed into the combined 

sewer system; (c) in-line and off-line storage structures; (d) the 

locations of flow-regulating devices; and (e) the locations of pump 

stations. Answer “yes” to Item 5.3 when you have completed and 

attached the diagram to the application package. 

CSO Outfall Description 

Item 5.4. Provide the following information for each CSO outfall: 

(a) outfall number; (b) city or town, state, ZIP code and county in 

which the outfall is located; (c) latitude and longitude to the nearest 

second of the outfall and associated metadata (e.g., horizontal 

collection method, scale of source, and horizontal reference 

datum), (d) distance of outfall from shore; and (e) depth of outfall 

below water surface. The location of each CSO outfall (i.e., where 

the coordinates are collected) shall be the point where the 

discharge is released into a water of the United States. (See LineBy-Line Instructions to Item 1.1 for guidance on supplying method 

of collection information.) 

CSO Monitoring 

Item 5.5. Indicate whether the POTW has monitored any of the 

following items in the past year for each of its CSO outfalls: 

(a) rainfall; (b) CSO flow volume; (c) CSO pollutant concentrations; 

(d) receiving water quality; (e) CSO frequency; and (f) number of 

storm events. 

CSO Events in Past Year 

Item 5.6. For each CSO outfall, record: (a) the number of CSO 

events in the past year; (b) the average duration in hours per event; 

(c) the average volume per CSO event in million gallons; and 

(d) the minimum rainfall that caused a CSO event in inches of 

rainfall in the past year. Note whether your responses for sub-items 

(b) through (d) above are based on actual or estimated data. 

CSO Receiving Waters 

Item 5.7. For each CSO outfall, record the following receiving water 

information: (a) receiving water name; (b) name of watershed / 

stream system; (c) U.S. Soil Conservation Service watershed (14-

digit) code (if known); (d) name of the state management / river 

basin; (e) USGS 8-digit hydrological cataloging unit code, if known; 

and (f) a description of any known water quality impacts on the 

receiving water caused by the CSO (e.g., permanent or intermittent 

beach closings, permanent or intermittent shellfish bed closings, 

fish kills, fish advisories, other recreational loss, or exceedance of 

any applicable state water quality standard). 

Section 6. Checklist and Certification Statement 

Item 6.1. Review the checklist provided. In Column 1, mark the 

sections of Form 2A that you have completed and are submitting 

with your application. In Column 2, indicate for each section 

whether you are submitting attachments. 

Item 6.2. The Clean Water Act provides for severe penalties for 

submitting false information on this application form. CWA Section 

309(c)(2) provides that, “Any person who knowingly makes any 

false statement, representation, or certification in any application, 

...shall upon conviction, be punished by a fine of no more than 

$10,000 or by imprisonment for not more than six months, or both.” 

FEDERAL REGULATIONS REQUIRE THIS APPLICATION TO BE 

SIGNED AS FOLLOWS: 

A. By a responsible corporate officer. For the purpose of this 

section, a responsible corporate officer means: (i) A president, 

secretary, treasurer, or vice-president of the corporation in charge 

of a principal business function, or any other person who performs 

similar policy- or decision-making functions for the corporation, or 

(ii) the manager of one or more manufacturing, production, or 

For Comment Only
Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2A—LINE-BY-LINE INSTRUCTIONS CONTINUED

operating facilities, provided, the manager is authorized to make 

management decisions which govern the operation of the 

regulated facility including having the explicit or implicit duty of 

making major capital investment recommendations, and 

initiating and directing other comprehensive measures to assure 

long term environmental compliance with environmental laws 

and regulations; the manager can ensure that the necessary 

systems are established or actions taken to gather complete 

and accurate information for permit application requirements; 

and where authority to sign documents has been assigned or 

delegated to the manager in accordance with corporate 

procedures. 

B. For partnership or sole proprietorship, by a general partner or 

the proprietor, respectively. 

C. For a municipality, State, Federal, or other public facility, By 

either a principal executive officer or ranking elected official. For 

purposes of this section, a principal executive officer of a 

Federal agency includes: (i) The chief executive officer of the 

agency, or (ii) a senior executive officer having responsibility for 

the overall operations of a principal geographic unit of the 

agency (e.g., Regional Administrators of EPA). 

END 

Submit your completed Form and all associated attachments 

to your NPDES permitting authority. 

For Comment Only
2A-11 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2A—GLOSSARY 

NOTE: This Glossary includes terms used in the various NPDES application forms, including Form 2A. The definitions are from the 

NPDES regulations at 40 CFR 122.2 unless otherwise specified. If you have any questions concerning the meaning of any of these terms, 

contact your NPDES permitting authority. 

ANIMAL FEEDING OPERATION (defined at § 122.23) means a lot or facility (other than an aquatic animal production facility) where the 

following conditions are met; 

 Animals (other than aquatic animals) have been, are, or will be stabled or confined and fed or maintained for a total of 45 days 

or more in any 12 month period; and 

 Crops, vegetation, forage growth, or post-harvest residues are not sustained in the normal growing season over any portion of 

the lot or facility. 

APPLICATION means the EPA standard national forms for applying for a permit, including any additions, revisions, or modifications to the 

forms; or forms approved by EPA for use in approved states, including any approved modifications or revisions. 

APPROVED PROGRAM OR APPROVED STATE means a State or interstate program which has been approved or authorized by EPA 

under part 123. 

AQUACULTURE PROJECT (defined at § 122.25) means a defined managed water area which uses discharges of pollutants into that 

designated area for the maintenance or production of harvestable freshwater, estuarine, or marine plants or animals. DESIGNATED 

PROJECT AREA means the portions of the waters of the United States within which the permittee or permit applicant plans to confine the 

cultivated species, using a method or plan or operation (including, but not limited to, physical confinement) which, on the basis of reliable 

scientific evidence, is expected to ensure that specific individual organisms comprising an aquaculture crop will enjoy increased growth 

attributable to the discharge of pollutants, and be harvested within a defined geographic area. 

AVERAGE MONTHLY DISCHARGE LIMITATION means the highest allowable average of daily discharges over a calendar month, 

calculated as the sum of all daily discharges measured during that month divided by the number of daily discharges measured during that 

month. 

AVERAGE WEEKLY DISCHARGE LIMITATION means the highest allowable average of daily discharges over a calendar week, 

calculated as the sum of all daily discharges measured during a calendar week divided by the number of daily discharges measured during 

that week. 

BEST MANAGEMENT PRACTICES (BMP) means schedules of activities, prohibitions of practices, maintenance procedures, and other 

management practices to prevent or reduce the pollution of waters of the United States. BMPs include treatment requirements, operation 

procedures, and practices to control plant site runoff, spillage or leaks, sludge or waste disposal, or drainage from raw material storage. 

BIOSOLIDS (see sewage sludge). 

BYPASS (defined at § 122.41(m)) means the intentional diversion of waste streams from any portion of a treatment facility. 

CWA means the Clean Water Act (formerly referred to as the Federal Water Pollution Control Act or Federal Water Pollution Control Act 

Amendments of 1972) Public Law 92–500, as amended by Public Law 95–217, Public Law 95–576, Public Law 96–483 and Public Law 

97–117, 33 U.S.C. 1251 et seq. 

CWA AND REGULATIONS means the Clean Water Act (CWA) and applicable regulations promulgated thereunder. In the case of an 

approved State program, it includes State program requirements. 

COMBINED SEWER OVERFLOW (CSO) means a discharge of untreated wastewater from a combined sewer system at a point before 

the headworks of a publicly owned treatment works. CSOs generally occur during wet weather (rainfall or snowmelt). During periods of wet 

weather, these systems become overloaded, bypass treatment works, and discharge directly to receiving waters at designed overflow 

points. 

COMBINED SEWER SYSTEM (CSS) means a wastewater collection system that conveys sanitary wastewaters (domestic, commercial 

and industrial wastewaters) and stormwater through a single pipe to a publicly owned treatment works for treatment before discharge to 

surface waters. 

