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United States Environmental Protection Agency Office of Water Washington, D.C. EPA Form 3510-1 Revised <INSERT DATE>



### Water Permits Division 

# Application Form 1

General Information

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 fo r comment purposes only. Comments and suggestions regarding this draft document should be submitted through electronic comments to http://www.regulations.gov.

Note: All applicants to the National Pollutant Di scharge Elimination System (NPDES) permits program, with the exception of publicly owned trea tment works and other treatment works treating domestic sewage, must complete Form 1. Additionally, all applicants must comple te one or more of the following forms: 2A, 2B, 2C, 2D, 2E, 2F or 2S. To determine the specific forms you must complete, consult the “General Instru ctions” of this form.

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### Paperwork Reduction Act Notice

The U.S. Environmental Protecti on Agency estimates the average burden to collect information and complete Form 1 to be 3 hours for new a pplicants and 1 hour for applicants renewing existing permits. This estimate includes time for reviewing instructions, searching existing data sources, gathering and maintaining the needed da ta, and completing and reviewing the collection of information. New respondents must also prepare a topographic map. Send comments regarding the burden estimate or a ny 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 17 th 

### Street, NW, Washington, DC 20503, marked “Attention: Desk Officer for EPA.”1-1 

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DESCRIPTION OF NPDES PERMIT APPLICATION FORMS CONTENTS OF FORM 1 PACKAGE
The application forms for individual NPDES permits include the following:

Form 1 – General Information ( included in this package ).
Form 2 – Forms Based on Facility or Activity Type (not included in this package) : Form 1—General Instructions Form 1—Line-By-Line Instructions Form 1—Activities That Do Not Require Permits Form 1—Glossary Form 1 Application 2A. Publicly Owned Treatment Works

2B. Concentrated Animal Feeding Operations and Concentrated Aquatic Animal Production Facilities 2C. Existing Manufacturing, Commercial, Mining, and Silvicultural Operations 2D. New Manufacturing, Commercial, Mining, and Silvicultural Operations 2E. New and Existing Industrial Facilities That Discharge Only Nonprocess Wastewater 2F. New and Existing Facilities Whose Discharge is Composed Entirely of Stormwater Associated with Industrial Activity 2S. New and Existing Treatment Works Treating Domestic Sewage.

FORM 1—GENERAL INSTRUCTIONS
Who Must Apply for an NPDES Permit?
With the exceptions described in Form 1—Activities That Do Not Require Permits, the federal Clean Water Act (33 U.S.C. 1251 et
seq .) prohibits any person from discharging pollutants into waters of the United States without first having been issued a permit under the National Pollutant Discharge Elimination System (NPDES) program.

Who Must Complete Form 1?
All applicants, other than publicly owned treatment works (POTWs) and treatment works treating domestic sewage (TWTDS), must submit Form 1. If you operate one of the following facilities, you must submit Form 1: concentrated animal feeding operations and aquatic animal production facilities; manufacturing, commercial, mining, and silvicultural operations; or other industrial facilities.
At the state level, either the U.S. Environmental Protection Agency (EPA) or an approved state agency operates the NPDES permit program. If you are located in a jurisdiction in which an EPA regional office administers the NPDES permit program, you should use Form 1 and all other applicable forms described in these instructions. If you are located in a jurisdiction where a state administers the NPDES permit program, contact the state to determine the forms you should complete. Often states develop their own application forms rather than use the federal forms. See http://www.epa.gov/npdes/npdes-state-program-information for a list of states that have approved NPDES permit programs and those that do not.
Exhibit 1–1 (see end of this section) provides contact information for each of EPA’s 10 regional offices. Since the content of Exhibit 1–1 is subject to change, consult EPA’s website for the latest information: http://www.epa.gov/aboutepa#regional

. Upon your request, and based upon information supplied by you, EPA or the authorized NPDES state will determine whether you are required to obtain a permit for a particu lar facility or activity. Be sure to contact EPA or your state if you have a question. Form 1 collects general information only. You must also complete a more detailed application based on your proposed discharge activity, as follows:

 If your facility is a concentrated animal feeding operation or a concentrated aquatic animal production facility , you must also complete Form 2B.

 If your facility is a new or existing facility (including manufacturing, commercial, mining, and silvicultural facilities) that discharges only nonprocess wastewater , you must also complete Form 2E.

 If your facility is a new or existing facility whose discharge is composed entirely of stormwater associated with industrial activity, excluding discharges fr om construction activity under 122.26(b)(14)(x) or (b)(15), you must also complete Form 2F. If the discharge is composed of stormwater and non-stormwater, you must complete Form 2F, and you must also complete Forms 2C, 2D, and/or 2E, as appropriate. See Form 2F “Instructions” for further details.

 If your facility is an existing manufacturing, commercial, mining, or silvicultural facility that currently discharges process wastewater, you must also complete Form 2C.

 If your facility is a new manufacturing, commercial, mining, or silvicultural facility that has yet to commence discharge of process wastewater, you must also complete Form 2D.1-2 

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FORM 1—GENERAL INSTRUCTIONS CONTINUED
Where to File Your Completed Form

 If you are in a jurisdiction with an approved state NPDES permit program, file according to the instructions on the state forms.

 If you are in a jurisdiction where EPA is the NPDES permitting authority (i.e., the state is not an NPDES-authorized state), mail the completed application forms to the EPA regional office that covers the state in which your facility is located (see Exhibit 1–1).

When to File Your Completed Form Because of statutory requirements, the deadlines for filing applications vary according to your facility or activity type and the type of permit you need. The various permit application deadlines are listed in Exhibit 1–2 at the end of this section.

