Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

United States 

Environmental Protection Agency 

Office of Water 

Washington, D.C. 

EPA Form 3510-2S 

Revised <INSERT DATE> 

Water Permits Division 

Application Form 2S 

Sewage Sludge Management 

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This document is being distributed for comment purposes only.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. 

Note: Complete Form 2S if you are a new or exis

For 

ting treatment works treating domestic sewage.

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Draft Application Forms – Not for Implementation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 and complete 

Form 2S to be 8.7 hours. This 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
2S-3 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2S—GENERAL INSTRUCTIONS 

Who Must Complete Form 2S? 

A person must complete Form 2S to apply for a National Pollutant 

Discharge Elimination System (NPDES) permit covering sewage 

sludge (biosolids) use or disposal standards if they own or operate 

a treatment works treating domestic sewage (TWTDS). A person is 

an owner or operator of a TWTDS if the facility generates, changes 

the quality of, or provides final disposition of solids, practices for 

which are ultimately subject to Part 503 of Title 40 of the Code of 

Federal Regulations (CFR).1 

The TWTDS that are required to apply for an NPDES permit 

include the following: 

 All generators of sewage sludge that are regulated by 40 CFR 

Part 503 (i.e., it is applied to the land, placed on a surface 

disposal site, fired in a sewage sludge incinerator, or placed in 

a municipal solid waste landfill unit). 

 Industrial facilities that separately treat domestic sewage and 

generate sewage sludge that are regulated by 40 CFR 

Part 503. 

 All surface disposal site owners/operators. 

 All sewage sludge incinerator owners/operators. 

 Any person (e.g., individual, corporation, or government entity) 

who changes the quality of sewage sludge regulated by 

40 CFR Part 503 (e.g., sewage sludge blenders or 

processors.2) 

 Any other person or facility designated by the NPDES 

permitting authority as a TWTDS. 

TWTDS and other persons that may be required to apply for an 

NPDES permit3 include the following: 

 Sewage sludge land appliers, haulers, persons who store, or 

transporters who do not generate or do not change the quality 

of the sewage sludge. 

 Landowners of property on which sewage sludge are applied. 

 Domestic septage pumpers/haulers/treaters/appliers. 

 Sewage sludge packagers/baggers that do not change the 

quality of the sewage sludge. 

If any of the above TWTDS categories are owned and operated by 

different persons/entities, it is the operator’s duty to obtain the 

NPDES permit. 

Notes 

1The U.S. Environmental Protection Agency (EPA) developed regulations in 1993 as 

required by the Clean Water Act (CWA) Amendments of 1987 to protect public 

health and the environment from any reasonably anticipated adverse effects of 

pollutants that might be present in sewage sludge biosolids. The regulation, The 

Standards for the Use or Disposal of Sewage Sludge (40 CFR Part 503) was 

published in the Federal Register (FR) on February 19, 1993 (58 CFR 9248 to 9404) 

and became effective March 22, 1993. The regulations are often referred to as “the 

Part 503 rule” or “Part 503.” 

2If all the sewage sludge received by a sewage sludge blender or composter are of 

exceptional quality (EQ) per 40 CFR Part 503, then no permit will be required for the 

person who receives or processes the EQ sludge. 

3The NPDES permitting authority may request permit applications from these 

facilities when necessary to protect public health and the environment from 

reasonably anticipated effects of pollutants that may be present in sewage sludge. 

If you are a TWTDS and discharge wastewater to surface water, 

you must also complete NPDES application Form 2A. 

Part 503 defines sewage sludge as a solid, semi-solid, or liquid 

residue generated during the treatment of domestic sewage in a 

treatment works. Sewage sludge includes scum or solids removed 

in primary, secondary, or advanced wastewater treatment 

processes and any material derived from sewage sludge (e.g., a 

blended sewage sludge/fertilizer product) but does not include grit 

and screenings or ash generated by the firing of sewage sludge in 

an incinerator. 

Part 503 considers domestic septage as sewage sludge and sets 

separate requirements for domestic septage applied to agricultural 

land, forests, or reclamation sites. Domestic septage is defined as a 

liquid or solid material removed from a septic tank, cesspool, 

portable toilet, Type III marine sanitation device, or similar system 

that receives only domestic sewage. The Part 503 definition of 

domestic septage excludes grease-trap pumpings and commercial 

or industrial waste. 

At the state level, either 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 2S. 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-stateprogram-information for a list of states that have approved NPDES 

permit programs and those that do not. 

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

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

2S–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 sewage 

sludge NPDES permit program, file according to the 

instructions on the state forms. 

 If you are in a jurisdiction where EPA is the sewage sludge 

NPDES permitting authority (i.e., the state is not a sewage 

sludge authorized state), mail the completed application forms 

to the EPA regional office that covers the state in which your 

facility is located (see Exhibit 2S–1). 

 To determine where to send your completed Form 2S, please 

visit: http://www.epa.gov/biosolids/forms/contact-us-aboutbiosolids. 

When to File Your Completed Form 

A TWTDS with a currently effective NPDES permit must submit a 

permit application at the time of its next NPDES permit renewal 

application. Any other TWTDS must submit the information in Part 1 

of Form 2S within 1 year after publication of a standard applicable 

to its sewage sludge or disposal practice(s). The NPDES permitting 

authority will determine when such TWTDS must submit a full 

permit application. The NPDES permitting authority may require 

For Comment Only
2S-4 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2S—GENERAL INSTRUCTIONS CONTINUED 

permit applications from a TWTDS at any time if the authority 

determines that a permit is necessary to protect public health and 

the environment from any potential adverse effects that may 

occur from toxic pollutants in sewage sludge. Any TWTDS that 

commences operations after promulgation of an applicable 

“standard for sewage sludge use or disposal” must submit an 

application to the NPDES permitting authority at least 180 days 

prior to the date proposed for commencing operations. 

Fees

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

NPDES permits. However, states that administer the NPDES 

programs 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 2S (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 2S. Note that NPDES authorities will deny claims for 

treating any biosolids data as confidential. 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 40 of the 

Code of Federal Regulations (CFR). 

Completion of Forms 

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 2S 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 2S–1 for contact information. 

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. 

Upon request of the NPDES permitting authority, you must submit 

any other information necessary to assess sewage sludge use or 

disposal practices at your facility or identify appropriate permitting 

requirements. 

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. 

Which Parts of the Form Apply 

Form 2S is presented in a modular format, enabling information 

collection to be tailored to your facility’s sewage sludge generation, 

treatment, use, or disposal practices. The form specifies which parts 

must be filled out for each type of applicant. 

Part 1 requests a limited amount of information from ‘‘sludge-only’’ 

facilities (facilities without a currently effective NPDES permit) that are 

not directed by the permitting authority to submit a full permit 

application at this time. It is intended to allow the permitting authority 

to identify these facilities, track sewage sludge use and disposal, and 

establish priorities for permitting. 

Part 2 of Form 2S is for facilities that are submitting a full NPDES 

permit application. See Exhibit 2S-2, located at the end of these 

General Instructions, to determine which sections of Part 2 cover your 

facility’s sewage sludge use or disposal practices. 

Complete the Preliminary Information section on page 1 of Form 2S 

by indicating whether your facility has an effective NPDES permit or 

you have been directed by your NPDES permitting authority to submit 

a full Form 2S permit application. If “yes”, skip Part 1 and complete 

Part 2 of the application package (see Part 2 Line-By-Line 

Instructions). If “no”, only complete Part 1 of the application package. 

Definitions 

Definitions of all significant terms used in these Instructions and 

Form 2S are in the “Glossary” located at the end of these Instructions. 

 For Comment Only
Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2S—GENERAL INSTRUCTIONS CONTINUED 

Exhibit 2S–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
2S-6 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2S—GENERAL INSTRUCTIONS CONTINUED 

Exhibit 2S–2. Part 2 Sections to Complete 

Activity(ies) Performed 

Part 2 Sections to Complete 

1 2 3 4 5 GENERAL INFORMATION GENERATION OF SEWAGE SLUDGE OR PREPARATION OF A MATERIAL DERIVED FROM SEWAGE SLUDGE LAND APPLICATION OF BULK SEWAGE SLUDGE SURFACE DISPOSAL INCINERATION 

Generates sewage sludge or derives material from 

sewage sludge that: 

 Meets ceiling concentrations in Table 1 of 40 CFR 

503.13, pollutant concentrations in Table 3 of 

Section 503.13, Class A pathogen requirements in 

Section 503.32, and one of the eight vector 

attraction reduction options in 40 CFR 

503.33(b)(1)-(8). 

 Is sold or given away in bag or other container for 

application to the land [and not already addressed 

in Item 2.4] 

 Is shipped off-site for treatment or blending 

 Is placed on a surface disposal site 

 Is fired in an incinerator 

 Is sent to a municipal solid waste landfill 

  

Generates sewage sludge or derives material from 

sewage sludge that is applied to the land in bulk form    

Applies bulk sewage sludge to land or generates 

sewage sludge that is applied to the land by others 

  

Owns or operates a surface disposal site  

Owns or operates a sewage sludge incinerator  

For Comment Only
2S-7 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2S—PART 1 LINE-BY-LINE INSTRUCTIONS

Part 1 – Limited Background Information 

Complete Part 1 if your facility is a “sludge-only” facility (i.e., a 

facility that does not currently have, and is not applying for, an 

NPDES permit for a direct discharge to a surface body of water). 

Section 1. 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 or site 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 the 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: (a) 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.); (b) 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 (c) 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 1.1, refer to 

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

Item 1.2. Indicate the legal status of the owner of the facility by 

marking the appropriate box. If the facility is a federal facility (i.e., 

owned by the U.S. government), check the box for “Public—Federal”. 

If the facility is owned by a state government, check the box for 

“Public—State”. If the facility is owned by a county government, 

municipal (e.g., city or town) government, tribal government, school 

district, water district, or other local government entity, check the box 

for “Public—Other) and specify the type of government entity. If the 

facility is owned by a corporation or other private entity, check the box 

for “Private”. If the facility has mixed ownership (e.g., public/private) or 

is not owned by an entity previously listed, check the box for “Other” 

and specify the type of entity. 

Section 2. Applicant Information 

Item 2.1. Indicate if the applicant is different from the entity listed 

under Item 1.1. If “yes,” continue to Item 2.2. If “no,” skip to Item 2.3 

(Part 1, Section 2). 

Item 2.2. Enter the applicant’s name and mailing address. Provide the 

name (first and last), title, work telephone number, and email address 

of the contact person for the applicant. 

Item 2.3. Indicate if the applicant is the facility’s owner, operator, or 

both. 

Item 2.4. Specify whether the NPDES permitting authority should 

send correspondence to the facility or the applicant. 

Section 3. Sewage Sludge Amount 

Item 3.1. Provide the total dry metric tons of sewage sludge 

generated, treated, used (i.e., received from off-site), and disposed 

over the last 365-day period. 

Section 4. Pollutant Concentrations 

Item 4.1. Provide the most recent sewage sludge monitoring data 

available on the quality of the sewage sludge, including for pollutants 

for which limits in sewage sludge have been established in 40 CFR 

Part 503 for your facility’s expected use or disposal practices. Provide 

the average monthly concentration in milligrams per kilogram (mg/kg) 

dry weight, analytical method, and detection level. If available, base 

data on three or more samples taken at least 1 month apart, that are 

no more than 4.5 years old. If providing the monitoring data in a 

separate attachment, check the box to indicate that this information 

has been attached to the application package. 

Section 5. Treatment Provided at Your Facility 

Item 5.1. In the “Use or Disposal Practice” column, check the sewage 

sludge use or disposal practice used at your facility. In the following 

columns, indicate the amount of sewage sludge used or disposed, 

For Comment Only
2S-8 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2S—PART 1 LINE-BY-LINE INSTRUCTIONS CONTINUED 

pathogen class and reduction alternative, and the vector 

attraction reduction option associated with the practice. To 

determine the applicable pathogen class and reduction 

alternative, see 40 CFR 503.32. To determine the applicable 

vector attraction reduction option, see 40 CFR 503.33. Vector 

attraction reduction options 1 through 8 are typically met at the 

point where sewage sludge is generated or where a material is 

derived from sewage sludge, and options 9 through 11 are 

typically met at the point of use or disposal. Complete Item 5.1 for 

each sewage sludge use or disposal practice by attaching 

additional sheets, as necessary.

Item 5.2. For each use or disposal practice indicated in Item 5.1, 

identify the treatment process(es) used at your facility to reduce 

pathogens or vector attraction properties in sewage sludge. If you 

check “Other”, specify the treatment process(es) in the space 

provided or in a separate attachment. 

Section 6. Sewage Sludge Sent to Other Facilities 

Item 6.1 Indicate whether or not the sewage sludge meets ceiling 

concentrations in Table 1 of 40 CFR 503.13, pollutant 

concentrations in Table 3 of 40 CFR 53.13, Class A pathogen 

reduction requirements at 40 CFR 503.32(a), and one of the 

vector attraction reduction requirements at 40 CFR 503.33(b)(1)-

(8). If “yes,” skip to Item 8.1 (Part 1, Section 8). If “no,” continue to 

Item 6.2. 

Item 6.2. Indicate whether sewage sludge from your facility is 

provided to another facility for treatment, distribution or disposal. 

If “yes” continue to Item 6.3. If “no” skip to Item 7.1 (Part 1, 

Section 7). 

Item 6.3. Enter the name and mailing address of the receiving 

facility. Provide the name (first and last), title, work telephone 

number, and email address of the contact person for the receiving 

facility. 