CONCENTRATED ANIMAL FEEDING OPERATION (defined at § 122.23) means an animal feeding operation which meets the criteria set 

forth in either (A) or (B) below or which the Director designates as such on a case-by-case basis: 

A. More than the numbers of animals specified in any of the following categories are confined: 

1. 1,000 slaughter or feeder cattle, 

2. 700 mature dairy cattle (whether milked or dry cows), 

For Comment Only
Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2A—GLOSSARY CONTINUED

3. 2,500 swine each weighing over 25 kilograms (approximately 55 pounds), 

4. 500 horses, 

5. 10,000 sheep or lambs, 

6. 55,000 turkeys, 

7. 100,000 laying hens or broilers (if the facility has a continuous overflow watering), 

8. 30,000 laying hens or broilers (if the facility has a liquid manure handling system), 

9. 5,000 ducks, or 

10. 1,000 animal units; or 

B. More than the following numbers and types of animals are confined: 

1. 300 slaughter or feeder cattle, 

2. 200 mature dairy cattle (whether milked or dry cows), 

3. 750 swine each weighing over 25 kilograms (approximately 55 pounds), 

4. 150 horses, 

5. 3,000 sheep or lambs, 

6. 16,500 turkeys, 

7. 30,000 laying hens or broilers (if the facility has continuous overflow watering), 

8. 9,000 laying hens or broilers (if the facility has a liquid manure handling system), 

9. 1,500 ducks, or 

10. 300 animal units; AND 

Either one of the following conditions are met: Pollutants are discharged into waters of the United States through a manmade ditch, 

flushing system or other similar manmade device (“manmade” means constructed by man and used for the purpose of transporting 

wastes); or Pollutants are discharged directly into waters of the Unites States which originate outside of and pass over, across, or 

through the facility or otherwise come into direct contact with the animals confined in the operation. 

Provided, however, that no animal feeding operation is a concentrated animal feeding operation as defined above if such animal 

feeding operation discharges only in the event of a 25 year, 24 hour storm event. 

CONCENTRATED AQUATIC ANIMAL PRODUCTION FACILITY (defined at § 122.24) means a hatchery, fish farm, or other facility which 

contains, grows or holds aquatic animals in either of the following categories, or which the Director designates as such on a case-by-case 

basis: 

A. Cold water fish species or other cold water aquatic animals including, but not limited to, the Salmonidae family of fish (e.g., trout and 

salmon) in ponds, raceways or other similar structures which discharge at least 30 days per year but does not include: 

1. Facilities which produce less than 9,090 harvest weight kilograms (approximately 20,000 pounds) of aquatic animals per year; 

and 

2. Facilities which feed less than 2,272 kilograms (approximately 5,000 pounds) of food during the calendar month of maximum 

feeding. 

B. Warm water fish species or other warm water aquatic animals including, but not limited to, the Ameiuridae, Cetrarchiclae, and 

Cyprinidae families of fish (e.g., respectively, catfish, sunfish, and minnows) in ponds, raceways, or other similar structures which 

discharge at least 30 days per year, but does not include; 

1. Closed ponds which discharge only during periods of excess runoff; or 

2. Facilities which produce less than 45,454 harvest weight kilograms (approximately 100,000 pounds) of aquatic animals per year. 

DAILY DISCHARGE means the “discharge of a pollutant” measured during a calendar day or any 24-hour period that reasonably 

represents the calendar day for purposes of sampling. For pollutants with limitations expressed in units of mass, the “daily discharge” is 

calculated as the total mass of the pollutant discharged over the day. For pollutants with limitations expressed in other units of 

measurement, the “daily discharge” is calculated as the average measurement of the pollutant over the day. 

DIRECT DISCHARGE means the “discharge of a pollutant.” 

DIRECTOR means the Regional Administrator or the State Director, as the context requires, or an authorized representative. When there 

is no “approved State program,” and there is an EPA administered program, “Director” means the Regional Administrator. When there is 

an approved State program, “Director” normally means the State Director. In some circumstances, however, EPA retains the authority to 

For Comment Only
Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2A—GLOSSARY CONTINUED 

take certain actions even when there is an approved State program. (For example, when EPA has issued an NPDES permit prior to the 

approval of a State program, EPA may retain jurisdiction over that permit after program approval, see § 123.1.) In such cases, the term 

“Director” means the Regional Administrator and not the State Director. 

DISCHARGE (OF A POLLUTANT) means: 

A. Any addition of any pollutant or combination of pollutants to waters of the United States from any point source; or 

B. Any addition of any pollutant or combination of pollutants to the waters of the contiguous zone or the ocean from any point source other 

than a vessel or other floating craft which is being used as a means of transportation. 

This definition includes discharges into waters of the United States from: Surface runoff which is collected or channelled by man; 

Discharges through pipes, sewers, or other conveyances owned by a State, municipality, or other person which do not lead to POTW’s; 

and discharges through pipes, sewers, or other conveyances, leading into privately owned treatment works. This term does not include an 

addition of pollutants by any indirect discharger. 

DISCHARGE MONITORING REPORT means the EPA uniform national form, including any subsequent additions, revisions, or 

modifications for the reporting of self-monitoring results by permittees. DMRs must be used by “approved States” as well as by EPA. EPA 

will supply DMRs to any approved State upon request. The EPA national forms may be modified to substitute the state agency name, 

address, logo, and other similar information, as appropriate, in place of EPA's. 

DRAFT PERMIT means a document prepared under § 124.6 indicating the Director's tentative decision to issue or deny, modify, revoke 

and reissue, terminate, or reissue a “permit.” A notice of intent to terminate a permit, and a notice of intent to deny a permit, as discussed 

in § 124.5, are types of “draft permits.” A denial of a request for modification, revocation and reissuance, or termination, as discussed in 

§ 124.5, is not a “draft permit.” A “proposed permit” is not a “draft permit.” 

EFFLUENT LIMITATION means any restriction imposed by the Director on quantities, discharge rates, and concentrations of “pollutants” 

which are “discharged” from “point sources” into “waters of the United States,” the waters of the “contiguous zone,” or the ocean. 

EFFLUENT LIMITATIONS GUIDELINES means a regulation published by the Administrator under section 304(b) of CWA to adopt or 

revise “effluent limitations.” 

ENVIRONMENTAL PROTECTION AGENCY (EPA) means the United States Environmental Protection Agency. 

FACILITY or ACTIVITY means any NPDES “point source” or any other facility or activity (including land or appurtenances thereto) that is 

subject to regulation under the NPDES program. 

GENERAL PERMIT means an NPDES “permit” issued under § 122.28 authorizing a category of discharges under the CWA within a 

geographical area. 

HAZARDOUS SUBSTANCE means any substance designated under 40 CFR part 116 pursuant to section 311 of CWA. 

INDIAN COUNTRY means: 

(1) All land within the limits of any Indian reservation under the jurisdiction of the United States Government, notwithstanding the issuance 

of any patent, and, including rights-of-way running through the reservation; 

(2) All dependent Indian communities with the borders of the United States whether within the originally or subsequently acquired territory 

thereof, and whether within or without the limits of a state; and 

(3) All Indian allotments, the Indian titles to which have not been extinguished, including rights-of-way running through the same. 

INDIAN TRIBE means any Indian Tribe, band, group, or community recognized by the Secretary of the Interior and exercising 

governmental authority over a Federal Indian reservation. 

INDIRECT DISCHARGE means a nondomestic discharger introducing “pollutants” to a “publicly owned treatment works.” 

LOG SORTING AND LOG STORAGE FACILITIES (defined at § 122.27) means facilities whose discharges result from the holding of 

unprocessed wood, for example, logs or roundwood with bark or after removal of bark held in self-contained bodies of water (mill ponds or 

log ponds) or stored on land where water is applied intentionally on the logs (wet decking). (See 40 CFR part 429, subpart I, including the 

effluent limitations guidelines.)

MAJOR FACILITY means any NPDES “facility or activity” classified as such by the Regional Administrator, or, in the case of “approved 

State programs,” the Regional Administrator in conjunction with the State Director. 

MAXIMUM DAILY DISCHARGE LIMITATION means the highest allowable “daily discharge.” 

For Comment Only
Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2A—GLOSSARY CONTINUED 

MUNICIPALITY means a city, town, borough, county, parish, district, association, or other public body created by or under State law and 

having jurisdiction over disposal of sewage, industrial wastes, or other wastes, or an Indian tribe or an authorized Indian tribal organization, 

or a designated and approved management agency under section 208 of CWA. 

MUNICIPAL SEPARATE STORM SEWER SYSTEM (MS4) (defined at § 122.26 (b)(4) and (b)(7)) means a conveyance or system of 

conveyances (including roads with drainage systems, municipal streets, catch basins, curbs, gutters, ditches, man-made channels, or 

storm drains): 

 Owned or operated by a state, city, town, borough, county, parish, district, association, or other public body (created by or 

pursuant to state law) having jurisdiction over disposal of sewage, industrial wastes, stormwater, or other wastes, including 

special districts under state law such as a sewer district, flood control district or drainage district, or similar entity, or an Indian 

tribe or an authorized Indian tribal organization, or a designated and approved management agency under CWA section 208 that 

discharges to waters of the United States. 

 Designed or used for collecting or conveying stormwater. 

 [That] is not a combined sewer. 

 [That] is not part of a Publicly Owned Treatment Works (POTW) as defined at § 122.2. 

MUNICIPAL SLUDGE (see sewage sludge) 

NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) means the national program for issuing, modifying, revoking 

and reissuing, terminating, monitoring and enforcing permits, and imposing and enforcing pretreatment requirements, under sections 307, 

402, 318, and 405 of CWA. The term includes an “approved program.” 