Fees EPA does not require applicants to pay a fee for applying for NPDES permits. However, states that administer the NPDES permit program may charge fees. Consult wi th 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 1 (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 1. If you do not assert a claim of confidentiality at the time you submit your information to the NPDES permitting authority, EPA may make the information available to the public without further notice to you. EPA will handle claims of confidentiality in accordance with the Agency’s business confidentiality regulations at Part 2 of Title 4 of the Code of Federal Regulations (CFR). Completion of Forms 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, usi ng a format consistent with the form.
The NPDES permitting authority will not consider your application package complete unless you answer every question on Form 1 and the applicable Form 2.
Provide your EPA Identification Nu mber from the Federal Registry Service, NPDES Permit Number, and facility name at the top of each page of Form 1 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 Number. If you do not know your EPA Identification Number, contact your NPDES permitting authority. See Exhibit 1–1 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.
If you have previously submitted info rmation that answers a specific question to EPA or an approved state NPDES agency, you may either repeat the information in the space provided or attach a copy of the previous submission. Some items in the form require narrative explanations. If more s pace is necessary to answer a question, attach a separate sheet entitled, “Additional Information.” Provide your information on the attachment in a format that is consistent with the form.
The NPDES permitting authority w ill 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.1-3 

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FORM 1—GENERAL INSTRUCTIONS CONTINUED

Exhibit 1–1. Addresses of EPA Region al Contacts and Covered States

REGION 1 U.S. Environmental Prot ection Agency, Region 1 5 Post Office Square, Suite 100, Boston, MA 02109-3912 Phone: (617) 918-1111, Fax: (617) 918-0101, Toll fr ee 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 Prot ection Agency, Region 6 1445 Ross Avenue, Suite 1200, Dallas, TX 75202-2733 Phone: (214) 665-2200, Fax: (214) 665-7113, Toll fr ee 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 Prot ection Agency, Region 2 290 Broadway, New York, NY 10007-1866 Phone: (212) 637-3000, Fax: (212) 637-3526, Toll fr ee 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 Prot ection 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 Prot ection Agency, Region 3 1650 Arch Street, Ph iladelphia, PA 19103-2029 Phone: (215) 814-5000, Fax: (215) 814-5103, To ll free: (800) 438-2474 Website: http://www.epa.gov/aboutepa/e pa-region-3-mid-atlantic Covered States: Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia REGION 8 U.S. Environmental Prot ection Agency, Region 8 1595 Wynkoop Street, Denver, CO 80202-1129 Phone: (303) 312-6312, Fax: (303) 312-6339, To ll free: (800) 227-8917 Website: http://www.epa.gov/aboutepa/epa-r egion-8-mountai ns-and-plains Covered States: Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming

REGION 4 U.S. Environmental Prot ection Agency, Region 4 Sam Nunn Atlanta Federal Center 61 Forsyth Street, SW, Atlanta, GA 30303-8960 Phone: (404) 562-9900, Fax: (404) 562-8174, To ll free: (800) 241-1754 Website: http://www.epa.gov/aboutepa/a bout-epa-region-4-southeast Covered States: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee REGION 9 U.S. Environmental Prot ection Agency, Region 9 75 Hawthorne Street, San Francisco, CA 94105 Phone: (415) 947-8000, Fax: (415) 947-3553, Toll fr ee within Region 9: (866) EPA-WEST Website: http://www.epa.gov/aboutepa/epa-region-9-pacific-southwest Covered States: Arizona, California, Ha waii, Nevada, Guam, American Samoa, and Trust Territories

REGION 5 U.S. Environmental Prot ection Agency, Region 5 77 West Jackson Boulevard, Chicago, IL 60604-3507 Phone: (312) 353-2000, Fax: (312) 353-4135, Toll fr ee 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 Prot ection Agency, Region 10 1200 Sixth Avenue, Suite 900, Seattle, WA 98101 Phone: (206) 553-1200, Fax: (206) 553-2955, To ll free: (800) 424-4372 Website: http://www.epa.gov/aboutepa/epa -region-10-pacific-northwest Covered States: Alaska, Idaho, Oregon, and Washington

Exhibit 1

– 2. Filing Dates for NPDES Permit Applications

Permit Application When to File

2A 180 days before your present NPD ES permit expires or, if you are a new discharger, 180 days before the date on which the discharge is to commence unl ess the NPDES permitting authority has granted permission for a later date.

2B 180 days before your present NPDES permit expires or 180 days prior to startup if you are a new facility.

2C 180 days before your present NPDES permit expires.

2D 180 days prior to startup.

2E 180 days before your present NPDES permit expires, or 180 days prior to startup if you are a new facility.

2F Construction: 90 days prior to date construction is to commence. Nonconstruction: 180 days befor e your present NPDES permit expires or 180 days prior to startup if you are a new facility.

2S 180 days before your present NPDES permit expires or 180 days prior to startup if you are a new facility.1-4 

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FORM 1

— LINE-BY-LINE INSTRUCTIONS
Section 1. Activities Requiring an NPDES Permit

Item 1.1. Review the questions in Item 1.1 to determine if you are required to submit Form 1. Be sure to check the Form 1—Glossary for the legal definitions of any key terms.
If you answer “yes” to a question in Item 1.1, then you do not need to complete Form 1, but you must comply with the application requirements specified.

Item 1.2. Respond to the questions in Items 1.2.1 to 1.2.5. If you answer “yes” to any question, you must complete Form 1 and the Form 2 application specified. See Exhibit 1–2 of the Form 1— General Instructions for filing deadlines.
If you answer “no” to every question in Items 1.1 and 1.2, then you do not need an NPDES permit, and you do not need to complete and return any of the NPDES application forms.
Section 2. Facility and Contact Information

Item 2.1. Enter the facility’s official or legal name. Do not use a colloquial name.

Item 2.2. Provide your EPA Identification Number from the Federal Registry System if you have an existing facility. If you do not know your EPA Identification Number, contact your NPDES permitting authority. If your facility is new (i .e., not yet constructed), write or type “New Facility”.

Item 2.3. Give the name (first and last), title, work telephone number, and electronic mail (e-mail) address of the person who is thoroughly familiar with the operation of the facility and with the facts reported in this applicati on. The individual listed will be contacted by the NPDES permitting authority if they have questions on the material submitted.