Item 6.4. Indicate the activities provided by the receiving facility. If 

you check “Other”, provide a description in the space provided or 

in a separate attachment. 

Section 7. Use and Disposal Sites 

Complete Items 7.1 through 7.2 for each site on which sewage 

sludge from the facility is used or disposed. Check the box to 

indicate that this information has been attached to the application 

package.

Item 7.1. Specify the site name or number and mailing address. 

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

and email address of the contact person for the use or disposal 

site. 

Include a complete location address for the site if different from 

the mailing address. If the facility or site 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 

site and the associated metadata (e.g., horizontal collection

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

reference datum). The location of the use or disposal site (i.e., where 

the coordinates are collected) shall be the approximate center of the 

area where the sewage sludge is directly released to the 

environment. (See Part 1 Line-By-Line Instructions to Item 1.1 for 

guidance on supplying method of collection information.) 

Item 7.2. Identify the type of use or disposal site (e.g., agricultural, 

surface disposal, reclamation, lawn or home garden, public contact, 

municipal solid waste landfill, forest, incineration). If you check 

“Other”, provide a description in the space provided or in a separate 

attachment. 

Section 8. Certification Statement 

Item 8.1. 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 

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 OF PART 1 

Submit your completed Part 1 of Form 2S and all associated 

attachments to your NPDES permitting authority.

For Comment Only
2S-9 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2S—PART 2 LINE-BY-LINE INSTRUCTIONS

Part 2 – Permit Application Information 

Complete Part 2 if you have an effective NPDES permit or have 

been directed by the NPDES permitting authority to submit a full 

permit application. Part 2 is divided into five sections. Section 1 

pertains to all applicants. The applicability of Sections 2 to 5 

depends on your facility’s sewage sludge use or disposal 

practices. See Exhibit 2S-2 at the end of the General Instructions 

to determine the sections that you are required to complete. 

Section 1. General Information 

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 or site 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 the 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: (a) 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.); (b) 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 (c) 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 1.1, refer to 

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

Item 1.2. Indicate whether the facility is a Class I sludge management 

facility. 

Item 1.3. Provide the facility design flow rate in million gallons per day 

(mgd). 

Item 1.4. Provide the total population served by the facility. Enter the 

best estimate of the actual population served at the time of application 

for all areas served by the treatment works (municipalities and 

unincorporated service areas). If another treatment works discharges 

into this treatment works, provide on a separate attachment the name 

of the other treatment works and the actual population it serves. It is 

not necessary to list the communities served by the other treatment 

works.

Item 1.5. Indicate the legal status of the owner of the facility by 

marking the appropriate box. If the facility is a federal facility (i.e., 

owned by the U.S. government), check the box for “Public—Federal”. 

If the facility is owned by a state government, check the box for 

“Public—State”. If the facility is owned by a county government, 

municipal (e.g., city or town) government, tribal government, school 

district, water district, or other local government entity, check the box 

for “Public—Other) and specify the type of government entity. If the 

facility is owned by a corporation or other private entity, check the box 

for “Private”. If the facility has mixed ownership (e.g., public/private) or 

is not owned by an entity previously listed, check the box for “Other” 

and specify the type of entity. 

Applicant Information

Item 1.6. Indicate if the applicant is different from the entity listed 

under Item 1.1. If “yes,” continue to Item 1.7. If “no,” skip to Item 1.18 

(Part 2, Section 1). 

Item 1.7. Enter the applicant’s name and mailing address. Provide the 

name (first and last), title, work telephone number, and email address 

of the contact person for the applicant. 

Item 1.8. Indicate if the applicant is the facility’s owner, operator, or 

both. 

Item 1.9. Specify whether the NPDES permitting authority should 

send correspondence to the facility or the applicant. 

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Draft Application Forms – Not for Implementation

FORM 2S—PART 2 LINE-BY-LINE INSTRUCTIONS CONTINUED

Permit Information 

Item 1.10. Provide the facility’s NPDES permit number or check 

the box to indicate that you do not have an NPDES permit 

number but are otherwise required to submit Part 2 of Form 2S by 

your NPDES permitting authority. 

Item 1.11. Indicate all other federal, state, and local permits or 

construction approvals received or applied for that regulate the 

facility’s sewage sludge management practices. If you check 

“Other”, specify the permit or approval in the space provided. You 

may provide a listing of permits or approvals and corresponding 

permit numbers in a separate attachment. If so, check the box to 

indicate that this information has been attached to the application 

package. 

Indian Country 

Item 1.12. Indicate whether any generation, treatment, storage, 

application to land, or disposal of sewage sludge from the facility 

occurs in Indian Country. If “yes” continue to Item 1.13. If “no” 

skip to Item 1.14 (Part 2, Section 1). 

Item 1.13. In the space provided or in a separate attachment, 

describe the generation, treatment, storage, land application, or 

disposal of sewage sludge that occurs in Indian Country. 

Topographic Map 

Item 1.14. Provide a topographic map(s) of the area extending at 

least 1 mile beyond the property boundaries of the facility that 

clearly shows the following: 

 The legal boundaries of the facility; 

 All sewage sludge management facilities, including on-site 

treatment, storage, and disposal sites; 

 Wells, springs, and other surface water bodies that are within 

1⁄4 mile of the property boundaries and listed in public records 

or otherwise known to applicant. 

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

north, and latitude and longitude to the nearest second. 

You may develop your map by going to 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. 

Answer “yes” when a topographic map containing all required 

information has been attached to the application. 

Line Drawing 

Item 1.15. Provide a line drawing and/or narrative description that 

identifies all sewage sludge practices that will be employed during 

the permit term, including all units used for collecting, dewatering, 

storing, or treating sewage sludge, the destination(s) of all liquids 

and solids leaving each such unit, and all processes used for 

pathogen reduction and vector attraction reduction. Answer “yes” 

when a line drawing and/or narrative description containing all 

required information has been attached to the application. 

Contractor Information 

Item 1.16. Indicate whether contractors have any operational or 

maintenance responsibilities related to sewage sludge generation, 

treatment, use, or disposal at the facility. If “yes” continue to 

Item 1.17. If “no” skip to Item 1.8 (Part 2, Section 1). 

Item 1.17. Provide the company name, mailing address, contact 

name (first and last), telephone number, and email address for each 

contractor and describe the contractor’s responsibilities. The 

application form provides reporting space for three contractors. If your 

facility has more than three contractors, attach additional sheets as 

necessary. 

Pollutant Concentrations 

Item 1.18. Provide the most recent sewage sludge monitoring data 

available on the quality of the sewage sludge, including for pollutants 

for which limits in sewage sludge have been established in 40 CFR, 

Part 503 for your facility’s expected use or disposal practices. Provide 

the average monthly concentration in milligrams per kilogram (mg/kg) 

dry weight, analytical method, and detection level. If available, base 

data on three or more samples taken at least 1 month apart, that are 

no more than 4.5 years old. If providing the monitoring data in a 

separate attachment, check the box to indicate that this information 

has been attached to the application package. 

Checklist and Certification Statement 

Item 1.19. Review the checklist provided. In Column 1, mark the 

sections of Form 2S, Part 2 that you have completed and are 

submitting with your application. For each section that you have 

completed, indicate in Column 2 whether you are submitting 

attachments. 

Item 1.20. The Clean Water Act provides for severe penalties for 

submitting false information on this application form. Section 309(c)(2) 

of the Clean Water Act 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 AT 40 CFR 122.22 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 person who performs similar 

policy- or decision-making functions for the corporation, or (ii) the 

manager of one or more manufacturing, production, or operating 

facilities, provided, the manager is authorized to make 

management decisions which govern the operation of the 

regulated facility 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 

For Comment Only
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FORM 2S—PART 2 LINE-BY-LINE INSTRUCTIONS CONTINUED

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). 

Section 2. Generation of Sewage Sludge or Preparation of a 

Material Derived from Sewage Sludge 

Complete this section if you are a ‘‘person who prepares sewage 

sludge.’’ This section pertains to any POTW or other TWTDS that 

generates sewage sludge, as well as to any facility that derives a 

material from sewage sludge (e.g., it composts sewage sludge or 

blends sewage sludge with another material). Simply distributing 

sewage sludge or placing it in a bag or other container for sale or 

give-away for application to the land is not considered ‘‘deriving a 

material’’ from sewage sludge (because it does not change 

sludge quality), and thus a facility that only distributes or bags a 

sewage sludge is not required to provide the information in this 

section. 

Item 2.1. Answer “yes” or “no” to indicate if the facility generates 

sewage sludge or derives a material from sewage sludge (e.g., it 

composts sewage sludge or blends sewage sludge with another 

material). If “yes”, continue to Item 2.2. If “no”, skip to Part 2, 

Section 3. 

Amount Generated Onsite 

Item 2.2. Provide the total dry metric tons of sewage sludge 

generated at the facility over a 365-day period. 

Amount Received from Off-site Facility 

Item 2.3. Indicate whether the facility receives sewage sludge 

from another facility for treatment, use, or disposal. If “yes”, 

continue to Item 2.4. If “no”, skip to Item 2.7 (Part 2, Section 2). 

Item 2.4. Indicate the total number of facilities from which your 

facility receives sewage sludge for treatment, use, or disposal. 

Item 2.5. Complete Items 2.5 through 2.7 for each facility from 

which your facility receives sewage sludge for treatment, use or 

disposal. Check the box to indicate that this information has been 

attached to the application package. 

Enter the name and mailing address of the facility. Provide the 

name (first and last), title, work telephone number, and email 

address of the contact person for the facility. 

Provide a complete location address for the facility if different 

from the mailing address. If the facility or site 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 

and the associated metadata (e.g., horizontal collection method, scale 

of source map or photo, if applicable, and horizontal reference 

datum). 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). (See Part 2 Line-By-Line Instructions to 

Item 1.1 for guidance on supplying method of collection information.) 

Item 2.6. Indicate the amount of sewage sludge received, the 

applicable pathogen class and reduction alternative, and the 

applicable vector attraction reduction option provided at the off-site 

facility. To determine the applicable pathogen class and reduction 

alternative, see 40 CFR 503.32. To determine the applicable vector 

attraction reduction option, see 40 CFR 503.33. Vector attraction 

reduction options 1 through 8 are typically met at the point where 

sewage sludge is generated or where a material is derived from 

sewage sludge, and options 9 through 11 are typically met at the 

point of use or disposal. 

Item 2.7. Identify the treatment process(es) that are known to occur at 

the off-site facility, including blending activities and treatment to 

reduce pathogens or vector attraction properties in sewage sludge. If 

you check “Other”, specify the treatment process(es) in the space 

provided or in a separate attachment. 

Treatment Provided at Your Facility 

Item 2.8. In the “Use or Disposal Practice” column, check the sewage 

sludge use or disposal practice used at your facility. In the following 

columns, indicate the pathogen class and reduction alternative and 

the vector attraction reduction option associated with the practice. To 

determine the applicable pathogen class and reduction alternative, 

see 40 CFR 503.32. To determine the applicable vector attraction 

reduction option, see 40 CFR 503.33. Vector attraction reduction 

options 1 through 8 are typically met at the point where sewage 

sludge is generated or where a material is derived from sewage 

sludge, and options 9 through 11 are typically met at the point of use 

or disposal. Complete Item 2.8 for each sewage sludge use or 

disposal practice by attaching additional sheets, as necessary. 

Item 2.9. For each use or disposal practice indicated in Item 2.8, 

identify the treatment process(es) used at your facility to reduce 

pathogens or vector attraction properties in sewage sludge. If you 

check “Other”, specify the treatment process(es) in the space 

provided or in a separate attachment. 

Item 2.10. Use the space provided to describe any other sewage 

sludge treatment or blending activities not identified in Items 2.8 and 

2.9. Check the box if your description has been attached to the 

application package. 

Preparation of Sewage Sludge Meeting Ceiling and Pollutant 

Concentrations, Class A Pathogen Requirements, and One of 

Vector Attraction Reduction Options 1-8. 

Item 2.11. Indicate whether the sewage sludge meets the ceiling 

concentrations in Table 1 of 40 CFR 503.13, the pollutant 

concentrations in Table 3 of 40 CFR 503.12, Class A pathogen 

reduction requirements at 40 CFR 503.32(a), and one of the vector 

attraction reduction requirements at 40 CFR 503.33(b)(1)-(8) and is 

land applied. Sewage sludge meeting all of these criteria is often 

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FORM 2S—PART 2 LINE-BY-LINE INSTRUCTIONS CONTINUED

referred to as “exceptional quality (EQ)” and is exempt from the 

general requirements of §503.12 and the management practices 

of §503.14, and thus fewer permitting and permit application 

requirements typically pertain to facilities generating such sludge. 

For this reason, if you check “yes” to Item 2.11 complete Items 

2.12 and 2.13, and then you may skip Items 2.14 through 2.16 

(Sale or Give-away in a Bag or Other Container for Application to 

the Land), Items 2.17 through 2.26 (Shipment Off-site for 

Treatment or Blending), and Items 2.27 through 2.31 (Land 

Application of Bulk Sewage Sludge) unless specifically required 

to complete any of them by the permitting authority. If “no,” skip to 

Item 2.14 (Part 2, Section 2). 

Item 2.12. Provide the total dry metric tons of sewage sludge, 

meeting the requirements specified in Item 2.11 that is applied to 

land per 365-day period. 

Item 2.13. Indicate whether the subject sewage sludge is placed 

in a bag or other container and sold or given away for land 

application. Check the box indicating completion of Items 2.11 

through 2.13 and skip to Item 2.32 (Part 2, Section 2). 

Sale or Give-away in a Bag or Other Container for 

Application to the Land. 