NEW DISCHARGER means any building, structure, facility, or installation: 

(a) From which there is or may be a “discharge of pollutants;” 

(b) That did not commence the “discharge of pollutants” at a particular “site” prior to August 13, 1979; 

(c) Which is not a “new source;” and 

(d) Which has never received a finally effective NDPES permit for discharges at that “site.” 

This definition includes an “indirect discharger” which commences discharging into “waters of the United States” after August 13, 1979. It 

also means any existing mobile point source (other than an offshore or coastal oil and gas exploratory drilling rig or a coastal oil and gas 

developmental drilling rig) such as a seafood processing rig, seafood processing vessel, or aggregate plant, that begins discharging at a 

“site” for which it does not have a permit; and any offshore or coastal mobile oil and gas exploratory drilling rig or coastal mobile oil and gas 

developmental drilling rig that commences the discharge of pollutants after August 13, 1979, at a “site” under EPA's permitting jurisdiction 

for which it is not covered by an individual or general permit and which is located in an area determined by the Regional Administrator in 

the issuance of a final permit to be an area of biological concern. In determining whether an area is an area of biological concern, the 

Regional Administrator shall consider the factors specified in 40 CFR 125.122(a) (1) through (10). 

An offshore or coastal mobile exploratory drilling rig or coastal mobile developmental drilling rig will be considered a “new discharger” only 

for the duration of its discharge in an area of biological concern. 

NEW SOURCE means any building, structure, facility, or installation from which there is or may be a “discharge of pollutants,” the 

construction of which commenced: 

(a) After promulgation of standards of performance under section 306 of CWA which are applicable to such source, or 

(b) After proposal of standards of performance in accordance with section 306 of CWA which are applicable to such source, but only if the 

standards are promulgated in accordance with section 306 within 120 days of their proposal. 

OWNER OR OPERATOR means the owner or operator of any “facility or activity” subject to regulation under the NPDES program. 

PERMIT means an authorization, license, or equivalent control document issued by EPA or an “approved State” to implement the 

requirements of this part and parts 123 and 124. “Permit” includes an NPDES “general permit” (§ 122.28). Permit does not include any 

permit which has not yet been the subject of final agency action, such as a “draft permit” or a “proposed permit.” 

PESTICIDE APPLICATIONS TO WATERS OF THE UNITED STATES means the application of biological pesticides, and the application 

of chemical pesticides that leave a residue, from point sources to waters of the United States. In the context of this definition of pesticide 

applications to waters of the United States, this does not include agricultural stormwater discharges and return flows from irrigated 

agriculture, which are excluded by law (Id. § 1342(l)). 

For Comment Only
Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2A—GLOSSARY CONTINUED 

POINT SOURCE means any discernible, confined, and discrete conveyance, including but not limited to, any pipe, ditch, channel, tunnel, 

conduit, well, discrete fissure, container, rolling stock, concentrated animal feeding operation, landfill leachate collection system, vessel or 

other floating craft from which pollutants are or may be discharged. This term does not include return flows from irrigated agriculture or 

agricultural stormwater runoff. (See § 122.3).

POLLUTANT means dredged spoil, solid waste, incinerator residue, filter backwash, sewage, garbage, sewage sludge, munitions, 

chemical wastes, biological materials, radioactive materials (except those regulated under the Atomic Energy Act of 1954, as amended (42 

U.S.C. 2011 et seq. )), heat, wrecked or discarded equipment, rock, sand, cellar dirt and industrial, municipal, and agricultural waste 

discharged into water. It does not mean: 

(a) Sewage from vessels; or 

(b) Water, gas, or other material which is injected into a well to facilitate production of oil or gas, or water derived in association with oil and 

gas production and disposed of in a well, if the well used either to facilitate production or for disposal purposes is approved by authority of 

the State in which the well is located, and if the State determines that the injection or disposal will not result in the degradation of ground or 

surface water resources. Note: Radioactive materials covered by the Atomic Energy Act are those encompassed in its definition of source, 

byproduct, or special nuclear materials. Examples of materials not covered include radium and accelerator-produced isotopes. See Train v. 

Colorado Public Interest Research Group, Inc., 426 U.S. 1 (1976). 

PRIMARY INDUSTRY CATEGORY means any industry category listed in the NRDC settlement agreement (Natural Resources Defense 

Council et al. v. Train, 8 E.R.C. 2120 (D.D.C. 1976), modified 12 E.R.C. 1833 (D.D.C. 1979)); also listed in appendix A of part 122. 

PRIVATELY OWNED TREATMENT WORKS means any device or system which is (a) used to treat wastes from any facility whose 

operator is not the operator of the treatment works and (b) not a “POTW.” 

PROCESS WASTEWATER means any water which, during manufacturing or processing, comes into direct contact with or results from the 

production or use of any raw material, intermediate product, finished product, byproduct, or waste product. 

PROPOSED PERMIT means a State NPDES “permit” prepared after the close of the public comment period (and, when applicable, any 

public hearing and administrative appeals) which is sent to EPA for review before final issuance by the State, or a State NPDES permit 

designated as a proposed permit under § 123.44(k). A “proposed permit” is not a “draft permit.” 

PUBLICLY OWNED TREATMENT WORKS or POTW (defined at § 403.3) means a treatment works as defined by CWA Section 212, 

which is owned by a state or municipality [as defined by CWA Section 502(4)]. This definition includes any devices or systems used in the 

storage, treatment, recycling, and reclamation) of municipal sewage or industrial wastes of a liquid nature. This definition also includes 

sewers, pipes, and other conveyances only if they convey wastewater to a POTW. The term also means the municipality as defined in 

CWA Section 502(4), which has jurisdiction over the indirect discharges to and the discharges from such a treatment works. 

REGIONAL ADMINISTRATOR means the Regional Administrator of the appropriate Regional Office of the Environmental Protection 

Agency or the authorized representative of the Regional Administrator. 

ROCK CRUSHING AND GRAVEL WASHING FACILITIES (defined at § 122.27) means facilities which process crushed and broken 

stone, gravel, and riprap (See 40 CFR part 436, subpart B, including the effluent limitations guidelines). 

SCHEDULE OF COMPLIANCE means a schedule of remedial measures included in a “permit”, including an enforceable sequence of 

interim requirements (for example, actions, operations, or milestone events) leading to compliance with the CWA and regulations. 

SECONDARY INDUSTRY CATEGORY means any industry category which is not a primary industry category. 

SEWAGE FROM VESSELS means human body wastes and the wastes from toilets and other receptacles intended to receive or retain 

body wastes that are discharged from vessels and regulated under section 312 of CWA, except that with respect to commercial vessels on 

the Great Lakes this term includes graywater. For the purposes of this definition, “graywater” means galley, bath, and shower water. 

SEWAGE SLUDGE means any solid, semi-solid, or liquid residue removed during the treatment of municipal waste water or domestic 

sewage. Sewage sludge includes, but is not limited to, solids removed during primary, secondary, or advanced waste water treatment, 

scum, septage, portable toilet pumpings, type III marine sanitation device pumpings (33 CFR part 159), and sewage sludge products. 

Sewage sludge does not include grit or screenings, or ash generated during the incineration of sewage sludge. 

SlLVICULTURAL POINT SOURCE (defined at § 122.27) means any discernible, confined, and discrete conveyance related to rock 

crushing, gravel washing, log sorting, or log storage facilities which are operated in connection with silvicultural activities and from which 

pollutants are discharged into waters of the United States. This term does not include nonpoint source silvicultural activities such as 

nursery operations, site preparation, reforestation and subsequent cultural treatment, thinning, prescribed burning, pest and fire control, 

harvesting operations, surface drainage, or road construction and maintenance from which there is natural runoff. However, some of these 

activities (such as stream crossing for roads) may involve point source discharges of dredged or fill material which may require a CWA 

Section 404 permit (see 33 CFR 209.120 and part 233). 

For Comment Only
Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2A—GLOSSARY CONTINUED 

SITE means the land or water area where any “facility or activity” is physically located or conducted, including adjacent land used in 

connection with the facility or activity. 

SLUDGE ONLY FACILITY means any “treatment works treating domestic sewage” whose methods of sewage sludge use or disposal are 

subject to regulations promulgated pursuant to section 405(d) of the CWA and is required to obtain a permit under § 122.1(b)(2). 

STANDARDS FOR SEWAGE SLUDGE USE OR DISPOSAL means the regulations promulgated pursuant to section 405(d) of the CWA 

which govern minimum requirements for sludge quality, management practices, and monitoring and reporting applicable to sewage sludge 

or the use or disposal of sewage sludge by any person. 

STATE means any of the 50 States, the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Virgin Islands, American 

Samoa, the Commonwealth of the Northern Mariana Islands, the Trust Territory of the Pacific Islands, or an Indian Tribe as defined in 

these regulations which meets the requirements of § 123.31 of this chapter. 