Item 2.4. Give the complete mailing address of the office to which the NPDES permitting authority should send correspondence. This often is not the address used to designate the location of the facility or activity.

Item 2.5. Give the address or location of the facility identified under Item 2.1. If the facility lacks a street name or route number, give the most accurate, alternative geographic information (e.g., section number or quarter section number from county records or “at intersection of Routes 425 and 22"). Also provide the county name, county code (if known), city or town, state, and zip code.

For concentrated aquatic animal pr oduction facilities, provide the address or location of the producti on area (i.e., the location where the animals are contained, grown, or held).

Item 2.6. Provide the latitude and longitude to the nearest second for the facility. Provide associated metadata in the subsequent columns of the table. In the column marked “Reference Point,” indicate where the coordinates were collected (e.g., from the main entrance of the facility or the center of the facility). For concentrated aquatic animal production facilities, provide the latitude and longitude of the entrance to the production area (i.e., the location where the animals are contained, gr own, or held). In the column marked “Collection Method Information,” indicate the following: (1) horizontal collection method, which is the type of method/device used to identify the coordinates (e.g., global positioning system or GPS device, census block centroid, an address, State Plane Coordinate System or SPCS, etc.); (2) the scale of your source map or photo if applicable (e.g., the proportional distance on the ground for one unit of measure typically expressed in ratio form such as 1:24,000); and (3) the horizontal reference datum (i.e., the coordinate reference system) to which your coordinates relate.
GPS devices are commonly used to electronically record the latitude and longitude coordinates of a property. It is also possible to use geographic information systems (e.g., ArcView), online sources (e.g., Terra Server or Google Earth), or paper maps from trusted sources (e.g., U.S. Geological Survey or USGS) to identify coordinates. The online services r equire 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 19 th

century. NAD27 was the standard for many years because the U.S. Geological Survey (USGS) published its topographic maps in this datum. If you are reporting a location using a USGS 7.5-minute map, NAD27 is your default datum.

2. North American Datum of 1983 (NAD83): NAD83 updated NAD27 with current measurements using radio astronomy and satellite observations. When the USGS began publishing digital data, the NAD83 was used, which provided a more accurate representation of the earth’s shape and a more accurate depiction of the location of objects on the earth.

3. World Geodetic System of 1984 (WGS84): This datum was developed from the measurements calculated in NAD83. If you used a GPS to calculate your latitude/longitude coordinates, WGS84 is the default datum.
If you need further guidance in responding to Item 2.6, refer to http://www.epa.gov/geospatial/latitudelongitude-data-standard

. Section 3. SIC and NAICS Codes

Items 3.1 and 3.2. List, in descending order of significance, the four 4-digit standard industrial classification (SIC) codes and North American Industrial Classification System (NAICS) codes that best describe your facility in terms of the principal products or services produced or provided. If the SIC or NAICS codes do not adequately describe your facility’s products or services, you have the option to provide additional descriptive information.
You can find SIC code numbers and descriptions in the 1987 Standard Industrial Classification Manual prepared by the Executive Office of the President, Office of Management and Budget. This document is available from the Government Printing Office, Washington, DC. An online version of the manual is also available courtesy of the Occupational Safety & Health Administration at http://www.osha.gov/pls/imis/sic_manual.html

.1-5 

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FORM 1

— LINE-BY-LINE INSTRUCTIONS CONTINUED
You can find NAICS code numbers and descriptions in the North American Industrial Classification System Manual prepared by the Executive Office of the President, Office of Management and Budget. This document is available in print and on CD ROM (compact disk read-only-memory) from the National Technical Information Service (NTIS) in Alexandria, Virginia. It is also available online at http://www.census.gov/eos/www/naics/

. Use the latest editions of both manuals. If you have any questions concerning the appropriate SIC or NAICS codes for your facility, contact your NPDES permitting authority.
Section 4. Operator Information

Item 4.1. Give the legal name of the person, firm, public organization, or other entity that operates the facility described in this application. This name may or may not be the same name as the facility. The operator of the facility is the legal entity that controls the facility’s operation rather than the plant or site manager. Do not use a colloquial name.

Item 4.2. Indicate whether the entity listed in response to Item 4.1 also owns the facility by marking the appropriate box.

Item 4.3. Indicate the legal status of the operator 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.

Items 4.4 to 4.6. Enter the telephone number, e-mail address, and address of the operator identified in Item 4.1.

Section 5. Indian Land

Item 5.1. Indicate whether the facility is located on Indian Land.
Section 6. Existing Environmental Permits

Item 6.1. Check the appropriate boxes and provide the permit numbers for all relevant federal, state, and local environmental permits or construction approvals received or applied for under any of the programs listed below. If you have more than one currently effective permit under a particular per mit program for your facility, list the additional permit numbers on the application form or on a separate sheet of paper.

 Hazardous waste management program under the Resource Conservation and Recovery Act (RCRA).

 Underground Injection Control (UIC) program under the Safe Drinking Water Act (SDWA).

 NPDES program under the Clean Water Act (CWA).  Prevention of Significant Deterioration (PSD) program under the Clean Air Act (CAA).

 Nonattainment program under the CAA.

 National Emission Standards for Hazardous Pollutants (NESHAPS) preconstruction approval under the CAA.

 Ocean dumping permits under the Marine Protection Research and Sanctuaries Act (MPRSA).

 Dredge or fill permits under Section 404 of the CWA.

 Other federal, state or local environmental permits.
Section 7. Map
Unless the facility is a concentrated animal feeding operation, provide a topographic map(s) of the area extending at least one mile beyond the property boundaries of the facility that clearly shows the following:

 The legal boundaries of the facility.

 The location and serial number of each of your existing and proposed intake and discharge structures.

 All hazardous waste management, storage, and disposal facilities.

 Each well where you inject fluids underground.

