Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

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This document is being distributed for comment purposes only.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 Discharge Elimination System (NPDES) permits 

program, with the exception of publicly owned treatment works and other treatment works treating 

domestic sewage, must complete Form 1. Additionally, all applicants must complete 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 Instructions” of this form. 

For Comment Only
Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

Paperwork Reduction Act Notice 

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

and complete Form 1 to be 3 hours for new applicants and 1 hour for applicants renewing 

existing permits. 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. New respondents must also prepare a topographic map. 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
1-1 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

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 particular 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 from 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. 

For Comment Only
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Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

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 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 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, using 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 Number 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 information 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 space 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 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. 

 

For Comment Only
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Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

FORM 1—GENERAL INSTRUCTIONS CONTINUED 

Exhibit 1–1. 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

Exhibit 1–2. Filing Dates for NPDES Permit Applications 

Permit Application When to File

2A

180 days before your present NPDES permit expires or, if you 

are a new discharger, 180 days before the date on which the 

discharge is to commence unless 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 before 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.

For Comment Only
1-4 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

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 application. 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 production facilities, provide the 

address or location of the production 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, grown, 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 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 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. 

For Comment Only
1-5 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

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 permit 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 to the nearest second. 

On all maps of rivers, show the direction of the current. In tidal 

waters, show the directions of ebb and flow tides. 

You may develop your map by going to the USGS’s National Map 

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

quadrangle format. If none is available, you may use a USGS 

15-minute series map. You may also use a plat or other appropriate 

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

commercial, etc.). 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 map 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.

For Comment Only
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Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

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-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).

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Exhibit 1–3. Example Topographic Map 

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FORM 1—ACTIVITIES THAT DO NOT REQUIRE PERMITS 

You are not required to obtain an NPDES 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 secured 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, municipality, 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, including 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 commercial use. This exclusion does 

not apply to pollutants introduced by the water transfer activity 

itself to the water being transferred. 

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FORM 1—GLOSSARY 

NOTE: This Glossary includes terms used in the various NPDES application 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 (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), 

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FORM 1—GLOSSARY CONTINUED

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

4. 500 horses, 

5. 10,000 sheep or lambs, 

6. 55,000 turkeys, 

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

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

9. 5,000 ducks, or 

10. 1,000 animal units; or 

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

1. 300 slaughter or feeder cattle, 

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

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

4. 150 horses, 

5. 3,000 sheep or lambs, 

6. 16,500 turkeys, 

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

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

9. 1,500 ducks, or 

10. 300 animal units; AND 

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

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

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

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

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

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

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

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

basis: 

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

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

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

and 

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

feeding. 

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

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

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

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

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

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

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

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

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

DIRECT DISCHARGE means the “discharge of a pollutant.” 

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

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

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

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FORM 1—GLOSSARY CONTINUED 

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

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

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

DISCHARGE (OF A POLLUTANT) means: 

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

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

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

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

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

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

addition of pollutants by any indirect discharger. 

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

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

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

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

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

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

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

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

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

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

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

revise “effluent limitations.” 

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

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

subject to regulation under the NPDES program. 

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

geographical area. 

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

INDIAN COUNTRY means: 

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

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

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

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

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

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

governmental authority over a Federal Indian reservation. 

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

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

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

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

effluent limitations guidelines.)

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

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

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

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FORM 1—GLOSSARY CONTINUED 

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

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

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

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

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

storm drains): 

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

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

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

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

discharges to waters of the United States. 

 Designed or used for collecting or conveying stormwater. 

 [That] is not a combined sewer. 

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

MUNICIPAL SLUDGE (see sewage sludge) 

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

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

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

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

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

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

(c) Which is not a “new source;” and 

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

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

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

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

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

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

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

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

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

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

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

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

construction of which commenced: 

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

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

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

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

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

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

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

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

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

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

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

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FORM 1—GLOSSARY CONTINUED 

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

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

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

agricultural stormwater runoff. (See § 122.3).

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

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

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

discharged into water. It does not mean: 

(a) Sewage from vessels; or 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Agency or the authorized representative of the Regional Administrator. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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FORM 1—GLOSSARY CONTINUED 

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

connection with the facility or activity. 

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

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

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

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

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

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

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

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

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

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

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

reference is made. 

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

drainage. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

of paragraph (b)(14): 

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

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

(b)(14) of this section); 

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

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

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

facilities); 

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

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

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

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

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

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

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

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

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

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

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

subtitle C of RCRA; 

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1-15 

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FORM 1—GLOSSARY CONTINUED 

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

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

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

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

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

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

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

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

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

associated with industrial activity; 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

preventive maintenance, or careless or improper operation.

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

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

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

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

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

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

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

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

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

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

interstate or foreign commerce including any such waters: 

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

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

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

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

For Comment Only
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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 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
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For Comment Only
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 NPDES 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 Code 

For Comment Only
EPA 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 Implementation

Name, 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)

For Comment Only
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> 

Contains Nonbinding Recommendations

Draft Application Forms – Not for Implementation

Operator 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)) Indian Land

5.1 Is the facility located on Indian Land? 

 Yes  No 

SECTION 6. EXISTING ENVIRONMENTAL 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 Water Intake 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 your NPDES permitting authority 

to determine the specific information that needs to be submitted and when.) 

For Comment Only
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 CERTIFICATION 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 attachments were prepared under my direction or supervision in 

accordance with a system designed to assure that qualified personnel properly gather and evaluate the information 

submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible 

for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and 

complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine 

and imprisonment for knowing violations. 

 Name (first and last) Official Title 

 Signature Date Signed 

For Comment Only