STATE DIRECTOR means the chief administrative officer of any State or interstate agency operating an “approved program,” or the 

delegated representative of the State Director. If responsibility is divided among two or more State or interstate agencies, “State Director” 

means the chief administrative officer of the State or interstate agency authorized to perform the particular procedure or function to which 

reference is made. 

STORMWATER (or STORM WATER) (defined at § 122.26(b)(13)) means stormwater runoff, snow melt runoff, and surface runoff and 

drainage. 

STORMWATER DISCHARGE ASSOCIATED WITH INDUSTRIAL ACTIVITY (defined at § 122.26(b)(14)) means the discharge from any 

conveyance that is used for collecting and conveying stormwater and that is directly related to manufacturing, processing or raw materials 

storage areas at an industrial plant. The term does not include discharges from facilities or activities excluded from the NPDES program 

under this part 122. For the categories of industries identified in this section, the term includes, but is not limited to, stormwater discharges 

from industrial plant yards; immediate access roads and rail lines used or traveled by carriers of raw materials, manufactured products, 

waste material, or by-products used or created by the facility; material handling sites; refuse sites; sites used for the application or disposal 

of process waste waters (as defined at part 401 of this chapter); sites used for the storage and maintenance of material handling 

equipment; sites used for residual treatment, storage, or disposal; shipping and receiving areas; manufacturing buildings; storage areas 

(including tank farms) for raw materials, and intermediate and final products; and areas where industrial activity has taken place in the past 

and significant materials remain and are exposed to stormwater. For the purposes of this paragraph, material handling activities include 

storage, loading and unloading, transportation, or conveyance of any raw material, intermediate product, final product, by-product or waste 

product. The term excludes areas located on plant lands separate from the plant's industrial activities, such as office buildings and 

accompanying parking lots as long as the drainage from the excluded areas is not mixed with stormwater drained from the above 

described areas. Industrial facilities (including industrial facilities that are federally, State, or municipally owned or operated that meet the 

description of the facilities listed in paragraphs (b)(14)(i) through (xi) of this section) include those facilities designated under the provisions 

of paragraph (a)(1)(v) of this section. The following categories of facilities are considered to be engaging in “industrial activity” for purposes 

of paragraph (b)(14): 

(i) Facilities subject to stormwater effluent limitations guidelines, new source performance standards, or toxic pollutant effluent standards 

under 40 CFR subchapter N (except facilities with toxic pollutant effluent standards which are exempted under category (xi) in paragraph 

(b)(14) of this section); 

(ii) Facilities classified as Standard Industrial Classifications 24, Industry Group 241 that are rock crushing, gravel washing, log sorting, or 

log storage facilities operated in connection with silvicultural activities defined in 40 CFR 122.27(b)(2)-(3) and Industry Groups 242 through 

249; 26 (except 265 and 267), 28 (except 283), 29, 311, 32 (except 323), 33, 3441, 373; (not included are all other types of silvicultural 

facilities); 

(iii) Facilities classified as Standard Industrial Classifications 10 through 14 (mineral industry) including active or inactive mining operations 

(except for areas of coal mining operations no longer meeting the definition of a reclamation area under 40 CFR 434.11(1) because the 

performance bond issued to the facility by the appropriate SMCRA authority has been released, or except for areas of non-coal mining 

operations which have been released from applicable State or Federal reclamation requirements after December 17, 1990) and oil and gas 

exploration, production, processing, or treatment operations, or transmission facilities that discharge stormwater contaminated by contact 

with or that has come into contact with, any overburden, raw material, intermediate products, finished products, byproducts or waste 

products located on the site of such operations; (inactive mining operations are mining sites that are not being actively mined, but which 

have an identifiable owner/operator; inactive mining sites do not include sites where mining claims are being maintained prior to 

disturbances associated with the extraction, beneficiation, or processing of mined materials, nor sites where minimal activities are 

undertaken for the sole purpose of maintaining a mining claim); 

(iv) Hazardous waste treatment, storage, or disposal facilities, including those that are operating under interim status or a permit under 

subtitle C of RCRA; 

For Comment Only
Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2A—GLOSSARY CONTINUED 

(v) Landfills, land application sites, and open dumps that receive or have received any industrial wastes (waste that is received from any of 

the facilities described under this subsection) including those that are subject to regulation under subtitle D of RCRA; 

(vi) Facilities involved in the recycling of materials, including metal scrapyards, battery reclaimers, salvage yards, and automobile 

junkyards, including but limited to those classified as Standard Industrial Classification 5015 and 5093; 

(vii) Steam electric power generating facilities, including coal handling sites; 

(viii) Transportation facilities classified as Standard Industrial Classifications 40, 41, 42 (except 4221–25), 43, 44, 45, and 5171 which have 

vehicle maintenance shops, equipment cleaning operations, or airport deicing operations. Only those portions of the facility that are either 

involved in vehicle maintenance (including vehicle rehabilitation, mechanical repairs, painting, fueling, and lubrication), equipment cleaning 

operations, airport deicing operations, or which are otherwise identified under paragraphs (b)(14) (i)–(vii) or (ix)–(xi) of this section are 

associated with industrial activity; 

(ix) Treatment works treating domestic sewage or any other sewage sludge or wastewater treatment device or system, used in the storage 

treatment, recycling, and reclamation of municipal or domestic sewage, including land dedicated to the disposal of sewage sludge that are 

located within the confines of the facility, with a design flow of 1.0 mgd or more, or required to have an approved pretreatment program 

under 40 CFR part 403. Not included are farm lands, domestic gardens or lands used for sludge management where sludge is beneficially 

reused and which are not physically located in the confines of the facility, or areas that are in compliance with section 405 of the CWA; 

(x) Construction activity including clearing, grading and excavation, except operations that result in the disturbance of less than five acres 

of total land area. Construction activity also includes the disturbance of less than five acres of total land area that is a part of a larger 

common plan of development or sale if the larger common plan will ultimately disturb five acres or more; 

(xi) Facilities under Standard Industrial Classifications 20, 21, 22, 23, 2434, 25, 265, 267, 27, 283, 285, 30, 31 (except 311), 323, 34 

(except 3441), 35, 36, 37 (except 373), 38, 39, and 4221–25;. 

TOXIC POLLUTANT means any pollutant listed as toxic under section 307(a)(1) or, in the case of “sludge use or disposal practices,” any 

pollutant identified in regulations implementing section 405(d) of the CWA. 

TREATMENT WORKS TREATING DOMESTIC SEWAGE (TWTDS) means a POTW or any other sewage sludge or waste water 

treatment devices or systems, regardless of ownership (including federal facilities), used in the storage, treatment, recycling, and 

reclamation of municipal or domestic sewage, including land dedicated for the disposal of sewage sludge. This definition does not include 

septic tanks or similar devices. For purposes of this definition, “domestic sewage” includes waste and waste water from humans or 

household operations that are discharged to or otherwise enter a treatment works. In States where there is no approved State sludge 

management program under section 405(f) of the CWA, the Regional Administrator may designate any person subject to the standards for 

sewage sludge use and disposal in 40 CFR part 503 as a “treatment works treating domestic sewage,” where he or she finds that there is 

a potential for adverse effects on public health and the environment from poor sludge quality or poor sludge handling, use or disposal 

practices, or where he or she finds that such designation is necessary to ensure that such person is in compliance with 40 CFR part 503. 

UPSET (defined at § 122.41(n)) means an exceptional incident in which there is unintentional and temporary noncompliance with 

technology based permit effluent limitations because of factors beyond the reasonable control of the permittee. An upset does not include 

noncompliance to the extent caused by operational error, improperly designed treatment facilities, inadequate treatment facilities, lack of 

preventive maintenance, or careless or improper operation.

VARIANCE means any mechanism or provision under section 301 or 316 of CWA or under 40 CFR part 125, or in the applicable “effluent 

limitations guidelines” which allows modification to or waiver of the generally applicable effluent limitation requirements or time deadlines of 

CWA. This includes provisions which allow the establishment of alternative limitations based on fundamentally different factors or on 

sections 301(c), 301(g), 301(h), 301(i), or 316(a) of CWA. 

WATERS OF THE UNITED STATES (defined at § 122.2) means:

(a) All waters which are currently used, were used in the past, or may be susceptible to use in interstate or foreign commerce, including all 

waters which are subject to the ebb and flow of the tide; 

(b) All interstate waters, including interstate “wetlands;” 

(c) All other waters such as intrastate lakes, rivers, streams (including intermittent streams), mudflats, sandflats, “wetlands,” sloughs, 

prairie potholes, wet meadows, playa lakes, or natural ponds, the use, degradation, or destruction of which would affect or could affect 

interstate or foreign commerce including any such waters: 

(1) Which are or could be used by interstate or foreign travelers for recreational or other purposes; 

(2) From which fish or shellfish are or could be taken and sold in interstate or foreign commerce; or 

(3) Which are used or could be used for industrial purposes by industries in interstate commerce; 

(d) All impoundments of waters otherwise defined as waters of the United States under this definition; 

For Comment Only
Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2A—GLOSSARY CONTINUED 

(e) Tributaries of waters identified in paragraphs (a) through (d) of this definition; 

(f) The territorial sea; and 

(g) “Wetlands” adjacent to waters (other than waters that are themselves wetlands) identified in paragraphs (a) through (f) of this definition. 