 All springs and surface water bodies in the area.

 All drinking water wells that are in the public record or otherwise known to you and that are located within 1/4 mile of the facility.
If the facility has associated water intakes, discharge structures, hazardous waste disposal sites, or injection wells and these items are located more than one mile from the facility, include them on the map, if possible. If not, attach additional sheets describing the location of the structures, disposal site(s), or well(s) and identify the USGS or other map corresponding to the location(s).
On each map, include the map scale, a meridian arrow showing north, and latitude and longitude t o the nearest second.
On all maps of rivers, show the direction of the current. In tidal waters, show the directions of ebb and flow tides.
You may develop your map by going to the USGS’s National Map website at http://nationalmap.gov/ . Use the traditional 7.5-minute quadrangle format. If none is available, you may use a USGS 15-minute series map. You may also use a plat or other appropriate map. Briefly describe land uses in the map area (e.g., residential, commercial, etc.). An example of an acceptable location map is shown as Exhibit 1–3 at the end of these Instructions. NOTE: Exhibit 1–3 is provided for illustration purposes only and does not reflect an actual facility.
If the facility is a concentrated animal feeding operation, you are not required to provide the topographic m ap required by this section of Form 1. Instead, you are required to provide a topographic map as specified in Section 4 of Form 2B.

Item 7.1. Note when you have completed and attached your topographic map to the application.1-6 

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FORM 1

— LINE-BY-LINE INSTRUCTIONS CONTINUED

Section 8. Nature of Business
Briefly describe the nature of your business (e.g., products produced or services provided). See examples below.

Example 1 Facilities Subject to 40 CFR Part 426, Subparts F and G
Industry A is an auto tempered and auto laminated glass manufacturing facility subject to effluent limitation guidelines (ELGs) for the Automotive Glass Tempering Automotive Glass Laminating Subcategories of the Glass Manufacturing Point Source Category at 40 CFR Part 426, Subparts F and G. At the facility, glass is cut and then passed through a series of processes that grind and polish the edges, bend the glass, and then temper the glass to produce side and back windows for automobiles. Tempering of the glass involves heating it near the melting point and then rapidly cooling it to increase its mechanical and thermal endurance. The facility also produces automobile windshields and undertakes processes that laminate a plastic sheet between two layers of glass and that prepare the glass for lamination (e.g., cutting, bending and washing).

Example 2 Facility Not Subject to ELGs
Industry B undertakes batch type resin manufacturing operations. It has above ground storage tanks for raw materials and finished goods, resin loading operations, and warehouses for 55-gallon drum finished products. Industry B manufactures alkyd, saturated and unsaturated polyester resins in batches with the use of reactor vessels and mix tanks. The majority of the feedstock liquids are pumped from storage tanks to the kettles and mixers via a closed piping system. Additional feedstocks are added manually as solids from bags and sacks via manways, which are located on top of the kettles. The resin is then chemically reacted in the kettles. After completion of the reaction step, the resin is transferred from the kettles to the mix tanks where solvents are added to thin the resin. The primary by-product of the reaction is water vapor containing condensed soluble organics. The by-product flows to an isolation tank where the vapors are directed to an onsite thermal oxidizer. The finished resin is then pumped through one of three types of filtration systems into finished goods storage tanks, 55-gallon drums, 350-gallon intermediate bulk container totes, or directly into tanker trucks. A typical “batch” takes about 30 hours to complete.
Section 9. Cooling Water Intake Structures

Item 9.1. Indicate whether the facility uses cooling water. If “yes”, continue to Item 9.2. If “no”, skip to Item 10.1.

Item 9.2. Identify the source of the cooling water. If the facility uses a cooling water intake structure as described at 40 CFR 125.81 and 125.91, the facility will be required to submit the information required under 40 CFR 122.21(r). Note that the information is not requested as part of Form 1. Contact your NPDES permitting authority to determine the specifics of what you should provide and when. Section 10. Variance Requests
An applicant (other than publicly owned treatment systems or POTWs) may request a variance from otherwise applicable effluent limitations under certain conditions described at 40 CFR 122.21(m).

Item 10.1. Check all of the authorized variances that you plan to request or renew. Note that you are not being asked to submit any other information at this time. Contact your NPDES permitting authority to determine the specifics of what you should provide and when.

Section 11. Checklist and Certification

Item 11.1. Review the checklist provided on the application. In Column 1, mark the sections of Form 1 that you have completed and are submitting with your application. In Column 2, indicate for each section whether you are submitting attachments.

Item 11.2. The Clean Water Act provides for severe penalties for submitting false information on this application form. CWA Section 309(c)(2) provides that, “Any person who knowingly makes any false statement, representation, or certification in any application, ...shall upon conviction, be punished by a fine of no more than $10,000 or by imprisonment for not more than six months, or both.”

FEDERAL REGULATIONS REQUIRE THIS APPLICATION TO BE SIGNED AS FOLLOWS:
A. By a responsible corporate officer. For the purpose of this section, a responsible corporate officer means: (i) A president, secretary, treasurer, or vice-p resident 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 wi th corporate procedures.
B. For partnership or sole proprie torship, by a general partner or the proprietor, respectively.
C. For a municipality, State, Federal, or other public facility, By either a principal executive office r 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 executiv e officer having responsibility for the overall operations of a principal geographic unit of the agency (e.g., Regional Administrators of EPA).1-7 

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Exhibit 1

– 3. Example Topographic Map1-8 

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FORM 1

— ACTIVITIES THAT DO NOT REQUIRE PERMITS
You are not required to obtain an NP DES permit if your discharge is in one of the following categories, as provided by the CWA and NPDES regulations at 40 CFR Parts 122 to 125. However, under CWA Section 510, a discharge exempted from the federal NPDES requirements may still be regulated by a state NPDES permitting authority.

