GENERAL REQUIREMENTS – (continued): What is the nearest 100-year flood elevation to the facility? feet mean sea level. Source: Are any treatment, storage or irrigation facilities located within the 100-year flood plain? Yes or No If yes, which facilities are affected and what measures are being taken to protect them against flooding? If yes, has the Applicant submitted written documentation of compliance with ? Yes or No Has the Applicant provided documentation of the presence or absence of threatened or endangered aquatic species utilizing information provided by the Department’s ? Yes or No Does the facility have a proposed or existing groundwater monitoring well network? Yes or No If no, provide an explanation as to why a groundwater monitoring well network is not proposed: If yes, complete the following table (NOTE – This table may be expanded for additional wells): Well Name Status Latitude a Longitude a Gradient Location . ○ - . ○ . ○ - . ○ . ○ - . ○ . ○ - . ○ . ○ - . ○ . ○ - . ○ . ○ - . ○ . ○ - . ○ . ○ - . ○ . ○ - . ○ a Provide the following latitude and longitude coordinate determination information: Datum: Level of accuracy: Method of measurement: If the Applicant is a Privately-Owned Public Utility, has a Certificate of Public Convenience and Necessity been submitted? Yes, No or N/A If the Applicant is a Developer of lots to be sold, has a been submitted? Yes, No or N/A If the Applicant is a Home/Property Owners' Association, has an been submitted? Yes, No or N/A Demonstration of historical consideration for permit approval – : Has the Applicant or any parent, subsidiary or other affiliate exhibited the following? Has been convicted of environmental crimes under Federal law or ? Yes or No Has previously abandoned a wastewater treatment facility without properly closing that facility? Yes or No Has unpaid civil penalty where all appeals have been abandoned or exhausted? Yes or No Is non-compliant with an existing non-discharge permit, settlement agreement or order? Yes or No Has unpaid annual fees in accordance with ? Yes or No WASTEWATER TREATMENT FACILITY DESIGN CRITERIA – : For the following parameters, provide the estimated influent concentrations and designed effluent concentrations as determined in the Engineering Calculations, and utilized in the Agronomic Evaluation and Groundwater Modeling (if applicable): Parameter Estimated Influent Concentration Designed Effluent Concentration (monthly average)
DISINFECTION Treatment Unit No. of Manufacturer or Material Dimensions (ft) Volume (gallons) Plan Sheet Reference Specification Reference If chlorination is the proposed method of disinfection, specify detention time provided: minutes (NOTE – 30 minutes minimum required), and indicate what treatment unit chlorine contact occurs: If ultraviolet (UV) light is the proposed method of disinfection, specify the number of banks: , number of lamps per bank: and maximum disinfection capacity: GPM. RESIDUAL TREATMENT Treatment Unit No. of Units Manufacturer or Material Dimensions (ft) Volume (gallons) Plan Sheet Reference Specification Reference WASTEWATER TREATMENT FACILITY DESIGN CRITERIA – (continued): PUMPS Location No. of Pumps Purpose Manufacturer / Type Capacity Plan Sheet Reference Specification Reference GPM TDH BLOWERS Location No. of Blowers Units Served Manufacturer / Type Capacity (CFM) Plan Sheet Reference Specification Reference