Item 2.14. Indicate whether the subject sewage sludge is placed 

in a bag or other container and sold or given away for land 

application. If “yes” continue to Item 2.15. If “no” skip to Item 2.17 

(Part 2, Section 2). 

Item 2.15. Provide the dry metric tons of sewage sludge place in 

a bag or other container and sold or given away for land 

application per 365-day period. 

Item 2.16. When sewage sludge is placed in a bag or other 

container for sale or give-away for application to the land, either a 

label must be affixed to the bag or other container, or an 

information sheet must be provided to the person receiving the 

sewage sludge. The information that must be on the label or 

information sheet is listed at 40 CFR Part 503.14(e). Attach 

copies of all labels or notices that accompany sewage sludge 

being sold or given away in a bag or other container for land 

application. Check the box to indicate that these copies have 

been attached to the application package. 

Check the box indicating completion of Items 2.14 through 2.16 

and skip to Item 2.32 (Part 2, Section 2). 

Shipment Off-site for Treatment or Blending 

Item 2.17. Indicate whether another facility provides treatment or 

blending of your facility’s sewage sludge. This does not pertain to 

dewatered sludge sent directly to a land application or surface 

disposal site. If “yes” continue to Item 2.18. If “no” skip to 

Item 2.32 (Part 2, Section 2). 

Item 2.18. Indicate the total number of facilities that provide 

treatment or blending of your facility’s sewage sludge. Complete 

Items 2.19 through 2.26 for each facility that provides treatment 

or blending of your facility’s sewage sludge. Check the box to 

indicate if this information has been attached to the application 

package.

Item 2.19. Enter the name and mailing address of the receiving 

facility. Provide the name (first and last), title, work telephone number, 

and email address of the contact person for the receiving facility. 

Include a complete location address for the facility if different from the 

mailing address. If the facility or site 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”). 

Item 2.20. Provide the dry metric tons of sewage sludge provided to 

the receiving facility per 365-day period. 

Item 2.21 Indicate whether the receiving facility provides any 

additional treatment to reduce pathogens in, or vector attraction 

properties of the sewage sludge from your facility. If “yes” continue to 

Item 2.22. If “no” skip to Item 2.24 (Part 2, Section 2). 

Item 2.22. Indicate the pathogen class and reduction alternative and 

the vector attraction reduction option met for the sewage sludge at the 

receiving facility. To determine the applicable pathogen class and 

reduction alternative, see 40 CFR 503.32. To determine the 

applicable vector attraction reduction option, see 40 CFR 503.33. 

Vector attraction reduction options 1 through 8 are typically met at the 

point where sewage sludge is generated or where a material is 

derived from sewage sludge, and options 9 through 11 are typically 

met at the point of use or disposal. 

Item 2.23. Identify the treatment process(es) used at the receiving 

facility to reduce pathogens or vector attraction properties of sewage 

sludge from your facility. If you check “Other”, specify the treatment 

process(es) in the space provided or in a separate attachment. 

Item 2.24. Attach a copy of any information you provide to the 

receiving facility to comply with the “notice and necessary information” 

requirement under 40 CFR 503.12(g). Check the box to indicate that 

this information has been attached to the application package. 

Item 2.25. Indicate whether the receiving facility places sewage 

sludge from your facility in a bag or other container to sell or give 

away for land application. If “yes” continue to Item 2.26. If “no” skip to 

Item 2.32 (Part 2, Section 2). 

Item 2.26. When sewage sludge is placed in a bag or other container 

for sale or give-away for application to the land, either a label must be 

affixed to the bag or other container, or an information sheet must be 

provided to the person receiving the sewage sludge. The information 

that must be on the label or information sheet is listed at 40 CFR 

503.14(e). Attach copies of all labels or notices that accompany 

sewage sludge being sold or given away in a bag or other container 

for land application. Check the box to indicate that these copies have 

been attached to the application package. 

Check the box indicating completion of Items 2.17 through 2.28 and 

skip to Item 2.32 (Part 2, Section 2). 

Land Application of Bulk Sewage 

Item 2.27. Answer “yes” or “no” to indicate whether or not sewage 

sludge from your facility is applied to the land. If “yes” continue to 

Item 2.28. If “no” skip to Item 2.32 (Part 2, Section 2). 

For Comment Only
Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2S—PART 2 LINE-BY-LINE INSTRUCTIONS CONTINUED

Item 2.28. Provide the total dry metric tons of sewage sludge 

applied to all land application sites per 365-day period. 

Item 2.29. Indicate whether all land application sites were 

identified in Part 2, Section 3 of this application. If “no” submit a 

copy of the land application plan with your application package. 

Current regulations require you to submit a land application plan 

at the time of permit application if you intend to apply sewage 

sludge that does not meet the EQ requirements to land 

application sites that have not been identified at the time of permit 

application. The minimum requirements for this plan are listed in 

40 CFR 122.21(q)(9)(v). The NPDES permitting authority will 

work with you to develop additional details of the land application 

plan on a case-by-case basis. Such details could include site 

selection criteria (site slope, run-on and run-off control, etc.) and 

site management guidelines (sludge application rates, access 

controls, etc.). A land application plan provides for public notice 

when the land application plan is developed as part of the permit, 

and it discusses how the public will be notified about new sites. 

Item 2.30. Indicate whether there are any land application sites 

located in states other than the state where you generate sewage 

sludge or derive a material from the sewage sludge. If “yes” 

continue to Item 2.31. If “no” skip to Item 2.32 (Part 2, Section 2). 

Item 2.31. If any land application sites are located in states other 

than the state where you generate the bulk sewage sludge or 

derive the material from sewage sludge, the notice to the 

permitting authority in the states where the land application sites 

are located must contain the requirements listed at 40 CFR 

503.12(i). In a separate attachment, describe how you notify the 

NPDES permitting authority for the states where the land 

application sites are located. Check the boxes to indicate if the 

explanation and/or the notification have been attached to the 

application package. 

Surface Disposal 

Item 2.32. Indicate whether sewage sludge from your facility is 

placed on a surface disposal site. If “yes” continue to Item 2.33. If 

“no” skip to Item 2.39 (Part 2, Section 2). 

Item 2.33. Provide the total dry metric tons of sewage sludge 

from your facility placed on all surface disposal sites per a 365-

day period. 

Item 2.34. Indicate whether you own or operate all surface 

disposal sites to which you send sewage sludge for disposal. If 

“yes” skip to Item 2.39 (Part 2, Section 2). If “no” continue to 

Item 2.35. 

Item 2.35. Provide the total number of surface disposal sites to 

which you send sewage sludge. Complete Items 2.36 through 

2.38 for each surface disposal site to which you send your 

sewage sludge. Check the box to indicate that this information 

has been attached to the application package. 

Item 2.36. Enter the site name or number and mailing address of 

the surface disposal site you do not own or operate. Provide the 

name (first and last), title, work telephone number, and email 

address of the contact person for the surface disposal site. 

Item 2.37. Indicate whether the site contact is the owner and/or 

operator of the surface disposal site. 

Item 2.38. Provide the total dry metric tons of sewage sludge from 

your facility placed on the surface disposal site per 365-day period. 

Incineration 

Item 2.39. Answer “yes” or “no” to indicate if sewage sludge from your 

facility is fired in a sewage sludge incinerator. If “yes” continue to 

Item 2.40. If “no” skip to Item 2.46 (Part 2, Section 2). 

Item 2.40. Provide the total dry metric tons of sewage sludge from 

your facility fired in all sewage sludge incinerators per 365-day period. 

Item 2.41. Answer “yes” or “no” to indicate if you own or operate all 

sewage sludge incinerators to which you send sewage sludge for 

firing. If “yes” skip to Item 2.46. If “no” continue to Item 2.42 (Part 2, 

Section 2). 

Item 2.42. Indicate the total number of sewage sludge incinerators 

used that you do not own or operate. Complete Items 2.43 through 

2.45 for each sewage sludge incinerator used that you do not own or 

operate. Check the box to indicate that this information has been 

attached to the application package. 

Item 2.43. Enter the name or number and mailing address of sewage 

sludge incinerator used that you do not own or operate. Provide the 

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

address of the contact person for the incinerator. 

Include a complete location address for the incinerator if different from 

the mailing address. If the incinerator 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”). 

Item 2.44. Indicate whether the site contact is the owner and/or 

operator of the incinerator. 

Item 2.45. Provide the total dry metric tons of sewage sludge from 

your facility fired in the sewage sludge incinerator per 365-day period. 

Disposal in a Municipal Solid Waste Landfill 

Item 2.46. Indicate whether sewage sludge from your facility is placed 

on a municipal solid waste landfill. If “yes” continue to Item 2.47. If 

“no” skip to Part 2, Section 3. 

Item 2.47. Provide the total number of municipal solid waste landfills 

to which you send sewage sludge. Complete Items 2.48 through 2.52 

for each landfill used. Check the box to indicate that this information 

has been attached to the application package. 

Item 2.48. Enter the name and mailing address of the municipal solid 

waste landfill. Provide the name (first and last), title, work telephone 

number, and email address of the contact person for the landfill. 

Include a complete location address for the landfill if different from the 

mailing address. If the landfill 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”).

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Draft Application Forms – Not for Implementation

FORM 2S—PART 2 LINE-BY-LINE INSTRUCTIONS CONTINUED

Provide the latitude and longitude to the nearest second for the 

landfill and the associated metadata (e.g., horizontal collection 

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

horizontal reference datum). In the column marked “Reference 

Point,” indicate where the coordinates were collected (e.g., from 

the main entrance of the landfill or the center of the landfill). (See 

Part 2 Line-By-Line Instructions to Item 1.1 for guidance on 

supplying method of collection information.) 

Item 2.49. Provide the total dry metric tons of sewage sludge 

from your facility placed in each municipal solid waste landfill per 

365-day period. 

Item 2.50. In the space provided or in a separate attachment, list 

the number and type of all other federal, state, and local permits 

that regulate the operation of this municipal solid waste landfill. 

Item 2.51. Attach information to determine whether the sewage 

sludge meets applicable requirements for disposal in a municipal 

solid waste landfill (e.g., results of paint filter liquids test and 

toxicity characteristic leaching procedure, or TCLP, test). Check 

the box to indicate that this information has been attached to the 

application package. 

Item 2.54. Sewage sludge placed on a municipal solid waste 

landfill must meet requirements in 40 CFR Part 258 concerning 

the quality of materials placed on a landfill unit. Part 258 specifies 

minimum Federal criteria for municipal solid waste landfills, 

including landfills that accept sewage sludge along with 

household waste. In contrast to Part 503, Part 258 controls 

sewage sludge placed in municipal solid waste landfills through a 

facility design and management practice approach. In Part 503, 

EPA has adopted the Part 258 criteria as the appropriate 

standard for sewage sludge disposed of with municipal waste. 

EPA concluded that if sewage sludge is disposed of in a 

municipal solid waste landfill complying with Part 258 criteria, 

public health and the environment are protected. Note that the 

POTW is legally responsible for knowing whether a municipal 

solid waste landfill is in compliance with Part 258 and may be 

liable if it sends sludge to a municipal solid waste landfill that is 

not in compliance with Part 258. Indicate whether the municipal 

solid waste landfill complies with applicable criteria set forth in 

40 CFR Part 258. 

Section 3. Land Application of Bulk Sewage Sludge 

Complete this section if you completed Section B, Items 2.27 

through 2.31 (Land Application of Bulk Sewage Sludge). Unless 

the NPDES permitting authority specifically requires you to 

complete this section, you may skip this section for sewage 

sludge that is covered in any of the following portions of this 

application: 

 Section B, Items 2.11 through 3.13 (Preparation of Sewage 

Sludge Meeting Ceiling and Pollutant Concentrations, Class 

A Pathogen Requirements, and One of Vector Attraction 

Reduction Options 1 to 8). Such sewage sludges are exempt 

from the general requirements and management practices of 

Part 503 when they are land applied (unless the permitting 

authority requires otherwise), and thus the site information in 

Section C is not required for permitting. 

 Section B, Items 2.14 through 2.16 (Sale or Give-away in a Bag 

or Other Container for Application to the Land). Section C does 

not cover the sale or give-away of sewage sludge in a bag or 

other container for application to the land because EPA typically 

will not control the users of such sewage sludge (typically, home 

gardeners or other small-scale users), or the land on which the 

sludge is applied, through the generator’s permit. 

 Section B, Items 2.17 through 2.26 (Shipment Off-site for 

Treatment or Blending). Section C does not apply to a generator 

that sends sewage sludge to another facility for treatment or for 

blending, because the Part 503 requirements addressed by 

Section C will largely be the responsibility of the receiving facility. 

Provide the information in this section for each land application site 

that has been identified at the time of permit application. In cases 

where the sewage sludge is applied to numerous sites with similar 

characteristics, you may combine the information for several sites 

under a single response (the name and address of each site must still 

be provided, however). 

Item 3.1. Indicate whether your facility applies sewage sludge to land. 

If “yes” continue to Item 3.2. If “no” skip to Part 2, Section 4. 

Item 3.2. Indicate if any of the following conditions apply: 

 The sewage sludge meets the ceiling concentrations in Table 1 

of 40 CFR 503.13, the pollutant concentrations in Table 3 of 

40 CFR 503.13, Class A pathogen requirements at 40 CFR 

503.32(a), and one of the vector attraction reduction 

requirements at 40 CFR 503.33(b)(1)-(8); 

 The sewage sludge is sold or given away in a bag or other 

container for application to the land; or 

 You provide the sewage sludge to another facility for treatment 

or blending. 