 Any discharge of sewage from vessels and any effluent from properly functioning marine engines, laundry, shower, and galley sink wastes, or any other discharge incidental to the normal operation of: (1) A vessel of the Armed Forces within the meaning of section 312 of the CWA; and (2) A recreational vessel within the meaning of section 502(25) of the CWA. Until December 18, 2017, an NPDES permit is not required for a vessel that is less than 79 feet in length or a fishing vessel as defined in 46 U.S.C. 2101 except for any discharge of ballast water or any discharge in a case in which the Administrator or State, as appropriate, determines that the discharge either contributes to a violation of a water quality standard or poses an unacceptable risk to human health or the environment. None of these exclusions apply to rubbish, trash, garbage, or other such materials discharged overboard; nor to other discharges when the vessel is operating in a capacity other than as a means of transportation such as when used as an energy or mining facility, a storage facility or a seafood processing facility, or when secu red to a storage facility or a seafood processing facility, or when secured to the bed of the ocean, contiguous zone or waters of the United States for the purpose of mineral or oil exploration or development.

 Discharges of dredged or fill material into waters of the United States that are regulated under CWA section 404.

 The introduction of sewage, industrial wastes or other pollutants into publicly owned treatment works by indirect dischargers. Plans or agreements to switch to this method of disposal in the future do not relieve dischargers of the obligation to have and comply with permits until all discharges of pollutants to waters of the United States are eliminated. (See also 40 CFR 122.47(b)). This exclusion does not apply to the introduction of pollutants to privately owned treatment works or to other discharges through pipes, sewers, or other conveyances owned by a state, m unicipality, or other party not leading to treatment works.  Any discharge in compliance with the instructions of an OnScene Coordinator pursuant to 40 CFR part 300 (The National Oil and Hazardous Substances Pollution Contingency Plan) or 33 CFR 153.10(e) (Pollution by Oil and Hazardous Substances).

 Any introduction of pollutants from nonpoint source agricultural and silvicultural activities, incl uding stormwater runoff from orchards, cultivated crops, pastures, range lands, and forest lands, but not discharges from concentrated animal feeding operations as defined in 40 CFR 122.23, discharges from concentrated aquatic animal production facilities as defined in 40 CFR 122.23, discharges from concentrated aquatic animal production facilities as defined in 40 CFR 122.24, discharges to aquaculture projects as defined in 40 CFR 122.25, and discharges from silvicultural point sources as defined in 40 CFR 122.27. [Note: Per 40 CFR 122.26(b)(14)(ii), facilities classified within Standard Industrial Classification 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, and 373 (not included are all other types of silviculture facilities) are considered stormwater discharges associated with industrial activity, and are required to obtain an NPDES permit.]

 Return flows from irrigated agriculture.

 Discharges into a privately owned treatment works, except as the NPDES permitting authority may otherwise require under 40 CFR 122.44(m).

 Discharges from a water transfer. Water transfer means an activity that conveys or connects waters of the United States without subjecting the transferred water to intervening industrial, municipal, or commerc ial use. This exclusion does not apply to pollutants introduced by the water transfer activity itself to the water being transferred.1-9 

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— GLOSSARY

NOTE: This Glossary includes terms used in the various NPDES applicati on forms, including Form 1. The definitions are from the NPDES regulations at 40 CFR 122.2 unless otherwise specified. If you have any questions concerning the meaning of any of these terms, contact your NPDES permitting authority.

ANIMAL FEEDING OPERATION (defined at § 122.23) means a lot or facility (oth er 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, in cluding any additions, revisions, or modifications to the forms; or forms approved by EPA for use in approved stat es, 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 harvestabl e freshwater, estuarine, or marine plants or animals. DESIGNATED PROJECT AREA means the portions of the waters of the United States with in which the permittee or permit applicant plans to confine the cultivated species, using a method or plan or operation (incl uding, but not limited to, physical confinement) which, on the bas is of reliable scientific evidence, is expected to ensure that specific i ndividual organisms comprising an aquaculture crop will enjoy increas ed 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 dur ing 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 dischar ges 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, op eration procedures, and practices to control plant site runoff, spillage or leaks, sludge or waste disposal, or drainage from raw mater ial 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 A ct 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 fr om 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 perio ds of wet weather, these systems become overloaded, bypass treatment works, and discharge directly to receiving waters at designed overfl ow points.
COMBINED SEWER SYSTEM (CSS) means a wastewater collection system tha t conv eys sanitary wastewaters (domestic, commercial and industrial wastewaters) and st ormwater through a single pipe to a publicly owned treatment works for treatment before disch arge 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 Di rector 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),1-10 

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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 fac ility 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 di scharged into waters of the United States through a manmade di tch, 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, acros s, 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 concent rated animal feeding operation as defined above if such animal feeding operation discharges only in the ev ent 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 followi ng categories, or which the Director designates as such on a c ase-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 kil ograms (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 dur ing 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 duri ng a calendar day or any 24- hour period that reasonably represents the calendar day for purposes of sampling. For pollutant s with limitations expressed in units of mass, the “daily di scharge” is calculated a s 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 author ized representative. When there is no “approved State program,” and there is an EPA administered program, “Director” means the Regional Administrator. When the re is an approved State program, “Director” normally means the State Di rector. In some circumstances, however, EPA retains the author ity to1-11 

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take certain actions even when there is an approved State program. (For example, w hen EPA has issued an NPDES permit prior to t he approval of a State program, EPA may retain jurisdiction over t hat 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 t he waters of the contiguous zone or the ocean from any point sou rce 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 St ates from: Surface runoff which is collected or channelled by m an; Discharges through pipes, sewers, or other c onveyances owned by a State, municipality, or other person which do not lead to POT W’s; and discharges through pipes, sewers, or othe r conveyances, leading into privately owned treatment works. This term does not in clude 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 permi t, 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 oce an.

EFFLUENT LIMITATIONS GUIDELINES means a regulation published by the Administra tor 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 an y 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 CF R 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, notwithstandin g 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 St ates whether within the originally or subsequently acquir ed 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 s ame.