Waste treatment systems, including treatment ponds or lagoons designed to meet the requirements of CWA (other than cooling ponds as 

defined in 40 CFR 423.11(m) which also meet the criteria of this definition) are not waters of the United States. This exclusion applies only 

to manmade bodies of water which neither were originally created in waters of the United States (such as disposal area in wetlands) nor 

resulted from the impoundment of waters of the United States. [See Note 1 of this section.] Waters of the United States do not include prior 

converted cropland. Notwithstanding the determination of an area's status as prior converted cropland by any other federal agency, for the 

purposes of the Clean Water Act, the final authority regarding Clean Water Act jurisdiction remains with EPA. 

WHOLE EFFLUENT TOXICITY (WET) means the aggregate toxic effect of an effluent measured directly by a toxicity test where the test 

results are based on acute (lethal) and/or chronic (lethal and sublethal) endpoints. 

For Comment Only
EPA Form 3510-2A (Revised <INSERT DATE>) Page 1 

EPA Identification Number NPDES Permit Number Facility Name Form Approved

OMB No. <INSERT NO.> 

Form Expires <INSERT DATE> 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

Form 

2A 

NPDES

U.S. Environmental Protection Agency 

Application for NPDES Permit to Discharge Wastewater 

NEW AND EXISTING PUBLICLY OWNED TREATMENT WORKS

SECTION 1. BASIC APPLICATION INFORMATION FOR ALL APPLICANTS (40 CFR 122.21(j)(1) and (9)) Facility Information 

1.1 Facility Name 

 Mailing Address (Street or P.O. Box) 

City or Town State ZIP Code 

Contact Name (first and last) Title Phone Number Email Address 

Location Address (Street, Route Number or Other Specific Identifier)  Same as mailing address 

City or Town State ZIP Code 

Facility Latitude/Longitude (See Instructions.)

Latitude Longitude 

Degrees Minutes Seconds Degrees Minutes Seconds 

 

Reference Point (Check one.) Collection Method Information 

 Entrance to Facility

 Center of Facility

 Other (specify)

Horizontal Collection Method (Type of 

method/device used to identify the coordinates)

Scale (Proportional distance on the ground for 

one unit of measure) Not Applicable

Horizontal Reference Datum

(Coordinate reference system)

 NAD 27  NAD 83 

 WGS85  Other (specify) 

1.2 Is this application for a facility that has yet to commence discharge? 

 Yes  See Instructions regarding data 

submission requirements for new 

dischargers. 

 No 

Applicant Information 

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) 

City or Town State ZIP Code 

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 in the same.) 

For Comment Only
EPA Form 3510-2A (Revised <INSERT DATE>) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved

OMB No. <INSERT NO.> 

Form Expires <INSERT DATE> 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

Existing Environmental Permits 

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 

water) 

 RCRA (hazardous waste)  UIC (underground injection 

control) 

 PSD (air emissions)  Nonattainment program (CAA)  NESHAPS (CAA) 

 Ocean dumping (MPRSA)  Dredge or fill (CWA section 

404) 

 Other (specify) 

Collection System and Population Served 

1.7 Provide the collection system information requested below for the treatment works. 

Municipality 

Served 

Population 

Served 

Collection System Type 

(indicate percentage) 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 

_____ % 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 

Total 

Population 

Served 

Total Percentage of Each Type of 

Sewer Line 

(in miles) 

Separate Sanitary Sewer System Combined Storm and 

Sanitary Sewer 

% % 

Indian Country

1.8 Is the treatment works located in Indian Country? 

 Yes  No 

1.9 Does the facility discharge to a receiving water that flows through Indian Country? 

 Yes  No 

Design and Actual 

 Flow Rates 

1.10 Provide design and actual flow rates in the designated spaces. Design Flow Rate 

mgd 

Annual Average Flow Rates (Actual)

Two Years Ago Last Year This Year 

mgd mgd mgd 

Maximum Daily Flow Rates (Actual) 

Two Years Ago Last Year This Year 

 mgd mgd mgd 

For Comment Only
EPA Form 3510-2A (Revised <INSERT DATE>) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved

OMB No. <INSERT NO.> 

Form Expires <INSERT DATE> 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

Discharge Points 

by Type 

1.11 Provide the total number of effluent discharge points to waters of the United States by type. 

Total Number of Effluent Discharge Points by Type 

Treated Effluent Untreated Effluent Combined Sewer 

Overflows Bypasses 

Constructed 

Emergency 

Overflows 

 

Outfalls and Other Discharge or Disposal Methods 

Outfalls Other Than to Waters of the United States 

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 United States?

 Yes  No  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 

Location 

Average Daily Volume 

Discharged to Surface 

Impoundment 

Continuous or Intermittent 

(Check one.) 

 gpd 

 Continuous 

 Intermittent 

 gpd 

 Continuous 

 Intermittent 

 gpd  Continuous 

 Intermittent 

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 

Location Size Average Daily Volume 

Applied 

Continuous or 

Intermittent 

(Check one.) 

acres gpd  Continuous 

 Intermittent 

acres gpd  Continuous 

 Intermittent 

acres gpd  Continuous 

 Intermittent 

1.16 Is effluent transported to another facility for treatment prior to discharge? 

 Yes  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  SKIP to Item 1.20. 

1.19 Provide information on the transporter below. 

Transporter 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 

For Comment Only
EPA Form 3510-2A (Revised <INSERT DATE>) Page 4

EPA Identification Number NPDES Permit Number Facility Name Form Approved

OMB No. <INSERT NO.> 

Form Expires <INSERT DATE> 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

Outfalls and Other Discharge or Disposal Methods Continued 

1.20 In the table below, indicate the name, address, contact information, NPDES number, and average daily flow rate of the 

receiving facility. 

Receiving Facility Data 

 Facility Name Mailing Address (Street or P.O. Box) 

 City or Town State ZIP Code 

 Contact Name (first and last) Title 

 Phone Number Email Address 

 NPDES Number of Receiving Facility (if any)  None Average Daily Flow Rate 

mgd 

1.21 Is the wastewater disposed to places/structures (other than those already mentioned) that do not have outlets to waters 

of the United States (e.g., underground percolation, underground injection)? 

 Yes  No  SKIP to Item 1.23. 

1.22 Provide information in the table below on these other disposal methods. 

Information on Other Disposal Methods 

Disposal 

Method 

Description 

Location of 

Disposal Site 

Size of 

Disposal Site 

Annual Average 

Daily Discharge 

Volume 

Continuous or Intermittent 

(Check one.) 

 acres gpd  Continuous 

 Intermittent 

 acres gpd  Continuous 

 Intermittent 

 acres gpd  Continuous 

 Intermittent 

Contractor Information 

1.23 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. 

1.24 Provide location and contact information for each contractor in addition to a description of the contractor's O&M 

responsibilities. 

Contractor Information 

Contractor 1 Contractor 2 Contractor 3 

Contractor Name 

(company name) 

 

Mailing Address 

(Street or P.O. Box) 

City, State, and ZIP 

Code 

Contact Name (first and 

last) 

Phone Number 

Email Address 

O&M Responsibilities of 

Contractor 

For 

 

Comment Only
EPA Form 3510-2A (Revised <INSERT DATE>) Page 5

EPA Identification Number NPDES Permit Number Facility Name Form Approved

OMB No. <INSERT NO.> 

Form Expires <INSERT DATE> 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

SECTION 2. ADDITIONAL INFORMATION (40 CFR 122.21(j)(1) and (2)) Design Flow

Outfalls to Waters of the United States 

2.1 Does the treatment works have a design flow greater than or equal to 0.1 mgd? 

 Yes  No  SKIP to Section 3. 

Inflow and Infiltration 

2.2 Provide the treatment work’s current average daily volume of inflow 

and infiltration. 

Average Daily Volume of Inflow and Infiltration 

gpd 

Indicate the steps the facility is taking to minimize inflow and infiltration. 

Topographic 

Map 

2.3 Have you attached a topographic map containing all required information to this application? (See Instructions for 

specific requirements.) 

 Yes  No 

Flow 

Diagram 

2.4 Have you attached a process flow diagram or schematic containing all required information to this application? (See 

Instructions for specific requirements.) 

 Yes  No 

Scheduled Improvements and Schedules of Implementation 

2.5 Are improvements to the facility scheduled? 

 Yes  No  SKIP to Section 3. 