If “yes” skip to Part 2, Section 4. If “no” continue to Item 3.3. 

Item 3.3. Complete the remainder of section 3 for each site on which 

sewage sludge is applied. Check the box to indicate if this information 

has been attached to the application package. 

Identification of Land Application Site 

Item 3.4. Enter the name or number and location address for the land 

application site. If the site 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 site 

and the associated metadata (e.g., horizontal collection method, scale 

of source map or photo, if applicable, and horizontal reference 

datum). The location of the land application site (i.e., where the 

coordinates are collected) shall be the approximate center of the area 

where the sewage sludge is directly released to the environment. 

(See Part 2 Line-By-Line Instructions to Item 1.1 for guidance on 

supplying method of collection information.) 

For Comment Only
Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2S—PART 2 LINE-BY-LINE INSTRUCTIONS CONTINUED

Item 3.5. Check the box to indicate that a topographic map (or 

other appropriate map if a topographic map is unavailable) 

showing the site location has been attached to the application. 

See Item 1.14 (Part 2, Section 1) for guidance on obtaining a 

topographic map. 

Owner Information 

Item 3.6. Indicate whether you are the owner of the land 

application site. If “yes” skip to Item 3.8 (Part 2, Section 3). If “no” 

continue to Item 3.7. 

Item 3.7. Enter the name and mailing address of the owner of the 

land application site. Provide the name (first and last), title, work 

telephone number, and email address of the contact person for 

the owner. 

Applier Information 

Item 3.8. Indicate whether you are the person who applies, or is 

responsible for application of, sewage sludge to this land 

application site. If “yes” skip to Item 3.10 (Part 2, Section 3). If 

“no” continue to Item 3.9. 

Item 3.9. Enter the name and mailing address of the applier. 

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

and email address of the contact person for the applier. 

Site Type 

Item 3.10. Identify the type of land application site (e.g., 

agricultural land, forest, reclamation site, public contact site, or 

other). If you check “Other”, provide a description in the space 

provided or in a separate attachment. 

Crop or Other Vegetation Grown on Site 

Item 3.11. In the space provided or in a separate attachment, 

describe the type of crop or other vegetation that is grown on the 

site. If the crop or vegetation to be grown on the site is not yet 

known, or is likely to change in an unforeseeable manner during 

the life of the permit, you may so indicate instead of providing the 

type of crop or other vegetation. 

Item 3.12. In the space provided or in a separate attachment, 

indicate the nitrogen requirement for the crop or other vegetation 

identified in Item 3.11. Information on the nitrogen content of 

vegetation grown on the site may be obtained from local 

agricultural extension services, a local Farm Advisor’s Office, or 

published sources. 

Vector Attraction Reduction 

Item 3.13. Indicate whether the vector attraction reduction 

requirements at 40 CFR 503.33(b)(9) and (b)(10) are met when 

sewage sludge is applied to the land application site. If “yes” 

continue to Item 3.14. If “no” skip to Item 3.16 (Part 2, Section 3). 

Item 3.14. Indicate which vector attraction option (Option 9 – 

injection below land surface; or Option 10 – incorporation into soil 

within 6 hours) is met when sewage sludge is applied to the land 

application site.

Item 3.15. In the space provided or in a separate attachment, 

describe any treatment processes used at the land application site to 

reduce vector attraction properties of sewage sludge. Check the box 

to indicate that your description has been attached to the application 

package. 

Cumulative Loadings and Remaining Allotments 

Item 3.16. Indicate whether the sewage sludge applied to this site 

since July 20, 1993 is subject to the cumulative pollutant loading rates 

(CPLRs) at 40 CFR 503.13(b)(2). If “yes” continue to Item 3.17. If “no” 

skip to Part 2, Section 4. 

Item 3.17. Indicate whether you have contacted the NPDES 

permitting authority in the state where the bulk sewage sludge subject 

to CPLRs will be applied, to ascertain whether bulk sewage sludge 

subject to CPLRs has been applied to this site on or since 

July 20, 1993. If “yes” continue to Item 3.18. If “no”, because sewage 

sludge subject to CPLRs may not be applied to this site, skip to 

Part 2, Section 4. 

Item 3.18. Provide your NPDES permitting authority’s name, contact 

person, telephone number, and email address. 

Item 3.19. Indicate, based on your inquiry, whether bulk sewage 

sludge subject to CPLRs has been applied to the site since 

July 20, 1993. If “yes” continue to Item 3.20. If “no” skip to Part 2, 

Section 4. 

Item 3.20. Provide the name and mailing address for every facility 

other than yours that is sending, or has sent, bulk sewage sludge 

subject to CPLRs to this site since July 20, 1993, Give the name (first 

and last), title, work telephone number, and email address of the 

contact person for the facility that is sending, or has sent, bulk 

sewage sludge subject to CPLRs to this site since July 20, 1993. 

Section 4. Surface Disposal 

Complete this section if you own or operate a surface disposal site 

and are required to submit a full permit application (i.e., Part 2 of 

Form 2S) at this time. A sewage sludge surface disposal site is, by 

definition, a TWTDS, and the owner/operator of the site is required to 

apply for a permit. 

Item 4.1. Indicate whether you own or operate a surface disposal site. 

If “yes” continue to Item 4.2. If “no” skip to Part 2, Section 5. 

Item 4.2. Complete the remainder of Section 4 for each active 

sewage sludge unit you own or operate. Check the box to indicate 

that this information has been attached to the application package. 

Information on Active Sewage Sludge Units 

Most requirements for surface disposal of sewage sludge under Part 

503 pertain to individual active sewage sludge units at a surface 

disposal site. The information required in Items 4.3 through 4.15 may 

be developed on a unit-by-unit basis, or may be developed for the 

entire surface disposal site if all units are sufficiently similar. 

Item 4.3. Enter the name or number and mailing address of the active 

sewage sludge unit. Provide the name (first and last), title, work 

telephone number, and email address of the contact person for the 

active sewage sludge unit. 

For Comment Only
Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2S—PART 2 LINE-BY-LINE INSTRUCTIONS CONTINUED

Include a complete location address for the unit if different from 

the mailing address. If the unit 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 

unit and the associated metadata (e.g., horizontal collection 

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

horizontal reference datum). The location of the unit (i.e., where 

the coordinates are collected) shall be the approximate center of 

the area where the sewage sludge is directly released to the 

environment. (See Part 2 Line-By-Line Instructions to Item 1.1 for 

guidance on supplying method of collection information.) 

Item 4.4. Check the box to indicate that a topographic map (or 

other appropriate map if a topographic map is unavailable) 

showing the site location has been attached to the application. 

See Item 1.14 (Part 2, Section 1) for guidance on obtaining a 

topographic map. 

Item 4.5. Provide the total dry metric tons of sewage sludge 

placed on the active sewage sludge unit per 365-day period. 

Item 4.6. Provide the total dry metric tons of sewage sludge 

placed on the active sewage sludge unit over the life of the unit. 

Item 4.7. Indicate whether the active sewage sludge unit has a 

liner with a maximum permeability of 10-7 centimeters per second 

(cm/sec). If “yes” continue to Item 4.8. If “no” skip to Item 4.9 

(Part 2, Section 4). 

Item 4.8. In the space provided or in a separate attachment, 

describe the liner. Check the box to indicate that a description 

has been attached to the application package. 

Item 4.9. Indicate whether or not the active sewage sludge unit

has a leachate collection system. If “yes” continue to Item 4.10. If 

“no” skip to Item 4.11 (Part 2, Section 4).

Item 4.10. In the space provided or in a separate attachment, 

describe the leachate collection system and the leachate disposal 

method. Also provide the numbers of any federal, state, or local 

permit(s) for leachate disposal. Check the box to indicate that this 

description has been attached to the application package. 

Item 4.11. Indicate if the boundary of the active sewage sludge 

site is less than 150 meters from the property line of the surface 

disposal site. If “yes” continue to Item 4.12. If “no” skip to 

Item 4.13 (Part 2, Section 4).

Item 4.12. Provide the distance, in meters, between the active 

sewage sludge site boundary and the surface disposal site 

property line. 

Item 4.13. Provide the remaining capacity of active sewage 

sludge in dry metric tons.

Item 4.14. List the anticipated closure date for the active sewage 

sludge unit, using the format MM/DD/YYYY, if known. 

Item 4.15. Submit a copy of any closure plan that has been 

developed for this active sewage sludge unit. Check the box to 

indicate that you have attached a copy to the application package. 

Sewage Sludge from Other Facilities 

Item 4.16. Indicate whether sewage sludge is sent to this active 

sewage sludge unit from any facilities other than yours. If “yes” 

continue to Item 4.17. If “no” skip to Item 4.21 (Part 2, Section 4). 

Item 4.17. Indicate the total number of facilities, other than yours, that 

send sewage sludge to this active sewage sludge unit. Complete 

Items 4.18 through 4.20 for each such facility. Check the box to 

indicate that this information has been attached to the application 

package. 

Item 4.18. Enter the name and mailing address of the facility that 

sends sewage sludge to this active sewage sludge unit. Provide the 

name (first and last), title, work telephone number, and email address 

of the contact person for the facility. 

Item 4.19. Indicate the pathogen class and reduction alternative and 

the vector attraction reduction option met for the sewage sludge 

before leaving the other facility. To determine the applicable pathogen 

class and reduction alternative, see 40 CFR 503.32. To determine the 

applicable vector attraction reduction option, see 40 CFR 503.33. 

Vector attraction reduction options 1 through 8 are typically met at the 

point where sewage sludge is generated or where a material is 

derived from sewage sludge, and options 9 through 11 are typically 

met at the point of use or disposal. 

Item 4.20. Identify the treatment process(es) used at the other facility 

to reduce pathogens or vector attraction properties of sewage sludge 

before leaving the other facility. If you check “Other”, specify the 

treatment process(es) in the space provided or in a separate 

attachment. 

Vector Attraction Reduction 

Item 4.21. Indicate which, if any, vector attraction reduction option 

(Option 9 – injection below land surface; Option 10 – incorporation 

into soil within 6 hours; Option 11 – covering active sewage sludge 

unit daily; or None) is met when sewage sludge is placed on this 

active sewage sludge unit. 

Item 4.22. In the space provided or in a separate attachment, 

describe any treatment processes used at the active sewage sludge 

unit to reduce vector attraction properties of sewage sludge. Check 

the box to indicate that this description has been attached to the 

application package. 

Groundwater Monitoring 

Placement of sewage sludge on an active sewage sludge unit must 

not contaminate an aquifer. Compliance must be demonstrated 

through either: (1) The results of a ground-water monitoring program 

developed by a qualified groundwater scientist, or (2) certification by a 

qualified groundwater scientist that contamination has not occurred. 

This section solicits existing groundwater monitoring data and other 

documentation to indicate the potential for contamination of an aquifer 

at the active sewage sludge unit, and the capability of the 

owner/operator of the surface disposal site to demonstrate that 

contamination has not occurred. 

For Comment Only
Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2S—PART 2 LINE-BY-LINE INSTRUCTIONS CONTINUED

Item 4.23. Indicate whether groundwater monitoring is currently 

conducted at, or ground monitoring data is otherwise available 

for, this active sewage sludge unit. If “yes” continue to Item 4.24. 

If “no” skip to Item 4.26 (Part 2, Section 4). 

Item 4.24. Provide a copy of available groundwater monitoring 

data. Check the box to indicate that the data has been attached 

to the application package. 

Item 4.25. In the space provided or in a separate attachment, 

describe the well locations, the approximate depth to groundwater 

and the groundwater monitoring procedures used to obtain the 

data. Check the box to indicate that the descriptions have been 

attached to the application package. 

Item 4.26. Indicate whether a groundwater monitoring program 

has been prepared for this active sewage sludge unit. If “yes” 

continue to Item 4.27. If “no” skip to Item 4.28 (Part 2, Section 4). 

Item 4.27. Submit a copy of the groundwater monitoring program 

that has been developed for this active sewage sludge unit. 

Check the box to indicate that this documentation has been 

attached to the application package. 

Item 4.28. Indicate whether you have obtained certification from a 

qualified groundwater scientist that the aquifer below the active 

sewage sludge unit has not been contaminated. If “yes” continue 

to Item 4.29. If “no” skip to Item 4.30 (Part 2, Section 4). 

Item 4.29. Submit a copy of the certification indicating that the 

aquifer below the active sewage sludge unit has not been 

contaminated. Check the box to indicate that this certification has 

been attached to the application package. 

Site Specific Limits 

After August 18, 1993, you are allowed to seek site-specific 

pollutant limits only for good cause, and must do so within 

180 days of becoming aware that good cause exists. If you 

request site-specific pollutant limits with this permit application, 

you are required to submit information supporting the request, 

including a demonstration that existing values for site parameters 

specified by the permitting authority differ from the values for 

those parameters used to develop the pollutant limits in Table 1 

of § 503.23. You must also submit follow-up information at the 

request of the NPDES permitting authority. If the NPDES 

permitting authority determines that site-specific pollutant limits 

are appropriate, he or she may specify site-specific limits in the 

permit as long as the existing concentrations of the pollutants in 

the sewage sludge are not exceeded. 

Item 4.30. Indicate whether you are seeking site-specific pollutant 

limits for the sewage sludge placed on the active sewage sludge 

unit. If “yes” continue to Item 4.31. If “no” skip to Part 2, Section 5. 

Item 4.31. Submit information to support the request for sitespecific pollutant limits. Check the box to indicate that this 

information has been attached to the application package.