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 “pollut ants” to a “publicly owned treatment works.”

LOG SORTING AND LOG STORAGE FACILITIES (defined at § 122.27) means facilities whos e 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 (mil l 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, i ncluding the effluent limitations guidelines.)

MAJOR FACILITY means any NPDES “facility or activity” classified as such by the Regional Administrator, or, in the case of “approved State programs,” the Regional Administrator in conjunction with the State Director.

MAXIMUM DAILY DISCHARGE LIMITATION means the highest allowable “daily discharge.”1-12 

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MUNICIPALITY means a city, town, borough, county, parish, district, associ ation, 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 tri bal 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 st reets, catch basins, curbs, gutters, ditches, man-made channels , or storm drains):

 Owned or operated by a state, city, town, borough, county, parish, district, associati on, or other public body ( created by or pursuant to state law ) having jurisdiction over disposal of sewage, indus trial 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 Treatm ent 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 secti ons 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 effectiv e NDPES permit for discharges at that “site.”
This definition includes an “indirect discharger” which commences discharging into “waters of the United States” after August 1 3, 1979. It also means any existing mobile point source (other than an offs hore or coastal oil and gas exploratory drilling rig or a coasta l oil and gas developmental drilling rig) such as a seafood processing rig, s eafood processing vessel, or aggregate plant, that begins discha rging at a “site” for which it does not have a permit; and any offshore or c oastal mobile oil and gas exploratory drilling rig or coastal mobile oil and gas developmental drilling rig that commences the discharge of pollu tants after August 13, 1979, at a “site” under EPA's permitting jurisdiction for which it is not covered by an individual or general permi t and which is located in an area determined by the Regional Admin istrator in the issuance of a final permit to be an area of biological concer n. In determining whether an area is an area of biological con cern, the Regional Administrator shall consider the factor s specified in 40 CFR 125.122(a) (1) through (10).

An offshore or coastal mobile explorator y drilling rig or coastal mobile developmen tal drilling rig will be considered a “new d ischarger” 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 se ction 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 o nly 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 docu ment 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 includ e any permit which has not yet been the subject of final agency ac tion, such as a “draft permit” or a “proposed permit.”

PESTICIDE APPLICATIONS TO WA TERS 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 definiti on of pesticide applications to waters of the United States, this does not in clude agricultural stormwater disc harges and return flows from irr igated agriculture, which are excluded by law (Id. § 1342(l)).1-13 

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POINT SOURCE means any discernible, confined, and discrete conveyance, in cluding 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 dischar ged. This term does not include return flows from irrigated agr iculture or agricultural stormwater runoff. (See § 122.3).

POLLUTANT means dredged spoil, solid waste, incinerator residue, f ilter backwash, sewage, garbage, sewage sludge, munitions, chemical wastes, biological materials, radioactive materials (e xcept those regulated under the Atomic Energy Act of 1954, as am ended (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 we ll to facilitate production of oil or gas, or water derived in ass ociation 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 degra dation of ground or surface water resources. Note: Radioactive materials covered by the Atomic Energy Act are those encompassed in its definition o f source, byproduct, or special nuclear materials. Examples of material s not covered include radium and accelerator-produced isotopes. Se e 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, intermediat e product, finished product, byproduct, or waste product.

PROPOSED PERMIT means a State NPDES “permit” prepared after the clos e 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 Se ction 502(4)]. This definition includes any devices or systems u sed in the storage, treatment, recycling, and reclamation) of municipal sewage or industrial wastes of a liquid nature. This definition al so includes sewers, pipes, and other conveyances only if they convey wastewat er to a POTW. The term also means the municipality as defined in CWA Section 502(4), which has jurisdiction over the indirect di scharges 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 representativ e 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 ves sels on the Great Lakes this term includes graywater. For the purposes of this definition, “graywater” means galley, bath, and shower w ater.

SEWAGE SLUDGE means any solid, semi-solid, or liquid residue removed duri ng 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 treatm ent, scum, septage, portable toilet pumpings, type III marine sanita tion device pumpings (33 CFR part 159), and sewage sludge produc ts. 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 facilit ies 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 f ire control, harvesting operations, surface drainage, or road construction and maintenance from whic h there is natural runoff. However, some of these activities (such as stream crossing for roads) may involve po int source discharges of dredged or fill material which may requir e a CWA Section 404 permit (see 33 CFR 209.120 and part 233).1-14 