Briefly list and describe the scheduled improvements. 

1. 

2. 

3. 

4. 

2.6 Provide scheduled or actual dates of completion for improvements. 

Scheduled or Actual Dates of Completion for Improvements 

Scheduled 

Improvement 

(from above) 

Affected 

Outfalls 

(list Outfall 

Number)

Begin 

Construction 

(MM/DD/YYYY) 

End 

Construction 

(MM/DD/YYYY)

Begin 

Discharge 

(MM/DD/YYYY)

Attainment of 

Operational 

Level 

(MM/DD/YYYY)

 1. 

 2. 

 3. 

 4. 

For Comment Only
EPA Form 3510-2A (Revised <INSERT DATE>) Page 6

EPA Identification Number NPDES Permit Number Facility Name Form Approved

OMB No. <INSERT NO.> 

Form Expires <INSERT DATE> 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

2.7 Have appropriate permits/clearances concerning other federal/state requirements been obtained? Briefly explain your 

response. 

 Yes  No  None required or applicable 

Explanation: 

SECTION 3. INFORMATION ON EFFLUENT DISCHARGES (40 CFR 122.21(j)(3) to (5)) Description of Outfalls 

3.1 Provide the following information for each outfall. (Attach additional sheets if you have more than three outfalls.) 

Outfall Number ______ Outfall Number _____ Outfall Number ______ 

State 

County 

City or Town 

Distance from Shore ft. ft. ft. 

Depth Below Surface ft. ft. ft. 

Average Daily Flow Rate mgd mgd mgd 

Latitude 

Longitude 

 Horizontal Collection 

Method (Type of method/device 

used to identify the coordinates)

 

 Scale (Proportional distance on 

the ground for one unit of 

measure)

Not Applicable Not Applicable Not Applicable

Horizontal Reference 

Datum (Coordinate reference 

system)

 NAD 27  NAD 83 

 WGS85  Other 

(specify) 

 NAD 27  NAD 83 

 WGS85  Other 

(specify) 

 NAD 27  NAD 83 

 WGS85  Other 

(specify) 

Seasonal or Periodic Discharge Data 

3.2 Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges? 

 Yes  No  SKIP to Item 3.4. 

3.3 If so, provide the following information for each applicable outfall. 

Outfall Number _____ Outfall Number _____ Outfall Number _____ 

 Number of times per year 

discharge occurs 

 Average duration of each 

discharge (specify units) 

 Average flow of each 

discharge mgd mgd mgd 

 Months in which discharge 

occurs 

 

 Diffuser Type 

3.4 Are any of the outfalls listed under Item 3.1 equipped with a diffuser? 

 Yes  No  SKIP to Item 3.6. 

3.5 Briefly describe the diffuser type at each applicable outfall.

Outfall Number _____ Outfall Number _____ Outfall Number _____ 

 

For Comment Only
EPA Form 3510-2A (Revised <INSERT DATE>) Page 7

EPA Identification Number NPDES Permit Number Facility Name Form Approved

OMB No. <INSERT NO.> 

Form Expires <INSERT DATE> 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

Waters of 

the U.S. 

3.6 Does the treatment works discharge or plan to discharge wastewater to waters of the United States from one or more 

discharge points? 

 Yes  No  SKIP to Section 6. 

Receiving Water Description 

3.7 Provide the receiving water and related information (if known) for each outfall.

Outfall Number _____ Outfall Number _____ Outfall Number _____ 

 Receiving Water Name 

Watershed, River or 

Stream System 

 14-Digit Watershed Code 

State Management / River 

Basin 

8-Digit Hydrological 

Cataloging Unit Code 

 Critical Low Flow (Acute) cfs cfs cfs 

 Critical Low Flow (Chronic) cfs cfs cfs 

Total Hardness at Critical 

Low Flow 

mg/L of 

CaCO3

mg/L of 

CaCO3

mg/L of 

CaCO3

Treatment Description 

3.8 Provide the following information describing the treatment provided for discharges from each outfall. 

Outfall Number _____ Outfall Number _____ Outfall Number _____ 

Highest Level of 

Treatment (Check all that 

apply per outfall.) 

 Primary 

 Equivalent to 

Secondary 

 Secondary 

 Advanced 

 Other (specify) 

 Primary 

 Equivalent to 

Secondary 

 Secondary 

 Advanced 

 Other (specify)

 Primary 

 Equivalent to 

Secondary 

 Secondary 

 Advanced 

 Other (specify)

Design Removal Rates by 

Outfall 

BOD5 or CBOD5 % % % 

TSS % % % 

Phosphorus 

 Not applicable  Not applicable  Not applicable 

% % % 

Nitrogen 

 Not applicable  Not applicable  Not applicable 

% % % 

 Other (specify)  Not applicable  Not applicable  Not applicable 

% % % 

For Comment Only
EPA Form 3510-2A (Revised <INSERT DATE>) Page 8

EPA Identification Number NPDES Permit Number Facility Name Form Approved

OMB No. <INSERT NO.> 

Form Expires <INSERT DATE> 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

Treatment Description Continued 

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. 

Outfall Number _____ Outfall Number _____ Outfall Number _____ 

 Disinfection Type 

 Seasons Used 

 Dechlorination Used? 



Not Applicable  Not Applicable  Not Applicable 

Yes  Yes  Yes 

 No  No  No 

Effluent Testing Data 

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  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 points. 

Outfall Number _____ Outfall Number ______ Outfall Number _____ 

Acute Chronic Acute Chronic Acute Chronic 

 Number of tests of discharge 

water 

 Number of tests of receiving 

water 

3.13 Does the treatment works have a design flow greater than or equal to 0.1 mgd? 

 Yes  No  SKIP to Item 3.16. 

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  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 

3.16 Do one or more of the following conditions apply? 

1. The facility has a design flow greater than or equal to 1 mgd. 

2. The POTW has an approved pretreatment program or is required to develop such a program. 

3. The NPDES permitting authority has informed the POTW that it must sample for the parameters in Table C, must 

sample other additional parameters (Table D), or submit the results of WET tests for acute or chronic toxicity for 

each of its discharge outfalls (Table E). 

 Yes  Complete Tables C, D, and E as 

applicable.  No  SKIP to Section 4. 

3.17 Have you completed monitoring for all applicable Table C pollutants and attached the results to this application 

package? 

 Yes  No 

3.18 Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and 

attached the results to this application package? 

 Yes  No additional sampling required by NPDES 

permitting authority. 

For Comment Only
EPA Form 3510-2A (Revised <INSERT DATE>) Page 9

EPA Identification Number NPDES Permit Number Facility Name Form Approved

OMB No. <INSERT NO.> 

Form Expires <INSERT DATE> 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

Effluent Testing Data Continued 

3.19 Has the POTW conducted either (a) minimum of four quarterly WET tests for one year preceding this permit application 

or (b) at least four annual WET tests in the past 4.5 years? 

 Yes  No  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 your NPDES permitting authority and provide a summary of the results. 

Date(s) Submitted 

(MM/DD/YYYY) Summary of Results

 

3.22 Regardless of how you provided your WET testing data to the NPDES permitting authority, did any of the tests result in 

toxicity? 

 Yes  No  SKIP to Item 3.26. 

3.23 Describe the cause(s) of the toxicity: 

3.24 Has the treatment works conducted a Toxicity Reduction Evaluation? 

 Yes  No  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. 

SECTION 4. INDUSTRIAL DISCHARGES AND HAZARDOUS WASTES (40 CFR 122.21(j)(6) and (7)) Industrial Discharges and Hazardous Wastes 

4.1 Does the POTW receive discharges from SIUs or CIUs? 

 Yes  No  SKIP to Item 4.7. 

4.2 Indicate the number of SIUs and CIUs that discharge to the POTW. 

Number of SIUs Number of CIUs 

 

4.3 Does the POTW have an approved pretreatment program? 

 Yes  No 

4.4 Have you submitted either of the following to the NPDES permitting authority that contains information substantially 

identical to that required in Table F: (a) a pretreatment program annual report submitted within one year of the 

application or (b) a pretreatment program? 

 Yes  No  SKIP to Item 4.6. 

4.5 Identify the title and date of the annual report or pretreatment program referenced in Item 4.4. SKIP to Item 4.7. 

4.6 Have you completed and attached Table F to this application package? 

 Yes  No 

For Comment Only
EPA Form 3510-2A (Revised <INSERT DATE>) Page 10

EPA Identification Number NPDES Permit Number Facility Name Form Approved

OMB No. <INSERT NO.> 

Form Expires <INSERT DATE> 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

4.7 Does the POTW receive, or has it been notified that it will receive, by truck, rail, or dedicated pipe, any wastes that are

regulated as RCRA hazardous wastes pursuant to 40 CFR Part 261? 

 Yes  No  SKIP to Item 4.9. 