Section 5. Incineration 

Complete this section if you own or operate a sewage sludge 

incinerator. A sewage sludge incinerator is, by definition, a treatment 

works treating domestic sewage, and the owner/ operator of a 

sewage sludge incinerator is required to submit a full permit 

application. 

Incinerator Information 

Item 5.1. Indicate whether or not you fire sewage sludge in a sewage 

sludge incinerator. If “yes” continue to Item 5.2. If “no” skip to END. 

Item 5.2. Indicate the total number of incinerators used at your facility. 

Complete the remainder of Section 5 for each incinerator. Check the 

box to indicate that you have attached information for one or more 

incinerator. 

Item 5.3. Enter the incinerator’s name or number. Include a complete 

location address for the incinerator. If the incinerator 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 

incinerator and the associated metadata (e.g., horizontal collection 

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

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

coordinates are collected) shall be the approximate center of the area 

where the sewage sludge is directly released to the environment. 

(See Part 2 Line-By-Line Instructions to Item 1.1 for guidance on 

supplying method of collection information.) 

Amount Fired 

Item 5.4. Provide the dry metric tons of sewage sludge fired in the 

sewage sludge incinerator per 365-day period. 

Beryllium NESHAP 

The firing of sewage sludge in a sewage sludge incinerator must not 

violate the National Emission Standard (NESHAP) for beryllium as 

established in Subpart C of 40 CFR Part 61. The beryllium NESHAP 

only applies, however, to sewage sludge incinerators firing ‘‘berylliumcontaining waste.’’ The beryllium NESHAP is 10 grams of beryllium in 

the exit gas over a 24-hour period, unless the incinerator 

owner/operator has been approved to meet a 30-day average 

ambient concentration limit on beryllium in the vicinity of the sewage 

sludge incinerator of 0.01 μg/m3. Complete this section to 

demonstrate compliance with the beryllium NESHAP. 

Item 5.5. Submit information, test data, and a description of measures 

taken that demonstrate whether the sewage sludge incinerated is 

beryllium-containing waste and will continue to remain as such. 

Check the box to indicate that this material has been attached to the 

application package. 

Item 5.6. Indicate whether or not the sewage sludge fired in the 

incinerator is beryllium-containing waste as defined at 40 CFR Part 

61.31. If “yes” continue to Item 5.7. If “no” skip to Item 5.8 (Part 2, 

Section 5). 

For Comment Only
Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2S—PART 2 LINE-BY-LINE INSTRUCTIONS CONTINUED

Item 5.7. Submit a complete report of the latest beryllium 

emission testing and documentation of ongoing incinerator 

operating parameters indicating that the NESHAP emission rate 

limit for beryllium has been and will continue to be met. Check the 

box to indicate that this documentation has been attached to the 

application package. 

Mercury NESHAP 

The firing of sewage sludge in a sewage sludge incinerator must 

not violate the NESHAP for mercury as established in Subpart E 

of 40 CFR Part 61. Complete this section to demonstrate 

compliance with the mercury NESHAP. Information on stack 

testing and sewage sludge sampling can be found at 40 CFR 

Parts 61.53 and 61.54. 

Item 5.8. Indicate whether or not compliance with the mercury 

NESHAP is being demonstrated via stack testing. If “yes” 

continue to Item 5.9. If “no” skip to Item 5.11 (Part 2, Section 5). 

Item 5.9. Submit a complete report of stack testing and 

documentation of ongoing incinerator operating parameters 

indicating that the NESHAP emission rate limit for mercury has 

been and will continue to be met. Check the box to indicate that 

this documentation has been attached to the application package. 

Item 5.10. Provide copies of mercury emission rate tests for the 

two most recent years in which testing was conducted. Check the 

box to indicate that this information has been attached to the 

application package. 

Item 5.11. Indicate whether you demonstrate compliance with the 

mercury NESHAP by performing sewage sludge sampling. If 

“yes” continue to Item 5.12. If “no” skip to Item 5.13 (Part 2, 

Section 5). 

Item 5.12. Submit a complete report of sewage sludge sampling 

and documentation of ongoing incinerator operating parameters 

indicating that the NESHAP emission rate limit for mercury has 

been and will continue to be met by the incinerator. Check the 

box to indicate that this documentation has been attached to the 

application package. 

Dispersion Factor 

Item 5.13. Provide the dispersion factor in micrograms/cubic 

meter per gram/second. 

Item 5.14. Specify the name and type of dispersion model. 

Item 5.15 Submit a copy of the modeling results and supporting 

documentation. Check the box to indicate that the documentation 

has been attached to the application package. 

Control Efficiency 

Item 5.16. Provide the control efficiency, in hundredths, for 

arsenic, cadmium, chromium, lead, and nickel. 

Item 5.17. Submit the results of performance testing and 

supporting documentation, including test dates. Check the box to 

indicate that this documentation has been attached to the 

application package. 

Risk-specific Concentration for Chromium 

Item 5.18. Provide the risk-specific concentration (RSC) used for 

chromium in micrograms per cubic meter. 

Item 5.19. Indicate whether the RSC was determined using Table 2 at 

40 CFR 503.43. If “yes” continue to Item 5.20. If “no” skip to Item 5.21 

(Part 2, Section 5). 

Item 5.20. Identify the incinerator used as the basis, as either 

fluidized bed with wet scrubber, other types with wet scrubber, 

fluidized bed with wet scrubber and wet electrostatic precipitator, or 

other types with wet scrubber and wet electrostatic precipitator. 

Item 5.21. Indicate whether or not the RSC was determined using 

Table 2 at 40 CFR 503.43 (site-specific determination). If “yes” 

continue to Item 5.22. If “no” skip to Item 5.23 (Part 2, Section 5). 

Item 5.22. Provide the decimal fraction of hexavalent chromium to 

total chromium concentration in the stack exit gas. 

Item 5.23. Submit the results of incinerator stack testing for 

hexavalent and total chromium concentrations, including test dates. 

Check the box to indicate that these results have been attached to the 

application package, or check “not applicable”. 

Incinerator Parameters 

Item 5.24. Indicate whether you monitor total hydrocarbons (THC) in 

the exit gas of the sewage sludge incinerator. 

Item 5.25. Indicate whether you monitor carbon monoxide (CO) in the 

exit gas of the sewage sludge incinerator. 

Item 5.26. Specify the type of sewage sludge incinerator used. 

Item 5.27. Provide the incinerator stack height in meters. 

Item 5.28. Indicate whether the value submitted in Item 5.27 is the 

actual stack height or creditable stack height. 

Performance Test Operating Parameters 

Item 5.29. Provide the maximum performance test combustion 

temperature. 

Item 5.30. Provide the performance test sewage sludge feed rate, in 

dry metric tons/day. 

Item 5.31. Indicate whether the value submitted in Item 5.30 is the 

average use rate or maximum design rate. 

Item 5.32. Supply supporting documentation describing how the feed 

rate was calculated. Check the box to indicate that this documentation 

has been attached to the application package. 

Item 5.33. Submit information documenting the performance test 

operating parameters for the air pollution control device(s) used for 

this sewage sludge incinerator. Check the box to indicate that this 

information has been attached to the application package. 

Monitoring Equipment 

Item 5.34. Use the table provided or a separate attachment, to 

indicate the equipment in place to monitor total hydrocarbons or 

For Comment Only
Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2S—PART 2 LINE-BY-LINE INSTRUCTIONS CONTINUED

carbon monoxide, percent oxygen, percent moisture, combustion 

temperature, and any other parameters not listed. 

Air Pollution Control Equipment 

Item 5.35. List all air pollution control equipment used with this 

sewage sludge incinerator. Check the box to indicate that the list 

has been attached to the application package. 

END OF PART 2

Submit your completed Part 2 of Form 2S and all associated 

attachments to your NPDES permitting authority.

For Comment Only
2S-20 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 2S—GLOSSARY 

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

NPDES regulations at 40 CFR 122.2 unless otherwise specified. If you have 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 2S—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 

For Comment Only
Contains Nonbinding Recommendations

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FORM 2S—GLOSSARY CONTINUED 

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

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 channeled 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. 

For Comment Only
Contains Nonbinding Recommendations

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FORM 2S—GLOSSARY CONTINUED 

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

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

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FORM 2S—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 gray water. For the purposes of this definition, “gray water” 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 

For Comment Only
Contains Nonbinding Recommendations

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FORM 2S—GLOSSARY CONTINUED 

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). 

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 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); 

For Comment Only
Contains Nonbinding Recommendations

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FORM 2S—GLOSSARY CONTINUED 

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

subtitle C of RCRA; 

(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, sand flats, “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; 

For Comment Only
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FORM 2S—GLOSSARY CONTINUED 

(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; 

(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 3510-2S (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

This Part should be complete by “sludge-only” facilities (i.e., facilities that do not currently have, and are not applying for, an NPDES permit 

for a direct discharge to a surface body of water). 

PART 1, SECTION 1. FACILITY INFORMATION (40 CFR 122.21(c)(2)(ii)(A)) 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 Horizontal Collection Method (Type of 

method/device used to identify the coordinates)

 Center of Facility Scale (Proportional distance on the ground for 

one unit of measure) Not Applicable

 Other (specify) Horizontal Reference Datum

(Coordinate reference system)

 NAD 27  NAD 83 

 WGS85  Other (specify) 

1.2 Ownership Status 

 Public—Federal  Public—State  Other Public (specify)  Private  Other (specify)

PART 1, SECTION 2. APPLICANT INFORMATION (40 CFR 122.21(c)(2)(ii)(B)) Applicant Information 

2.1 Is applicant different from entity listed under Item 1.1 above? 

 Yes  No  SKIP to Item 2.3 (Part 1, Section 2) 

2.2 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 

2.3 Is the applicant the facility’s owner, operator, or both? (Check only one response.) 

 Owner  Operator  Both 

2.4 To which entity should the NPDES permitting authority send correspondence? (Check only one response.) 

 Facility  Applicant  Facility and Applicant 

(They are one and the same.) 

Form 

2S 

NPDES

U.S Environmental Protection Agency 

Application for NPDES Permit for Sewage Sludge Management 

NEW AND EXISTING TREATMENT WORKS TREATING DOMESTIC SEWAGE

PRELIMINARY INFORMATION 

Does your facility currently have an effective NPDES permit or have you been directed by your NPDES permitting authority to submit a full 

Form 2S permit application? 

 Yes  Complete Part 2 of application package (begins p. 5).  No  Complete Part 1 of application package (below). 

PART 1 LIMITED BACKGROUND INFORMATION (40 CFR 122.21(c)(2)(ii)) 

For Comment Only
EPA Form 3510-2S (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

PART 1, SECTION 3. SEWAGE SLUDGE AMOUNT (40 CFR 122.21(c)(2)(ii)(D)) Sewage Sludge Amount

3.1 Provide the total dry metric tons per the latest 365 day period of sewage sludge generated, treated, used, and 

disposed: 

Practice Dry Metric Tons per 

365-Day Period

Amount generated at the facility 

Amount treated at the facility 

Amount used (i.e., received from off-site) at the facility 

Amount disposed at the facility 

PART 1, SECTION 4. POLLUTANT CONCENTRATIONS (40 CFR 122.21(c)(2)(ii)(E)) Pollutant Concentrations

4.1 Using the table below or a separate attachment, provide existing sewage sludge monitoring data for the pollutants for 

which limits in sewage sludge have been established in 40 CFR Part 503 for your facility’s expected use or disposal 

practices. If available, base data on three or more samples taken at least one month apart and no more than 

4.5 years old. 

 Check () here if you have provided a separate attachment with this information. 

Pollutant Concentration 

(mg/kg dry weight) Analytical Method Detection Level 

for Analysis 

Arsenic 

Cadmium 

Chromium 

Copper 

Lead 

Mercury 

Molybdenum 

Nickel 

Selenium 

Zinc 

Other (specify) 

Other (specify) 

Other (specify) 

Other (specify) 

Other (specify) 

Other (specify) 

Other (specify) 

Other (specify) 

Other (specify) 

For Comment Only
EPA Form 3510-2S (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

PART 1, SECTION 5. TREATMENT PROVIDED AT YOUR FACILITY (40 CFR 122.21(c)(2)(ii)(C)) Treatment Provided At Your Facility 

5.1 For each sewage sludge use or disposal practice, indicate the amount of sewage sludge used or disposed, the 

applicable pathogen class and reduction alternative, and the applicable vector attraction reduction option. Attach 

additional pages, as necessary. 

Use or Disposal Practice 

(Check one.) 

Amount 

(Dry Metric 

Tons) 

Pathogen Class and 

Reduction Alternative 

Vector Attraction 

Reduction Option 

 Land application of bulk sewage 

 Land application of biosolids (bulk) 

 Land application of biosolids (bags) 

 Surface disposal in a landfill 

 Other surface disposal 

 Incineration 

 Not Applicable 

 Class A – Alternative 1 

 Class A – Alternative 2 

 Class A – Alternative 3 

 Class A – Alternative 4 

 Class A – Alternative 5 

 Class A – Alternative 6 

 Class B – Alternative 1 

 Class B – Alternative 2 

 Class B – Alternative 3 

 Class B – Alternative 4 

 Domestic septage – pH 

adjustment 

 Not Applicable 

 Option 1 

 Option 2 

 Option 3 

 Option 4 

 Option 5 

 Option 6 

 Option 7 

 Option 8 

 Option 9 

 Option 10 

 Option 11 

5.2 For each of the use and disposal practices specified in Item 5.1, identify the treatment process(es) used at your 

facility to reduce pathogens in sewage sludge or reduce the vector attraction properties of sewage sludge? (Check all 

that apply.) 