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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 SL UDGE USE OR DISPOSAL means the regulations promulgated purs uant to section 405(d) of the CWA which govern minimum requirements for sludge quality, management practices, and monitoring and reporting applicable to sewage s ludge 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 Trus t Territory of the Pacific Islands, or an Indian Tribe as defi ned 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, “S tate Director” means the chief administrative officer of the State or inters tate agency authorized to perform t he particular procedure or func tion 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 c onveying stormwater and that is directly related to manufacturing, processing or raw materials storage areas at an industrial plant. The term does not include di scharges from facilities or activities excluded from the NPDE S program under this part 122. For the categories of industries identified in this section, the term includes, but is not limited to, sto rmwater 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 cr eated by the facility; material handling sites; refuse sites; sites used for the appli cation or disposal of process waste waters (as defined at part 401 of this chapt er); sites used for the storage and maintenance of material handli ng equipment; sites used for residual treatment, storage, or dispos al; shipping and receiving areas; manufacturing buildings; stor age areas (including tank farms) for raw materials, and intermediate and fi nal products; and areas where industrial activity has taken pl ace in the past and significant materials remain and are exposed to stormwater. For the purposes of this paragraph, material handling activitie s include storage, loading and unloading, transportation, or conveyance of an y 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 buildin gs and accompanying parking lots as long as the drainage from the excl uded areas is not mixed with stormwater drained from the above described areas. Industrial facilities (including industrial faci lities that are federally, Stat e, or municipally owned or oper ated that meet the description of the facilities listed in paragraphs (b)(14)(i) thr ough (xi) of this section) include those facilities designated under the provisions of paragraph (a)(1)(v) of this section. The following categor ies of facilities are considered to be engaging in “industrial act ivity” for purposes of paragraph (b)(14):
(i) Facilities subject to stormwater effluent limitations guidelines, new source performance standards, or toxic pollutant effl uent standards under 40 CFR subchapter N (except facilities with toxic pollut ant effluent standards which are exempted under category (xi) in paragraph (b)(14) of this section);
(ii) Facilities classified as Standard Industr ial 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 Gro ups 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 si lvicultural facilities);
(iii) Facilities classified as Standard Industrial Classification s 10 through 14 (mineral industry) including active or inactiv e mining operations (except for areas of coal mining operations no longer meeting the definition of a reclamation area under 40 CFR 434.11(1) becau se the performance bond issued to the facility by the appropriate SMCRA authority has been released, or except for areas of non-coal m ining operations which have been released from applic able State or Federal reclamation requirements after December 17, 1990) and oil and gas exploration, production, processing, or tr eatment operations, or transmission faciliti es that discharge stormwater contaminated by contact with or that has come into contact with, any overburden, ra w material, intermediate products, finished products, byproducts or waste products located on the site of such operations; (inactive mini ng 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 pr ocessing of mined materials, nor sites where minimal activities are undertaken for the sole purpose of maintaining a mining claim);
(iv) Hazardous waste treatment, storage, or disposal facilities, including those that are operating under interim status or a p ermit under subtitle C of RCRA;1-15 

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— GLOSSARY CONTINUED (v) Landfills, land application sites, and open dumps that receive or have received any industrial wastes (waste that is receiv ed 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 auto mobile junkyards, including but limited to those classified as Standard Industrial Classification 5015 and 5093;
(vii) Steam electric power generating fa cilities, 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 air port deicing operations. Only those portions of the facility th at are either involved in vehicle maintenance (including vehicle rehabilitation, mechanical repairs, painting, fueling, and lubrication), equ ipment cleaning operations, airport deicing operations, or wh ich are otherwise identified under paragraphs (b)(14) (i)–(vii) or (ix)–(xi) of th is section are associated with industrial activity;
(ix) Treatment works treating domestic sew age 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 sludg e 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 pretreatmen t program under 40 CFR part 403. Not included are farm lands, domestic gardens or lands used for sludge management where sludge is benefi cially reused and which are not physically located in the confines of th e facility, or areas that are in compliance with section 405 o f the CWA;
(x) Construction activity including clearing, grading and excavati on, 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 pa rt of a larger common plan of development or sale if the larger comm on 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 im plementing 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 n ot 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 tr eatment works. In States where there is no approved State sl udge management program under section 405(f) of the CWA, the Regional Administrator may designate any person subject to the standard s for sewage sludge use and disposal in 40 CFR part 503 as a “treatment works treating domestic sewage,” where he or she finds that t here is a potential for adverse effects on public health and the environm ent from poor sludge quality or poor sludge handling, use or d isposal 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 wh ich there is unintentional and temporary noncompliance with technology based permit effluent limitations because of factor s beyond the reasonable control of the permittee. An upset does n ot include noncompliance to the extent caused by operational error, im properly designed treatment facilities, inadequate treatment facilit ies, lack of preventive maintenance, or ca reless 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 th e 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, stream s (including intermittent streams), mudflats, sandflats, “wetlands,” sloughs, prairie potholes, wet meadows, playa lakes, or natural ponds, the use, degradation, or destruction of which would affect or cou ld affect interstate or foreign commerce including any such waters: (1) Which are or could be used by interstate or fo reign travelers for recreational or other purposes; (2) From which fish or shellfish are or could be ta ken and sold in interstate or foreign commerce; or (3) Which are used or could be used for industrial pur poses by industries in interstate commerce; (d) All impoundments of waters otherwise defined as waters of the United States under this definition;1-16 

### Contains Nonbinding Recommendations
Draft Application Forms

– Not for Implementation

FORM 1

— GLOSSARY CONTINUED (e) Tributaries of waters identified in paragraphs (a) through (d) of this definition; (f) The territorial sea; and (g) “Wetlands” adjacent to waters (other than waters that are themselves wetlands) identified in paragraphs (a) through (f) of this definition.
Waste treatment systems, including treatment ponds or lagoons designed to meet the requirements of CWA (other than cooling pond s as defined in 40 CFR 423.11(m) which also meet the criteria of this definition) are not waters of the United States. This exclusio n applies only to manmade bodies of water which neither were originally created in waters of the United States (such as disposal area in wetla nds) 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 agen cy, for the purposes of the Clean Water Act, the final authority regar ding 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.

### Contains Nonbinding Recommendations
Draft Application Forms

– Not for Implementation 

### This page intentionally left blank.EPA Form 3510-1 (revised <INSERT DATE>) Page 1 EPA Identification Number NPDES Permit Number Facility Name Form Approved OMB No. <INSERT NO.> Form Expires <INSERT DATE>



### Contains Nonbinding Recommendations
Draft Application Forms

– Not for Implementation Form

1 NPDES U.S. Environmental Protection Agency Application for NPDES Permit to Discharge Wastewater



### GENERAL INFORMATION

SECTION 1. ACTIVITIES REQUIRING AN NPD ES PERMIT (40 CFR 122.21(f) and (f)(1))Activities Requiring an NPDES Permit 1.1 Applicants Not Required to Submit Form 1

1.1.1 Is the facility a new or existing publicly owned treatment works ? 1.1.2 Is the facility a new or existing treatment works treating domestic sewage ? If yes, STOP. Do NOT complete Form 1. Complete Form 2A only. 

##  No If yes, STOP. Do NOT complete Form 1. Complete Form 2S only. 

##  No

1.2 Applicants Required to Submit Form 1 1.2.1 Is the facility a concentrated animal feeding operation or a concentrated aquatic animal production facility? 1.2.2 Is the facility a new or existing facility that discharges only nonprocess wastewater ?