Industrial Discharges and Hazardous Wastes Continued 

4.8 If yes, provide the following information: 

Hazardous Waste 

Number 

Waste Transport Method 

(Check all that apply.) 

Annual 

Amount of 

Waste 

Received 

Units 

 Truck  Rail 

 Dedicated Pipe  Other (specify) 

 Truck  Rail 

 Dedicated Pipe  Other (specify) 

 Truck  Rail 

 Dedicated Pipe  Other (specify) 

4.9 Does the POTW receive, or has it been notified that it will receive, wastewaters that originate from remedial activities, 

including those undertaken pursuant to CERCLA and sections 3004(7) or 3008(h) of RCRA? 

 Yes  No  SKIP to Section 5. 

4.10 Does the POTW receive (or expect to receive) less than 15 kilograms per month of non-acute hazardous wastes as 

specified in 40 CFR 261.30(d) and 261.33(e)? 

 Yes  SKIP to Section 5.  No 

4.11 Have you reported the following information in an attachment to this application: identification and description of the 

site(s) or facility(ies) at which the wastewater originates; the identities of the wastewater’s hazardous constituents; and 

the extent of treatment, if any, the wastewater receives or will receive before entering the POTW? 

 Yes  No 

SECTION 5. COMBINED SEWER OVERFLOWS (40 CFR 122.21(j)(8)) CSO Map and Diagram 

5.1 Does the treatment works have a combined sewer system? 

 Yes  No  SKIP to Section 6. 

5.2 Have you attached a CSO system map to this application? (See Instructions for map requirements.) 

 Yes  No 

5.3 Have you attached a CSO system diagram to this application? (See Instructions for diagram requirements.) 

 Yes  No 

For Comment Only
EPA Form 3510-2A (Revised <INSERT DATE>) Page 11

EPA Identification Number NPDES Permit Number Facility Name Form Approved

OMB No. <INSERT NO.> 

Form Expires <INSERT DATE> 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

CSO Outfall Description 

5.4 For each CSO outfall, provide the following information. (Attach additional sheets as necessary.)

CSO Outfall Number ____ CSO Outfall Number _____ CSO Outfall Number _____ 

City or Town 

State and ZIP Code 

County 

Latitude 

Longitude 

 Horizontal Collection 

Method (Type of 

method/device used to identify 

the coordinates)

 

 Scale (Proportional distance on 

the ground for one unit of 

measure)

Not Applicable Not Applicable Not Applicable

Horizontal Reference 

Datum (Coordinate reference 

system)

 NAD 27  NAD 83 

 WGS85  Other 

(specify) 

 NAD 27  NAD 83 

 WGS85  Other 

(specify) 

 NAD 27  NAD 83 

 WGS85  Other 

(specify) 

Distance from Shore ft. ft. ft. 

Depth Below Surface ft. ft. ft. 

CSO Monitoring 

5.5 Did the POTW monitor any of the following items in the past year for its CSO outfalls? 

CSO Outfall Number ____ CSO Outfall Number _____ CSO Outfall Number _____ 

Rainfall  Yes  No  Yes  No  Yes  No 

CSO Flow Volume  Yes  No  Yes  No  Yes  No 

 CSO Pollutant 

Concentrations  Yes  No  Yes  No  Yes  No 

Receiving Water Quality  Yes  No  Yes  No  Yes  No 

CSO Frequency  Yes  No  Yes  No  Yes  No 

Number of Storm Events  Yes  No  Yes  No  Yes  No 

CSO Events in Past Year 

5.6 Provide the following information for each of your CSO outfalls. 

CSO Outfall Number ____ CSO Outfall Number ____ CSO Outfall Number ____

Number of CSO Events in 

the Past Year events events events 

Average Duration Per 

Event 

hours hours hours 

 Actual or  Estimated  Actual or  Estimated  Actual or  Estimated 

Average Volume per 

Event 

million gallons million gallons million gallons 

 Actual or  Estimated  Actual or  Estimated  Actual or  Estimated 

Minimum Rainfall Causing 

a CSO Event in Last Year 

inches of rainfall inches of rainfall inches of rainfall 

 Actual or  Estimated  Actual or  Estimated  Actual or  Estimated 

For Comment Only
EPA Form 3510-2A (Revised <INSERT DATE>) Page 12

EPA Identification Number NPDES Permit Number Facility Name Form Approved

OMB No. <INSERT NO.> 

Form Expires <INSERT DATE> 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

CSO Receiving Waters 

5.7 Provide the information in the table below for each of your CSO outfalls. 

CSO Outfall Number ____ CSO Outfall Number ____ CSO Outfall Number ____ 

Receiving Water Name 

 Name of Watershed / 

Stream System 

 U.S. Soil Conservation 

Service 14-digit 

Watershed Code 

(if known) 

 Unknown  Unknown  Unknown 

 

 Name of State 

Management / River 

Basin 

 

 U.S. Geological Survey 8-

Digit Hydrologic 

Cataloging Unit Code (if 

known)

 Unknown  Unknown  Unknown 

 

 Description of Known 

Water Quality Impacts on 

Receiving Stream by CSO 

(See Instructions for 

examples.)

 

SECTION 6. CHECKLIST AND CERTIFICATION STATEMENT Checklist and Certification Statement 

6.1 In Column 1 below, mark the Form 2A sections you have completed. Specify the attachments you are enclosing with 

each section in Column 2. 

Column 1  Column 2 

 Section 1  w/attachments 

 Section 2  w/topographic map  w/process flow diagram 

  w/additional attachments 

 Section 3  w/Table A  w/Table D 

 w/Table B  w/Table E 

  w/Table C  w/additional attachments 

 Section 4  w/SIU and CIU attachments  w/Table F 

 w/additional attachments 

 Section 5  w/CSO map  w/additional attachments 

  w/CSO system diagram 

 Section 6 

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 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 (first and last) Official Title 

 

 Signature Date Signed 

 

For Comment Only
EPA Form 3510-2A (Revised <INSERT DATE>) 

EPA Identification Number NPDES Permit Number Facility Name Outfall Number 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

TABLE A. EFFLUENT PARAMETERS FOR ALL POTWS 

Pollutant 

Maximum Daily Discharge Average Daily Discharge An

M

Value Units Value Units 

Number of Samples 

Biochemical Oxygen Demand (BOD5 or CBOD5) Fecal Coliform Design Flow pH (minimum) 

pH (maximum) 

Temperature (winter) 

Temperature (summer) 

Total Suspended Solids (TSS) 

1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR Part 136 for the analysis of polluta

required under 40 CFR chapter I, subchapter N or O. See Instructions and 40 CFR 122.21(e)(3).

For Comment Only
Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

This page intentionally left blank.

For Comment Only
EPA Form 3510-2A (Revised <INSERT DATE>) 

EPA Identification Number NPDES Permit Number Facility Name Outfall Number 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

TABLE B. EFFLUENT PARAMETERS FOR ALL POTWS WITH A FLOW EQUAL TO OR GREATER THAN 0.1 MGD. 

Pollutant 

Maximum Daily Discharge Average Daily Discharge Ana

Me

Value Units Value Units 

Number of Samples 

Ammonia (as N) Chlorine (Total Residual, TRC)2 Dissolved Oxygen Nitrate/Nitrite Kjeldahl Nitrogen Oil and Grease Phosphorus Total Dissolved Solids 

1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR Part 136 for the analysis of polluta

required under 40 CFR chapter I, subchapter N or O. See Instructions and 40 CFR 122.21(e)(3). 

2 Facilities that do not use chlorine for disinfection, do not use chlorine elsewhere in the treatment process, and have no reasonable potential to discharge 

required to report data for chlorine. 

For Comment Only
Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

This page intentionally left blank.