 Preliminary operations (e.g., sludge 

grinding and degritting)  Thickening (concentration) 

 Stabilization  Anaerobic digestion 

 Composting  Conditioning 

 Disinfection (e.g., beta ray irradiation, 

gamma ray irradiation, pasteurization)  Dewatering (e.g., centrifugation, sludge drying beds, sludge lagoons) 

 Heat drying  Thermal reduction 

 Methane or biogas capture and recovery  Other (specify) 

PART 1, SECTION 6. SEWAGE SLUDGE SENT TO OTHER FACILITIES (40 CFR 122.21(c)(2)(ii)(C)) Sewage Sludge Sent to Other Facilities 

6.1 Does the sewage sludge from your facility meet the ceiling concentrations in Table 1 of 40 CFR 503.13, the pollutant 

concentrations in Table 3 of 40 CFR 503.13, Class A pathogen reduction requirements at 40 CFR 503.32(a), and one 

of vector attraction reduction requirements at 40 CFR 503.33(b)(1)-(8)? 

 Yes  SKIP to Part 1, Section 8 (Certification)  No 

6.2 Is sewage sludge from your facility provided to another facility for treatment, distribution, use, or disposal?

 Yes  No  SKIP to Part 1, Section 7 (Use and 

Disposal Sites) 

6.3 Receiving 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 

6.4 Which activities does the receiving facility provide? (Check all that apply.) 

 Treatment or blending  Sale or give-away in bag or other container 

 Land application  Surface disposal 

 Incineration  Other (describe) 

 Composting 

For Comment Only
EPA Form 3510-2S (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

PART 1, SECTION 7. USE AND DISPOSAL SITES (40 CFR 122.21(c)(2)(ii)(C)) Use and Disposal Sites 

Provide the following information for each site on which sewage sludge from this facility is used or disposed. 

 Check () here if you have provided separate attachments with this information. 

7.1 Site Name or Number 

 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 

 County County Code  Not Available 

Latitude/Longitude of Use or Disposal Site (See Instructions.) 

Latitude Longitude 

Degrees Minutes Seconds Degrees Minutes Seconds 

 

Collection Method Information 

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) 

7.2 Site type (Check all that apply.) 

 Agricultural  Lawn or home garden  Forest 

 Surface disposal  Public contact  Incineration 

 Reclamation  Municipal solid waste landfill  Other (describe) 

PART 1, SECTION 8. CERTIFICATION STATEMENT (40 CFR 122.22(a) and (d)) Certification Statement 

8.1 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 Phone Number 

 

Signature Date Signed 

PART 1 APPLICANTS STOP HERE.

Submit completed application package to your NPDES permitting authority. 

 

For Comment Only
EPA Form 3510-2S (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

PART 2 PERMIT APPLICATION INFORMATION (40 CFR 122.21(q)) 

Complete this part if you have an effective NPDES permit or have been directed by the NPDES permitting authority to submit a full permit 

application. In other words, complete this part if your facility has, or is applying for, an NPDES permit. 

Part 2 is divided into five sections. Section 1 pertains to all applicants. The applicability of Sections 2 to 5 depends on your facility’s 

sewage sludge use or disposal practices. See the Instructions to determine the sections you are required to complete. 

PART 2, SECTION 1. GENERAL INFORMATION (40 CFR 122.21(q)(1–7) and (q)(13)) General Information

This section must be completed by all Part 2 applicants. 

Facility Information 

1.1 Facility Name 

 Mailing Address (Street or P.O. Box) 

 City or Town State ZIP Code Phone Number 

 Contact Name (first and last) Title 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 Horizontal Collection Method (Type of 

method/device used to identify the coordinates)

 Center of Facility Scale (Proportional distance on the ground for 

one unit of measure) Not Applicable 

 Other (specify) Horizontal Reference Datum

(Coordinate reference system)

 NAD 27  NAD 83 

 WGS85  Other (specify) 

1.2 Is this facility a Class I sludge management facility? 

 Yes  No 

1.3 Facility Design Flow Rate million gallons per day (mgd)

1.4 Total Population Served 

1.5 Ownership Status 

 Public–Federal  Public—State  Other Public (specify)  Private  Other (specify) 

Applicant Information 

1.6 Is applicant different from entity listed under Item 1.1 above? 

 Yes  No  SKIP to Item 1.18 (Part 2, Section 1) 

1.7 Applicant Name 

 Applicant Mailing Address (Street or P.O. Box) 

 City or Town State ZIP Code 

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

1.8 Is the applicant the facility’s owner, operator, or both? (Check only one response.) 

 Operator  Owner  Both 

1.9 To which entity should the NPDES permitting authority send correspondence? (Check only one response.) 

 Facility  Applicant  Facility and Applicant 

(They are one and the same.) 

For Comment Only
EPA Form 3510-2S (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

General Information Continued

Permit Information 

1.10 Facility’s NPDES permit number NPDES Permit Number 

 Check () here if you do not have an NPDES permit but are otherwise 

required to submit Part 2 of Form 2S. 

1.11 Indicate all other federal, state, and local permits or construction approvals received or applied for that regulate this 

facility’s sewage sludge management practices below. 

 Check () here if you have provided a separate attachment with this information. 

Existing Environment Permits (Check all that apply and print or type the corresponding permit number for each.)

 RCRA (hazardous wastes)  Nonattainment program (CAA)  NESHAPS (CAA) 

 PSD (air emissions)  Dredge or fill (CWA Section 404)  Other (specify) 

 Ocean dumping (MPRSA)  UIC (underground injection of 

fluids) 

Indian Country 

1.12 Does any generation, treatment, storage, application to land, or disposal of sewage sludge from this facility occur in 

Indian Country? 

 Yes  No  SKIP to Item 1.14 (Part 2, Section 1) below. 

1.13 Provide a description of the generation, treatment, storage, land application, or disposal of sewage sludge that occurs. 

Topographic Map 

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

specific requirements.) 

 Yes  No 

Line Drawing 

1.15 Have you attached a line drawing and/or a narrative description that identifies all sewage sludge practices that will be 

employed during the term of the permit containing all the required information to this application? (See Instructions for 

specific requirements.) 

 Yes  No 

Contractor Information

1.16 Do contractors have any operational or maintenance responsibilities related to sewage sludge generation, treatment, 

use, or disposal at the facility? 

 Yes  No  SKIP to Item 1.18 (Part 2, Section 1) below. 

1.17 Provide the following information for each contractor. 

 Check () here if you have attached additional sheets to the application package. 

Contractor 1 Contractor 2 Contractor 3 

Contractor Company Name 

Mailing Address (Street or 

P.O. Box) 

City, State, and ZIP Code 

Contact Name (first and last) 

Telephone Number 

Email Address  Not Available  Not Available  Not Available

For Comment Only
EPA Form 3510-2S (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

General Information Continued

1.17 Contractor 1 Contractor 2 Contractor 3

cont. Responsibilities of Contractor 

Pollutant Concentrations 

Using the table below or a separate attachment, provide sewage sludge monitoring data for the pollutants for which limits in 

sewage sludge have been established in 40 CFR Part 503 for this facility’s expected use or disposal practices. All data must be

based on three or more samples taken at least one month apart and must be no more than 4.5 years old. 

 Check () here if you have attached additional sheets to the application package. 

1.18

Pollutant 

Average Monthly 

Concentration 

(mg/kg dry weight) 

Analytical Method Detection Level 

Arsenic 

Cadmium 

Chromium 

Copper 

Lead 

Mercury 

Molybdenum 

Nickel 

Selenium 

Zinc 

Checklist and Certification Statement 

1.19 In Column 1 below, mark the Form 2S, Part 2 section you have completed and are submitting with your application. For 

each section, specify in Column 2 if you are enclosing attachments. Note that not all applicants are required to 

complete all sections or provide attachments. See Exhibit 2S-2 in the Instructions. 

Column 1 Column 2 

 Section 1 (General Information)  w/ attachments 

 Section 2 (Generation of Sewage Sludge or Preparation of a Material 

Derived from Sewage Sludge)  w/ attachments 

 Section 3 (Land Application of Bulk Sewage Sludge)  w/ attachments 

 Section 4 (Surface Disposal)  w/ attachments 

 Section 5 (Incineration)  w/ attachments 

1.20 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 

Telephone Number 

Upon the request of the NPDES permitting authority, you must submit any other information the authority deems necessary to 

assess sewage sludge use or disposal practices at your facility and identify appropriate permitting requirements. 

For Comment Only
EPA Form 3510-2S (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

PART 2, SECTION 2. GENERATION OF SEWAGE SLUDGE OR PREPARATION OF A MATERIAL DERIVED FROM SEWAGE 

SLUDGE (40 CFR 122.21(q)(8) through (12)) Generation of Sewage Sludge or Preparation of a Material Derived from Sewage Sludge 

2.1 Does your facility generate sewage sludge or derive a material from sewage sludge? 

 Yes  No  SKIP to Part 2, Section 3. 

Amount Generated Onsite 

2.2 Total dry metric tons per 365-day period generated at your facility: 

Amount Received from Off-site Facility 

2.3 Does your facility receive sewage sludge from another facility for treatment use or disposal? 

 Yes  No  SKIP to Item 2.7 (Part 2, Section 2) below. 

2.4 Indicate the total number of facilities from which you receive sewage sludge for treatment, 

use, or disposal: 

Provide the following information for each of the facilities from which you receive sewage sludge. 

 Check () here if you have attached additional sheets to the application package. 

2.5 Name of Facility 

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 

County County Code  Not Available

Latitude/Longitude of Off-site Facility (See Instructions.)

Latitude Longitude 

Degrees Minutes Seconds Degrees Minutes Seconds 

 

Reference Point (Check one.) Collection Method Information 

 Entrance to Facility Horizontal Collection Method (Type of 

method/device used to identify the coordinates)

 Center of Facility Scale (Proportional distance on the ground for 

one unit of measure) Not Applicable 

 Other (specify) Horizontal Reference Datum (Coordinate 

reference system)

 NAD 27  NAD 83 

 WGS85  Other (specify) 

For Comment Only
EPA Form 3510-2S (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

Generation of Sewage Sludge or Preparation of a Material Derived from Sewage Sludge Continued

2.6 Indicate the amount of sewage sludge received, the applicable pathogen class and reduction alternative, and the 

applicable vector reduction option provided at the off-site facility. 

Amount 

(Dry Metric Tons)

Pathogen Class and Reduction 

Alternative Vector Attraction Reduction Option

 Not Applicable 

 Class A – Alternative 1 

 Class A – Alternative 2 

 Class A – Alternative 3 

 Class A – Alternative 4 

 Class A – Alternative 5 

 Class A – Alternative 6 

 Class B – Alternative 1 

 Class B – Alternative 2 

 Class B – Alternative 3 

 Class B – Alternative 4 

 Domestic septage – pH adjustment 

 Not Applicable 

 Option 1 

 Option 2 

 Option 3 

 Option 4 

 Option 5 

 Option 6 

 Option 7 

 Option 8 

 Option 9 

 Option 10 

 Option 11 

2.7 Identify the treatment process(es) that are known to occur at the off-site facility, including blending activities and 

treatment to reduce pathogens or vector attraction properties? (Check all that apply.) 

 Preliminary operations (e.g., sludge grinding and 

degritting)  Thickening (concentration) 

 Stabilization  Anaerobic digestion 

 Composting  Conditioning 

 Disinfection (e.g., beta ray irradiation, gamma ray 

irradiation, pasteurization)  Dewatering (e.g., centrifugation, sludge drying beds, sludge lagoons) 

 Heat drying  Thermal reduction 

 Methane or biogas capture and recovery  Other (specify) 

Treatment Provided at Your Facility 

2.8 For each sewage sludge use or disposal practice, indicate the applicable pathogen class and reduction alternative and 

the applicable vector attraction reduction option provided at your facility. Attach additional pages, as necessary. 

Use or Disposal Practice 

(Check one.) 

Pathogen Class and Reduction 

Alternative Vector Attraction Reduction Option

 Land application of bulk sewage 

 Land application of biosolids (bulk) 

 Land application of biosolids (bags) 

 Surface disposal in a landfill 

 Other surface disposal 

 Incineration 

 Not Applicable 

 Class A – Alternative 1 

 Class A – Alternative 2 

 Class A – Alternative 3 

 Class A – Alternative 4 

 Class A – Alternative 5 

 Class A – Alternative 6 

 Class B – Alternative 1 

 Class B – Alternative 2 

 Class B – Alternative 3 

 Class B – Alternative 4 

 Domestic septage – pH adjustment 

 Not Applicable 

 Option 1 

 Option 2 

 Option 3 

 Option 4 

 Option 5 

 Option 6 

 Option 7 

 Option 8 

 Option 9 

 Option 10 

For 

 Option 11 

Comment Only
EPA Form 3510-2S (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

Generation of Sewage Sludge or Preparation of a Material Derived from Sewage Sludge Continued

2.9 Identify the treatment process(es) used at your facility to reduce pathogens in sewage sludge or reduce the vector 

attraction properties of sewage sludge? (Check all that apply.) 

 Preliminary operations (e.g., sludge grinding and 

degritting)  Thickening (concentration) 

 Stabilization  Anaerobic digestion 

 Composting  Conditioning 

 Disinfection (e.g., beta ray irradiation, gamma ray 

irradiation, pasteurization)  Dewatering (e.g., centrifugation, sludge drying beds, sludge lagoons) 

 Heat drying  Thermal reduction 

 Methane or biogas capture and recovery 

2.10 Describe any other sewage sludge treatment or blending activities not identified in Items 2.8 and 2.9 (Part 2, Section 2) 

above. 