##  Yes  Complete Form 1 and Form 2B. 

##  No 

##  Yes  Complete Form
1 and Form 2E. 

##  No

1.2.3 Is the facility a new or existing facility whose discharge is composed entirely of stormwater associated with industrial activity or whose discharge is composed of both stormwater and nonstormwater ? 1.2.4 Is the facility an existing manufacturing, commercial mining, or silvicultural facility that is currently discharging process wastewater ?



##  Yes  Complete Form 1 and Form 2F unless exempted by 40 CFR 122.26(b)(14)(x) or (b)(15). 

##  No 

##  Yes  Complete Form
1 and Form 2C. 

##  No

1.2.5 Is the facility a new manufacturing, commercial mining, or silvicultural facility that has not yet commenced to discharge ? 

##  Yes  Complete Form 1 and Form 2D. 

##  No

SECTION 2. NAME, MAILING ADDRESS, AND LOCATION (40 CFR 122.21(f)(2))Name, Mailing Address, and Location 2.1 Facility Name

2.2 EPA Identification Number

2.3 Facility Contact Name (first and last) Title Phone Number

Email Address

2.4 Facility Mailing Address

Street or P.O. Box

City or Town State ZIP CodeEPA Form 3510-1 (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 ImplementationName, Mailing Address, and Location Continued 2.5 Facility Location Street, Route Number, or Other Specific Identifier

County Name County Code (if known)

City or Town State ZIP Code

2.6 Facility Latitude and 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)

SECTION 3. SIC AND NAICS CODES (40 CFR 122.21(f)(3))SIC and NAICS Codes 3.1 SIC Code(s) Description (optional)

3.2 NAICS Code(s) Description (optional)

SECTION 4. OPERATOR INFORMATION (40 CFR 122.21(f)(4))Operator Information 4.1 Name of Operator

4.2 Is the name you listed in Item 4.1 also the owner?


##  Yes 

##  No

4.3 Operator Status



##  Public

– Federal 

##  Public

– State 

##  Other Public (specify) 

##  Private 

##  Other (specify)EPA Form 3510-1 (revised <INSERT DATE>) Page 3 EPA Identification Number NPDES Permit Number Facility Name Form Approved OMB No. <INSERT NO.> Form Expires <INSERT DATE>



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Draft Application Forms

– Not for ImplementationOperator Information Continued 4.4 Phone Number of Operator

4.5 Operator Address
Street or P.O. Box

City or Town State ZIP Code

Email Address of Operator

SECTION 5. INDIAN LAND (40 CFR 122.21(f)(5))IndianLand 5.1 Is the facility located on Indian Land? 

##  Yes 

##  No

SECTION 6. EXISTING ENVIRONMENTA L PERMITS (40 CFR 122.21(f)(6))Existing Environmental Permits 6.1 Existing Environmental Permits (Check all that apply and print or type the corresponding permit number for each.) 

##  NPDES (discharges to surface water) 

##  RCRA (hazardous wastes) 

##  UIC (underground injection of fluids)



##  PSD (air emissions) 

##  Nonattainment program (CAA) 

##  NESHAPS (CAA)



##  Ocean dumping (MPRSA) 

##  Dredge or fill (CWA Section 404) 

##  Other (specify)

SECTION 7. MAP (40 CFR 122.21(f)(7))Map 7.1 Have you attached a topographic map containing all required information to this application? (See Instructions for specific requirements.)


##  Yes 

##  No
SECTION 8. NATURE OF BUSINESS (40 CFR 122.21(f)(8))Nature of Business 8.1 Describe the nature of your business.

SECTION 9. COOLING WATER INTAKE STRUCTURES (40 CFR 122.21(f)(9))Cooling WaterIntake Structures 9.1 Does your facility use cooling water?


##  Yes 

##  No  SKIP to Item 10.1.
9.2 Identify the source of cooling water. (Note that facilities that use a cooling water intake structure as described at 40 CFR 125.81 and 125.91 must comply with requirements at 40 CFR 122.21(r). Consult with y our NPDES permitting authority to determine the specific information that needs to be submitted and when.)EPA Form 3510-1 (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 SECTION 10. VARIANCE REQUESTS (40 CFR 122.21(f)(10))Variance Requests 10.1 Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(m)? (Check all that apply.) Consult with your NPDES permitting authority to determine what information needs to be submitted and when.



##  Fundamentally different factors (CWA section 301(n)) 

##  Water quality related effluent limitations (CWA section 302(b)(2))



##  Non-conventional pollutants (CWA section 301(c) and (g)) 

##  Thermal discharges (CWA section 316(a))

SECTION 11. CHECKLIST AND CERTIFIC ATION STATEMENT (40 CFR 122.22(a))Checklist and Certification Statement 11.1 In column 1 below, mark the sections of Form 1 that you have completed and are submitting with your application. For each section, specify in Column 2 any attachments that you are enclosing.

Column 1 Column 2 

##  Section 1: Activities Requiring an NPDES Permit 

##  w/attachments



##  Section 2: Name, Mailing Address, and Location 

##  w/attachments



##  Section 3: SIC and NAICS Codes 

##  w/attachments



##  Section 4: Operator Information 

##  w/attachments



##  Section 5: Indian Land 

##  w/attachments



##  Section 6: Existing Environmental Permits 

##  w/attachments



##  Section 7: Map 

##  w/topographic
map 

##  w/additional attachments



##  Section 8: Nature of Business 

##  w/attachments



##  Section 9: Cooling Water Intake Structures 

##  w/attachments



##  Section 10: Variance Requests 

##  w/attachments



##  Section 11: Certification Statement signed by responsible party. 

##  w/attachments

11.2 Certification Statement
I certify under penalty of law that this document and all atta chments were prepared under my direction or supervision in accordance with a system designed to assure that qualif ied 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