For Comment Only
EPA Form 3510-2A (Revised <INSERT DATE>) 

EPA Identification Number NPDES Permit Number Facility Name Outfall Number 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS 

Pollutant 

Maximum Daily Discharge Average Daily Discharge An

M

Value Units Value Units Number of Samples 

Metals, Cyanide, and Total Phenols 

Hardness (as CaCO3) 

Antimony, Total Recoverable Arsenic, Total Recoverable Beryllium, Total Recoverable Cadmium, Total Recoverable Chromium, Total Recoverable Copper, Total Recoverable Lead, Total Recoverable Mercury, Total Recoverable Nickel, Total Recoverable Selenium, Total Recoverable Silver, Total Recoverable Thallium, Total Recoverable Zinc, Total Recoverable Cyanide Total Phenolic Compounds 

Volatile Organic Compounds 

Acrolein 

Acrylonitrile Benzene Bromoform 

For 

Comment Only
EPA Form 3510-2A (Revised <INSERT DATE>) 

EPA Identification Number NPDES Permit Number Facility Name Outfall Number 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS 

Pollutant 

Maximum Daily Discharge Average Daily Discharge An

M

Value Units Value Units Number of Samples 

Carbon Tetrachloride Chlorobenzene Chlorodibromomethane Chloroethane 2-Chloroethylvinyl Ether Chloroform Dichlorobromomethane 1,1-Dichloroethane 

1,2-Dichloroethane 

trans-1,2-Dichloroethylene 1,1-Dichloroethylene 1,2-Dichloropropane 1,3-Dichloropropylene Ethylbenzene Methyl Bromide Methyl Chloride Methylene Chloride 1,1,2,2-Tetrachloroethane Tetrachloroethylene Toluene 1,1,1-Trichloroethane 1,1,2-Trichloroethane 

For 

Comment Only
EPA Form 3510-2A (Revised <INSERT DATE>) 

EPA Identification Number NPDES Permit Number Facility Name Outfall Number 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS 

Pollutant 

Maximum Daily Discharge Average Daily Discharge An

M

Value Units Value Units Number of Samples 

Trichloroethylene Vinyl Chloride 

Acid-Extractable Compounds 

p-Chloro-m-Creso 

2-Chlorophenol 2,4-Dichlorophenol 4,6-Dinitro-o-Cresol 2,4-Dinitrophenol 2-Nitrophenol 4-Nitrophenol Pentachlorophenol Phenol 2,4,6-Trichlorophenol 

Base-Neutral Compounds 

Acenaphthene 

Acenaphthylene 

Anthracene 

Benzidine Benzo(a)anthracene Benzo(a)pyrene 3,4-Benzofluoranthene Benzo(ghi)perylene 

For Comment Only
EPA Form 3510-2A (Revised <INSERT DATE>) 

EPA Identification Number NPDES Permit Number Facility Name Outfall Number 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS 

Pollutant 

Maximum Daily Discharge Average Daily Discharge An

M

Value Units Value Units Number of Samples 

Benzo(k)fluoranthene Bis (2-Chloroethoxy) Methane Bis (2-Chloroethyl) Ether Bis (2-Chloroisopropyl) Ether Bis (2-Ethylhexyl) Phthalate 4-Bromophenyl Phenyl Ether Butyl Benzyl Phthalate 2-Chloronaphthalene 4-Chlorophenyl Phenyl Ether Chrysene di-n-Butyl Phthalate di-n-Octyl Phthalate Dibenzo(a,h)anthracene 1,2-Dichlorobenzene 1,3-Dichlorobenzene 1,4-Dichlorobenzene 3,3-Dichlorobenzidine Diethyl Phthalate Dimethyl Phthalate 2,4-Dinitrotoluene 2,6-Dinitrotoluene 1,2-Diphenylhydrazine 

For 

Comment Only
EPA Form 3510-2A (Revised <INSERT DATE>) 

EPA Identification Number NPDES Permit Number Facility Name Outfall Number 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS 

Pollutant 

Maximum Daily Discharge Average Daily Discharge An

M

Value Units Value Units Number of Samples 

Fluoranthene Fluorene Hexachlorobenzene Hexachlorobutadiene Hexachlorocyclo-pentadiene Hexachloroethane Indeno(1,2,3-cd)pyrene Isophorone Naphthalene Nitrobenzene N-nitrosodi-n-propylamine N-nitrosodimethylamine N-nitrosodiphenylamine Phenanthrene Pyrene 1,2,4-Trichlorobenzene 

1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR Part 136 for the analysis of polluta

required under 40 CFR chapter I, subchapter N or O. See Instructions and 40 CFR 122.21(e)(3).

For Comment Only
EPA Form 3510-2A (Revised <INSERT DATE>) 

EPA Identification Number NPDES Permit Number Facility Name Outfall Number 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

TABLE D. ADDITIONAL POLLUTANTS AS REQUIRED BY NPDES PERMITTING AUTHORITY 

Pollutant 

(list) 

Maximum Daily Discharge Average Daily Discharge An

M

Value Units Value Units 

Number of Samples 

 No additional sampling is required by NPDES permitting authority. 

1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR Part 136 for the analysis of polluta

required under 40 CFR chapter I, subchapter N 

For 

or O. See Instructions and 40 CFR 122.21(e)(3).

Comment Only
Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

This page intentionally left blank.

For Comment Only
EPA Form 3510-2A (Revised <INSERT DATE>) 

EPA Identification Number NPDES Permit Number Facility Name Outfall Number 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results. Test Information 

Test Number _____ Test Number _____ 

Test Species Age at Initiation of Test Outfall Number Date Sample Collected Date Test Started Duration Toxicity Test Methods Test Method Number Manual Title Edition Number and Year of Publication Page Number(s) Sample Type Sample Type (check one)  Grab 

 24-Hour Composite 

 Grab  24-Hour Composite 

 Grab  24-Ho

Sample Location Sample Location (check one)  Before Disinfection 

 After Disinfection  After Dechlorination 

 Before Disinfection  After Disinfection  After Dechlorination 

 Before  After D After D

Point in Treatment Process Describe the point in the treatment process at which the sample was collected for each test. Toxicity Type Indicate for each test whether the test was performed to asses acute or chronic toxicity, or both. (Check one response.)

 Acute  Chronic  Both 

 Acute  Chronic  Both 

 Acute  Chron

For 

 Both 

Comment Only
EPA Form 3510-2A (Revised <INSERT DATE>) 

EPA Identification Number NPDES Permit Number Facility Name Outfall Number 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results. 

Test Number _____ Test Number _____ 

Test Type Indicate the type of test performed. (Check one 

response.)

 Static  Static-renewal  Flow-through 

 Static  Static-renewal  Flow-through 

 Static  Static- Flow-t

Source of Dilution Water Indicate the source of dilution water. (Check 

one response.)

 Laboratory Water  Receiving Water 

 Laboratory Water  Receiving Water 

 Labor Recei

If laboratory water, specify type. If receiving water, specify source. Type of Dilution Water Indicate the type of dilution water. If salt water, specify “natural” or type of artificial sea salts or brine used. 

 Fresh Water  Salt Water (specify)

 Fresh Water 

 Salt Water (specify)

 Fresh 

 Salt W

Percentage Effluent Used Specify the percentage effluent used for all concentrations in the test series. Parameters Tested Check the parameters tested.  pH 

 Salinity  Temperature 

 Ammonia  Dissolved Oxygen 

 pH  Salinity  Temperature 

 Ammonia  Dissolved Oxygen 

 pH  Salinit Temp

Acute Test Results Percent Survival in 100% Effluent % % LC5095% Confidence Interval % % Control percent survival 

For 

% % 

Comment Only
EPA Form 3510-2A (Revised <INSERT DATE>) 

EPA Identification Number NPDES Permit Number Facility Name Outfall Number 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results. 

Test Number _____ Test Number _____ 

Acute Test Results Continued Other (describe)Chronic Test Results NOEC % % IC25 % % Control Percent Survival % % Other (describe)Quality Control/Quality Assurance Is reference toxicant data available?  Yes  No  Yes  No  Was reference toxicant test within acceptable bounds?  Yes  No  Yes  No  What date was reference toxicant test run (MM/DD/YYYY)? Other (describe)

For Comment Only
Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

This page intentionally left blank.

For Comment Only
EPA Form 3510-2A (Revised <INSERT DATE>) 

EPA Identification Number NPDES Permit Number Facility Name 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

TABLE F. INDUSTRIAL DISCHARGE INFORMATION Response space is provided for three SIUs or CIUs. Copy the table to report information for additional SIUs and CIUs. 

SIU _____ or CIU _____ SIU _____ or CIU _____ 

Name of SIU or CIU Mailing Address (street or P.O. Box) City, State and ZIP Code Provide a description of all industrial processes that affect or contribute to the SIU’s or CIU’s discharge and SIC or NAICS code(s), if available. List the principal products and raw materials that affect or contribute to the SIU’s or the CIU’s discharge. Indicate the average daily volume of wastewater discharged by the SIU or the CIU. gpd gpd How much of the average daily volume is attributable to process flow? gpd gpd How much of the average daily volume is attributable to non-process flow? gpd gpd Is the SIU or the CIU subject to local limits?  Yes  No  Yes  No Is the SIU subject to categorical standards?  Yes  No  Yes  No 

For Comment Only
EPA Form 3510-2A (Revised <INSERT DATE>) 

EPA Identification Number NPDES Permit Number Facility Name 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

TABLE F. INDUSTRIAL DISCHARGE INFORMATION Response space is provided for three SIUs or CIUs. Copy the table to report information for additional SIUs and CIUs. 

SIU _____ or CIU _____ SIU _____ or CIU _____ 

Under what categories and subcategories is the SIU or the CIU subject? Has the POTW experienced problems (e.g., upsets, pass-through interferences, etc.) in the past 4.5 years that are attributable to the SIU or CIU? 

 Yes  No  Yes  No 

If yes, describe. 

For Comment Only