 Check () here if you have attached the description to the application package. 

 

Preparation of Sewage Sludge Meeting Ceiling and Pollutant Concentrations, Class A Pathogen Requirements, and One 

of Vector Attraction Reduction Options 1 to 8 

2.11 Does the sewage sludge from your facility meet the ceiling concentrations in Table 1 of 40 CFR 503.13, the pollutant 

concentrations in Table 3 of 40 CFR 503.13, Class A pathogen reduction requirements at 40 CFR 503.32(a), and one of 

the vector attraction reduction requirements at 40 CFR 503.33(b)(1)-(8) and is it land applied? 

 Yes  No  SKIP to Item 2.14 (Part 2, Section 2) below. 

2.12 Total dry metric tons per 365-day period of sewage sludge subject to this subsection 

that is applied to the land: 

2.13 Is sewage sludge subject to this subsection placed in bags or other containers for sale or give-away for application to the 

land? 

 Yes  No 

 Check () here once you have completed Items 2.11 to 2.13 then  SKIP to Item 2.32 (Part 2, Section 2) below. 

Sale or Give-away in a Bag or Other Container for Application to the Land 

2.14 Do you place sewage sludge in a bag or other container for sale or give-away for land application? 

 Yes  No  SKIP to Item 2.17 (Part 2, Section 2) below. 

2.15 Total dry metric tons per 365-day period of sewage sludge placed in a bag or other 

container at your facility for sale or give-away for application to the land: 

2.16 Attach a copy of all labels or notices that accompany the sewage sludge being sold or given away in a bag or other 

container for application to the land. 

 Check () here to indicate that you have attached all labels or notices to this application package. 

 Check () here once you have completed Items 2.14 to 2.16 then  SKIP to Part 2, Section 2, Item 2.32.

For Comment Only
EPA Form 3510-2S (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

Generation of Sewage Sludge or Preparation of a Material Derived from Sewage Sludge Continued 

Shipment Off-site for Treatment or Blending 

2.17 Does another facility provide treatment or blending of your facility’s sewage sludge? (This question does not pertain to 

dewatered sludge sent directly to a land application or surface disposal site.) 

 Yes  No  SKIP to Item 2.32 (Part 2, Section 2) below. 

2.18 Indicate the total number of facilities that provide treatment or blending of your facility’s 

sewage sludge: 

(Provide the information in Items 2.19 to 2.26 (Part 2, Section 2) below for each facility.) 

 Check () here if you have attached additional sheets to the application 

package. 

2.19 Name of Receiving Facility 

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 

2.20 Total dry metric tons per 365-day period of sewage sludge provided to receiving facility: 

2.21 Does the receiving facility provide additional treatment to reduce pathogens in sewage sludge from your facility or reduce

the vector attraction properties of sewage sludge from your facility? 

 Yes  No  SKIP to Item 2.24 (Part 2, Section 2) 

below. 

2.22 Indicate the pathogen class and reduction alternative and the vector attraction reduction option met for the sewage 

sludge at the receiving facility. 

Pathogen Class and Reduction Alternative Vector Attraction Reduction Option 

 Not Applicable 

 Class A – Alternative 1 

 Class A – Alternative 2 

 Class A – Alternative 3 

 Class A – Alternative 4 

 Class A – Alternative 5 

 Class A – Alternative 6 

 Class B – Alternative 1 

 Class B – Alternative 2 

 Class B – Alternative 3 

 Class B – Alternative 4 

 Domestic septage – pH adjustment

 Not Applicable 

 Option 1 

 Option 2 

 Option 3 

 Option 4 

 Option 5 

 Option 6 

 Option 7 

 Option 8 

 Option 9 

 Option 10 

 Option 11

2.23 Which treatment process(es) are used at the receiving facility to reduce pathogens in sewage sludge or reduce the vector 

attraction properties of sewage sludge from your facility? (Check all that apply.) 

 Preliminary operations (e.g., sludge grinding and 

degritting)  Thickening (concentration) 

 Stabilization  Anaerobic digestion 

 Composting  Conditioning 

 Disinfection (e.g., beta ray irradiation, gamma ray 

irradiation, pasteurization)  Dewatering (e.g., centrifugation, sludge drying beds, sludge lagoons) 

 Heat drying  Thermal reduction 

 Methane or biogas capture and recovery  Other (specify) 

For Comment Only
EPA Form 3510-2S (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

2.24 Attach a copy of any information you provide the receiving facility to comply with the “notice and necessary information” 

requirement of 40 CFR 503.12(g). 

 Check () here to indicate that you have attached material. 

2.25 Does the receiving facility place sewage sludge from your facility in a bag or other container for sale or give-away for 

application to the land? 

 Yes  No  SKIP to Item 2.32 (Part 2, Section 2) 

below. 

2.26 Attach a copy of all labels or notices that accompany the product being sold or given away. 

 Check () here to indicate that you have attached material. 

 Check () here once you have completed Items 2.17 to 2.26 (Part 2, Section 2) then  SKIP to Item 2.32 (Part 2, 

Section 2) below. 

Land Application of Bulk Sewage Sludge 

2.27 Is sewage sludge from your facility applied to the land? 

 Yes  No  SKIP to Item 2.32 (Part 2, Section 2) 

below. 

2.28 Total dry metric tons per 365-day period of sewage sludge applied to all land 

application sites: 

2.29 Did you identify all land application sites in Part 2, Section 3 of this application? 

 Yes  No  Submit a copy of the land application plan 

with your application. 

2.30 Are any land application sites located in states other than the state where you generate sewage sludge or derive a 

material from sewage sludge? 

 Yes  No  SKIP to Item 2.32 (Part 2, Section 2) 

below. 

2.31 Describe how you notify the NPDES permitting authority for the states where the land application sites are located. 

Attach a copy of the notification. 

 Check () here if you have attached the explanation to the application package. 

 Check () here if you have attached the notification to the application package. 

Surface Disposal 

2.32 Is sewage sludge from your facility placed on a surface disposal site? 

 Yes  No  SKIP to Item 2.39 (Part 2, Section 2) 

below. 

2.33 Total dry metric tons of sewage sludge from your facility placed on all surface 

disposal sites per 365-day period: 

2.34 Do you own or operate all surface disposal sites to which you send sewage sludge for disposal? 

 Yes  SKIP to Item 2.39 (Part 2, Section 2) 

below.  No 

2.35 Indicate the total number of surface disposal sites to which you send your sewage sludge: 

(Provide the information in Items 2.36 to 2.38 of Part 2, Section 2 for each facility.) 



For 

Check () here if you have attached additional sheets to the application package. 

Comment Only
EPA Form 3510-2S (Revised <INSERT DATE>) Page 13 

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

Generation of Sewage Sludge or Preparation of a Material Derived from Sewage Sludge Continued

2.36 Site name or number of surface disposal site you do not own or operate 

Mailing Address (Street or P.O. Box) 

City or Town State ZIP Code 

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

2.37 Site Contact (Check all that apply.) 

 Owner  Operator 

2.38 Total dry metric tons of sewage sludge from your facility placed on this surface 

disposal site per 365-day period: 

Incineration 

2.39 Is sewage sludge from your facility fired in a sewage sludge incinerator? 

 Yes  No  SKIP to Item 2.46 (Part 2, Section 2) 

below. 

2.40 Total dry metric tons of sewage sludge from your facility fired in all sewage sludge 

incinerators per 365-day period: 

2.41 Do you own or operate all sewage sludge incinerators in which sewage sludge from your facility is fired? 

 Yes  SKIP to Item 2.46 (Part 2, Section 2) 

below.  No 

2.42 Indicate the total number of sewage sludge incinerators used that you do not own or 

operate: 

(Provide the information in Items 2.43 to 2.45 directly below for each facility.) 

 Check () here if you have attached additional sheets to the application package. 

2.43 Incinerator Name or Number 

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 

2.44 Contact (Check all that apply.) 

 Incinerator Owner  Incinerator Operator 

2.45 Total dry metric tons of sewage sludge from your facility fired in this sewage 

sludge incinerator per 365-day period: 

Disposal in a Municipal Solid Waste Landfill 

2.46 Is sewage sludge from your facility placed on a municipal solid waste landfill? 

 Yes  No  SKIP to Part 2, Section 3. 

2.47 Indicate the total number of municipal solid waste landfills used: 

(Provide the information in Items 2.48 to 2.52 directly below for each facility.) 

 Check () here if you have attached additional sheets to the application 

package. 

For Comment Only
EPA Form 3510-2S (Revised <INSERT DATE>) Page 14 

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

Generation of Sewage Sludge or Preparation of a Material Derived from Sewage Sludge Continued

2.48 Name of Landfill 

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 

County County Code  Not Available 

City or Town State ZIP Code 

Latitude/Longitude of Landfill (See Instructions.) 

Latitude Longitude 

Degrees Minutes Seconds Degrees Minutes Seconds 

 

Reference Point (Check one.) Collection Method Information 

 Entrance to Facility Horizontal Collection Method (Type of 

method/device used to identify the coordinates)

 Center of Facility Scale (Proportional distance on the ground for 

one unit of measure) Not Applicable

 Other (specify) Horizontal Reference Datum

(Coordinate reference system)

 NAD 27  NAD 83 

 WGS85  Other (specify) 

2.49 Total dry metric tons of sewage sludge from your facility placed in this municipal 

solid waste landfill per 365-day period: 

2.50 List the numbers of all other federal, state, and local permits that regulate the operation of this municipal solid waste 

landfill. 

Permit Number Type of Permit 

 

 

 

2.51 Attach to the application information to determine whether the sewage sludge meets applicable requirements for disposal 

of sewage sludge in a municipal solid waste landfill (e.g., results of paint filter liquids test and TCLP test)? 

 Check here () to indicate you have attached the requested information. 

2.52 Does the municipal solid waste landfill comply with applicable criteria set forth in 40 CFR Part 258? 

 Yes  No 

 

For Comment Only
EPA Form 3510-2S (Revised <INSERT DATE>) Page 15 

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

PART 2, SECTION 3—LAND APPLICATION OF BULK SEWAGE SLUDGE (40 CFR 122.21(q)(9)) Land Application of Bulk Sewage Sludge 

3.1 Does your facility apply sewage sludge to land? 

 Yes  No  SKIP to Part 2, Section 4. 

3.2 Do any of the following conditions apply? 

 The sewage sludge meets the ceiling concentrations in Table 1 of 40 CFR 503.12, the pollutant concentrations 

in Table 3 of 40 CFR 503.13, Class A pathogen reduction requirements at 40 CFR 503.32(a), and one of the 

vector attraction reduction requirements at 40 CFR 503.33(b)(1)-(8); 

 The sewage sludge is sold or given away in a bag or other container for application to the land; or 

 You provide the sewage sludge to another facility for treatment or blending. 

 Yes  SKIP to Part 2, Section 4.  No 

3.3 Complete Section 3 for every site on which the sewage sludge is applied. 

 Check here () if you have attached sheets to the application package for one or more land application sites. 

Identification of Land Application Site 

3.4 Site Name or Number 

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

County County Code  Not Available 

City or Town State ZIP Code 

Latitude/Longitude of Land Application Site (See Instructions.) 

Latitude Longitude 

Degrees Minutes Seconds Degrees Minutes Seconds 

 

Collection Method Information 

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) 

3.5 Provide a topographic map (or other appropriate map if a topographic map is unavailable) that shows the site location. 

 Check here () to indicate you have attached a topographic map for this site. 

Owner Information 

3.6 Are you the owner of this land application site? 

 Yes  SKIP to Item 3.8 (Part 2, Section 3) below.  No 

3.7 Owner Name 

 Mailing Address (Street or P.O. Box) 

City or Town State ZIP Code 

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

Applier Information 

3.8 Are you the person who applies, or who is responsible for application of, sewage sludge to this land application site? 

 Yes  SKIP to Item 3.10 (Part 2, Section 3) 

below.  No 

For Comment Only
EPA Form 3510-2S (Revised <INSERT DATE>) Page 16 

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

Land Application of Bulk Sewage Sludge Continued

3.9 Applier’s Name 

 Mailing Address (Street or P.O. Box) 

City or Town State ZIP Code 

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

Site Type 

3.10 Type of Land Application: 

 Agricultural land  Forest 

 Reclamation site  Public contact site 

 Other (describe) 

Crop or Other Vegetation Grown on Site 

3.11 What type of crop or other vegetation is grown on this site? 

3.12 What is the nitrogen requirement for this crop or vegetation? 

Vector Attraction Reduction 

3.13 Are the vector attraction reduction requirements at 40 CFR 503.33(b)(9) and (b)(10) met when sewage sludge is applied 

to the land application site? 

 Yes  No  SKIP to Item 3.16 (Part 2, Section 3) 

below. 

3.14 Indicate which vector attraction reduction option is met. (Check only one response.) 

 Option 9 (Injection below land surface)  Option 10 (Incorporation into soil within 6 hours) 

3.15 Describe any treatment processes used at the land application site to reduce vector attraction properties of sewage 

sludge. 

 Check here () if you have attached your description to the application package. 

Cumulative Loadings and Remaining Allotments 

3.16 Is the sewage sludge applied to this site since July 20, 1993 subject to the cumulative pollutant loading rates (CPLRs) in

40 CFR 503.13(b)(2)? 

 Yes  No  SKIP to Part 2, Section 4. 

3.17 Have you contacted the NPDES permitting authority in the state where the bulk sewage sludge subject to CPLRs will be 

applied to ascertain whether bulk sewage sludge subject to CPLRs has been applied to this site on or since 

July 20, 1993? 

 Yes 

No  Sewage sludge subject to CPLRs may not 

be applied to this site. SKIP to Part 2, 

Section 4. 

3.18 Provide the following information regarding your NPDES permitting authority: 

NPDES Permitting Authority Name 

Contact Person 

Telephone Number 

Email Address 

3.19 Based upon your inquiry, has bulk sewage sludge subject to CPLRs been applied to this site since July 20, 1993? 

 Yes  No  SKIP to Part 2, Section 4. 

For Comment Only
EPA Form 3510-2S (Revised <INSERT DATE>) Page 17 

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

Land Application of Bulk Sewage Sludge 

Continued

3.20 Provide the following information for every facility other than yours that is sending, or has sent, bulk sewage sludge 

subject to CPLRs to this site since July 20, 1993. If more than one such facility sends sewage sludge to this site, attach 

additional pages as necessary. 

 Check here () to indicate that additional pages are attached. 

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 

 

For Comment Only
EPA Form 3510-2S (Revised <INSERT DATE>) Page 18 

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

PART 2, SECTION 4—SURFACE DISPOSAL (40 CFR 122.21(q)(10)) Surface Disposal

4.1 Do you own or operate a surface disposal site? 

 Yes  No  SKIP to Part 2, Section 5. 

4.2 Complete all items in Section 4 for each active sewage sludge unit that you own or operate. 

 Check here () to indicate that you have attached material to the application package for one or more 

active sewage sludge units. 

Information on Active Sewage Sludge Units 

4.3 Unit Name or Number 

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 

County County Code  Not Ava

City or Town State ZIP Code 

Latitude/Longitude of Active Sewage Sludge Unit (See Instructions.)

Latitude Longitude 

Degrees Minutes Seconds Degrees Minutes Seconds 

 

Collection Method Information 

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) 

4.4 Provide a topographic map (or other appropriate map if a topographic map is unavailable) that shows the site location. 

 Check here () to indicate that you have completed and attached a topographic map. 

4.5 Total dry metric tons of sewage sludge placed on the active sewage sludge unit per 

365-day period: 

4.6 Total dry metric tons of sewage sludge placed on the active sewage sludge unit over 

the life of the unit: 

4.7 Does the active sewage sludge unit have a liner with a maximum permeability of 1 × 10-7 centimeters per second 

(cm/sec)? 

 Yes  No SKIP to Item 4.9 (Part 2, Section 4) 

below. 

4.8 Describe the liner: 

 Check here () to indicate that you have attached a description to the application package. 

4.9 Does the active sewage sludge unit have a leachate collection system? 

 Yes  No  SKIP to Item 4.11 (Part 2, Section 

4) below. 

4.10 Describe the leachate collection system and the method used for leachate disposal and provide the numbers of any 

federal, state, or local permit(s) for leachate disposal. 

 Check here () to indicate that you have attached the description to the application package. 

For Comment Only
EPA Form 3510-2S (Revised <INSERT DATE>) Page 19 

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

Surface Disposal Continued 

4.11 Is the boundary of the active sewage sludge unit less than 150 meters from the property line of the surface disposal site?

 Yes  No  SKIP to Item 4.13 (Part 2, 

Section 4) below. 

4.12 Provide the actual distance in meters: meters 

4.13 Remaining capacity of active sewage sludge unit in dry metric tons: dry metric tons 

4.14 Anticipated closure date for active sewage sludge unit, if known (MM/DD/YYYY): 

4.15 Attach a copy of any closure plan that has been developed for this active sewage sludge unit. 

 Check here () to indicate that you have attached a copy of the closure plan to the application package. 

Sewage Sludge from Other Facilities

4.16 Is sewage sludge sent to this active sewage sludge unit from any facilities other than your facility? 

 Yes  No  SKIP to Item 4.21 (Part 2, Section 

4) below. 

4.17 Indicate the total number of facilities (other than your facility) that send sewage 

sludge to this active sewage sludge unit: 

Complete Items 4.18 to 4.20 directly below for each such facility. 

 Check here () to indicate that you have attached responses for each facility to 

the application package. 

4.18 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 

4.19 Indicate the pathogen class and reduction alternative and the vector attraction reduction option met for the sewage 

sludge before leaving the other facility. 

Pathogen Class and Reduction Alternative Vector Attraction Reduction Option

 Not Applicable 

 Class A – Alternative 1 

 Class A – Alternative 2 

 Class A – Alternative 3 

 Class A – Alternative 4 

 Class A – Alternative 5 

 Class A – Alternative 6 

 Class B – Alternative 1 

 Class B – Alternative 2 

 Class B – Alternative 3 

 Class B – Alternative 4 

 Domestic septage – pH adjustment

 Not Applicable 

 Option 1 

 Option 2 

 Option 3 

 Option 4 

 Option 5 

 Option 6 

 Option 7 

 Option 8 

 Option 9 

 Option 10 

 Option 11

4.20 Which treatment process(es) are used at the other facility to reduce pathogens in sewage sludge or reduce the vector 

attraction properties of sewage sludge before leaving the other facility? (Check all that apply.) 

 Preliminary operations (e.g., sludge grinding and 

degritting)  Thickening (concentration) 

 Stabilization  Anaerobic digestion 

 Composting  Conditioning 

 Disinfection (e.g., beta ray irradiation, gamma ray 

irradiation, pasteurization)  Dewatering (e.g., centrifugation, sludge drying beds, sludge lagoons) 

 Heat drying  Thermal reduction 

 Methane or biogas capture and recovery  Other (specify) 

For Comment Only
EPA Form 3510-2S (Revised <INSERT DATE>) Page 20 

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

Vector Attraction Reduction 

4.21 Which vector attraction reduction option, if any, is met when sewage sludge is placed on this active sewage sludge unit? 

 Option 9 (Injection below and surface)  Option 11 (Covering active sewage sludge 

unit daily) 

 Option 10 (Incorporation into soil within 6 hours)  None 

4.22 Describe any treatment processes used at the active sewage sludge unit to reduce vector attraction properties of sewage 

sludge. 

 Check here () if you have attached your description to the application package. 

Groundwater Monitoring 

4.23 Is groundwater monitoring currently conducted at this active sewage sludge unit, or are groundwater monitoring data 

otherwise available for this active sewage sludge unit? 

 Yes  No  SKIP to Item 4.26 (Part 2, 

Section 4) below. 

4.24 Provide a copy of available groundwater monitoring data. 

 Check here () to indicate you have attached the monitoring data. 

4.25 Describe the well locations, the approximate depth to groundwater, and the groundwater monitoring procedures used to 

obtain these data. 

 Check here () if you have attached your description to the application package. 

4.26 Has a groundwater monitoring program been prepared for this active sewage sludge unit? 

 Yes  No  SKIP to Item 4.28 (Part 2, 

Section 4) below. 

4.27 Submit a copy of the groundwater monitoring program with this permit application. 

 Check here () to indicate you have attached the monitoring program. 

4.28 Have you obtained a certification from a qualified groundwater scientist that the aquifer below the active sewage sludge 

unit has not been contaminated? 

 Yes  No  SKIP to Item 4.30 (Part 2, 

Section 4) below. 

4.29 Submit a copy of the certification with this permit application. 

 Check here () to indicate you have attached the certification to the application package. 

Site-Specific Limits 

4.30 Are you seeking site-specific pollutant limits for the sewage sludge placed on the active sewage sludge unit? 

 Yes  No  SKIP to Part 2, Section 5. 

4.31 Submit information to support the request for site-specific pollutant limits with this application 

 Check here () to indicate you have attached the requested information. 

 

For Comment Only
EPA Form 3510-2S (Revised <INSERT DATE>) Page 21 

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

PART 2, SECTION 5—INCINERATION (40 CFR 122.21(q)(11)) Incineration 

Incinerator Information 

5.1 Do you fire sewage sludge in a sewage sludge incinerator? 

 Yes  No  SKIP to END. 

5.2 Indicate the total number of incinerators used at your facility? 

(Complete the remainder of Section 5 for each such incinerator.) 

 Check () here to indicate that you have attached information for one or more 

incinerators. 

5.3 Incinerator Name or Number 

Location Address (Street, Route Number or Other Specific Identifier) 

County County Code  Not Available 

City or Town State ZIP Code 

Latitude/Longitude of Incinerator (See Instructions.) 

Latitude Longitude 

Degrees Minutes Seconds Degrees Minutes Seconds 

 

Collection Method Information 

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) 

Amount Fired 

5.4 Dry metric tons per 365-day period of sewage sludge fired in the sewage sludge 

incinerator: 

Beryllium NESHAP 

5.5 Submit information, test data, and a description of measures taken that demonstrate whether the sewage sludge 

incinerated is beryllium-containing waste and will continue to remain as such. 

 Check () here to indicate that you have attached this material to the application package. 

5.6 Is the sewage sludge fired in this incinerator “beryllium-containing waste” as defined at 40 CFR Part 61.31? 

 Yes  No  SKIP to Item 5.8 (Part 2, Section 5) below. 

5.7 Submit with this application a complete report of the latest beryllium emission rate testing and documentation of ongoing 

incinerator operating parameters indicating that the NESHAP emission rate limit for beryllium has been and will continue 

to be met. 

 Check () here to indicate that you have attached this information. 

Mercury NESHAP 

5.8 Is compliance with the mercury NESHAP being demonstrated via stack testing? 

 Yes  No  SKIP to Item 5.11 (Part 2, Section 5) below. 

5.9 Submit a complete report of stack testing and documentation of ongoing incinerator operating parameters indicating that 

the incinerator has met and will continue to meet the mercury NESHAP emission rate limit. 

 Check () here to indicate that you have attached this information. 

5.10 Provide copies of mercury emission rate tests for the two most recent years in which testing was conducted? 

 Check () here to indicate that you have attached this information. 

For Comment Only
EPA Form 3510-2S (Revised <INSERT DATE>) Page 22 

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

Incineration Continued 

5.11 Do you demonstrate compliance with the mercury NESHAP by sewage sludge sampling? 

 Yes  No  SKIP to Item 5.13 (Part 2, Section 5) below. 

5.12 Submit a complete report of sewage sludge sampling and documentation of ongoing incinerator operating parameters 

indicating that the incinerator has met and will continue to meet the mercury NESHAP emission rate limit. 

 Check () here to indicate that you have attached this information. 

Dispersion Factor 

5.13 Dispersion factor in micrograms/cubic meter per gram/second: 

5.14 Name and type of dispersion model: 

5.15 Submit a copy of the modeling results and supporting documentation. 

 Check () here to indicate that you have attached this information. 

Control Efficiency 

5.16 Provide the control efficiency, in hundredths, for each of the pollutants listed below. 

Pollutant Control efficiency, in hundredths 

Arsenic 

Cadmium 

Chromium 

Lead 

Nickel 

5.17 Attach a copy of the results or performance testing and supporting documentation (including testing dates). 

 Check () here to indicate that you have attached this information. 

Risk-Specific Concentration for Chromium 

5.18 Provide the risk-specific concentration (RSC) used for chromium in 

micrograms per cubic meter: 

5.19 Was the RSC determined via Table 2 in 40 CFR 503.43? 

 Yes  No  SKIP to Item 5.21 (Part 2, Section 5) below. 

5.20 Identify the type of incinerator used as the basis. 

 Fluidized bed with wet scrubber  Other types with wet scrubber 

 Fluidized bed with wet scrubber and wet 

electrostatic precipitator  Other types with wet scrubber and wet electrostatic precipitator 

5.21 Was the RSC determined via Table 6 in 40 CFR 503.43 (site-specific determination)? 

 Yes  No  SKIP to Item 5.23 (Part 2, Section 5) below. 

5.22 Provide the decimal fraction of hexavalent chromium concentration to total 

chromium concentration in stack exit gas: 

5.23 Attach the results of incinerator stack tests for hexavalent and total chromium concentrations, including the date(s) of 

any test(s), with this application. 

 Check () here to indicate that you have attached this information.  Not Applicable 

Incinerator Parameters 

5.24 Do you monitor total hydrocarbons (THC) in the exit gas of the sewage sludge incinerator? 

 Yes  No 

5.25 Do you monitor carbon monoxide (CO) in the exit gas of the sewage sludge incinerator? 

 Yes  No 

5.26 Indicate the type of sewage sludge incinerator. 

For Comment Only
EPA Form 3510-2S (Revised <INSERT DATE>) Page 23 

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

Incineration Continued 

5.27 Incinerator stack height in meters: 

5.28 Indicate whether the value submitted in Item 5.27 is (check only one response): 

 Actual stack height  Creditable stack height 

Performance Test Operating Parameters 

5.29 Maximum Performance Test Combustion Temperature: 

5.30 Performance test sewage sludge feed rate, in dry metric tons/day 

5.31 Indicate whether value submitted in Item 5.30 is (check only one response): 

 Average use  Maximum design 

5.32 Attach supporting documents describing how the feed rate was calculated. 

 Check () here to indicate that you have attached this information. 

5.33 Submit information documenting the performance test operating parameters for the air pollution control device(s) used 

for this sewage sludge incinerator. 

 Check () here to indicate that you have attached this information. 

Monitoring Equipment 

5.34 List the equipment in place to monitor the listed parameters. 

Parameter Equipment in Place for Monitoring 

Total hydrocarbons or carbon monoxide 

Percent oxygen 

Percent moisture 

Combustion temperature 

Other (describe) 

Air Pollution Control Equipment 

5.35 List all air pollution control equipment used with this sewage sludge incinerator. 

 Check () here if you have attached the list to the application package for the noted incinerator. 

END of PART 2

Submit completed application package to your NPDES permitting authority.

For Comment Only