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Home My WebLink AboutDWQ-2023-200147Part I. General Information Permit No. (if known): Coverage No. (if known): Permit Type: Non-Discharging Domestic Wastewater Lagoons with an Annual Flow ABOVE 15,000 gpd Non-Discharging Domestic Wastewater Lagoons with an Annual Flow UNDER 15,000 gpd Type I Reuse Type II Reuse Subsurface Disposal of Wastewater Facility Name: Facility Classification: Federal State Municipal Private Facility Location: City State Zip Facility Mailing Address: City State Zip Facility Contact: Title: Phone Number: Email Address: Name of Signatory: Title: Is the applicant the facility owner, operator or both? (check only one response.) Owner Operator Both Is the facility privately owned? Yes No Indicate below any existing environmental permits. (Check all that apply and type the corresponding permit number for each.) RCRA (hazardous waste) UIC (underground injection control) PSD (air emissions) Nonattainment program (CAA) NESHAPs (CAA) Dredge or fill (CWA Section 404) Other (specify) Nature of Business Describe the nature of your business: Part II. Facility Information Population Served Design and Actual Flow Rates Provide design and actual flow rates in designated spaces. Design Flow Rates Daily Maximum Monthly Average Annual Average mgd mgd mgd Annual Average Flow Rates (Actual) Current Year Last Year Five Years Ago mgd mgd mgd Maximum Daily Flow Rates (Actual) Current Year Last Year Five Years Ago mgd mgd mgd Reuse Flow Rate (if applicable) Current Year Last Year Five Years Ago mgd mgd mgd Describe the Treatment of the System Types of Treatment (check all that apply per outfall) Include additional pages if needed. Primary Advanced Secondary Equivalent to secondary Grinder Bar Screen Aerators Tertiary Chlorination Disinfection Other (specify)_______ Number of Lagoon Cells Does the Treatment Works use chlorine for disinfection, use chlorine elsewhere in the treatment process, or otherwise have reasonable potential to discharge chlorine in its effluent? YES NO Describe the type of disinfection used for the effluent for each outfall and if disinfection varies by season. below. MAP: Attach a USGS topographic map or aerial photo extending one mile beyond the property boundaries of the site, the facility or activity boundaries, any treatment area(s), outfall(s), major drainage patterns, and the receiving surface waters stated above. Map Attached Describe the current treatment system.Include a diagram of system showing major components: Part III: Public Drinking Water Well How far is the closest Public Drinking Water Well to your Treatment Works or disposal fields: feet. Describe the location of the nearest public drinking water well and attach a map. Drinking Water Well Map Attached Part IV. Collection System Service Area(s) Population Served Miles of Pipe Total Population Served: Total Miles of Pipe: Does the Wastewater Originate from Multiple Units under separate Ownership? YES NO If yes above, does the System only serve a condominium? YES NO Utah Sewer Management Program implemented? YES NO Part V. Lagoon Characteristics(Only Applicable for lagoons) Cell # Lagoon Cell Size (acres) Cells # Lagoon Cell Size (acres) Cells # Lagoon Cell Size (acres) Total Population Served: Total Miles of Pipe: Part VI. Sampling Information Yes No Are you applying for the Land Application or Mechanical Plant Operating Permit? If you selected NO skip to Part VII. Facility monitoring data. Please provide the past five years of all parameters required to be monitored in the operating permit. The data can be entered in the section below or an excel spreadsheet. Attach additional sheets if needed. Month Year Parameter Min Max Avg MDL/RL* *MDL/RL is the analysis method detection limit or reporting limit located on the laboratory analysis report. Part VII. Pretreatment Information Does the facility have an approved pretreatment program? YES NO If YES, skip to next section. If No, complete the below industrial user forms and inspections as needed. Industrial Pretreatment Wastewater SurveyCheck any of the following that have occurred in the past five years either at the wastewater treatment plant or in the collection system:FoamingUnusual colorsPlugged collection lines caused by grease Plugged collection lines caused by sandPlugged collection lines caused by other debrisDischarging of excessive BODDischarging of excessive suspended solidsSmells unusually bad or unusual smellsUpsets of the treatment plant due to unknown conditionsDoes the facility have any industrial users (IUs)which meet any of the following criteria:Has a lot of process wastewater (5% of the flow at the waste treatment facility or more than 25,000 gallons per work day.)Examples: food processor, dairy, slaughterhouse, industrial laundry. YES NOIs subject to federal categorical pretreatment standards;Examples: metal plating, cleaning or coating of metals, blueing of metals, aluminum extruding, circuit board manufacturing, tanning animal skins, pesticide formulating or packaging, and pharmaceutical manufacturing or packaging, YES NOIs a concern to the POTW.Examples: septage hauler, restaurant and food service, car wash, hospital, photo lab, carpet cleaner, commercial laundry. YES NODo any users of the water treatment facility caused any of the following to occur: YES NO A discharge which creates a fire or explosion hazard in the collection system. YES NOA discharge which creates toxic gases, vapor or fumes in the collection system. YES NOA discharge of solids or thick liquids which creates flow obstructions in the collection system. YES NOAn acidic discharge (low pH) which causes corrosive damage to the collection system. YES NOPetroleum oil, nonbiodegradable cutting oil, or products of mineral oil origin in amounts thatwill cause problems in the collection system or at the waste treatment facility. YES NOWaste haulers are prohibited from discharging without permission. YES NO Does the facility believe that illegal dumping is occurring in the jurisdiction? Part VII. Pretreatment Information continued Complete and submit the following preliminary inspection of each business that is discharging process wastewater to the wastewater treatment plant. PRELIMINARY INSPECTION FORM Inspection Date Inspection Time A Name of Business Person Contacted Street Address City Email Address Phone Number Description of Business: Principal product or service: Raw Materials used: Production process is: BatchContinuousBoth YES NO Does the facility have a seasonal production cycle? If yes, briefly describe seasonal production cycle. This facility generates the following types of wastes (check all that apply): Domestic wastes (Restrooms, employee showers, etc.) Cooling water, non-contact Boiler/Tower blowdown Cooling water, contact Process Equipment/Facility washdown Air Pollution Control Unit Storm water runoff to sewer Other describe Wastes are discharged to (check all that apply): Evaporation Ground water Sanitary sewer Other (describe below) Storm sewer Surface water Waste haulers Name of waste hauler(s), if used Is a grease trap installed?YesNo Is it operational?YesNo Part VII. Pretreatment Informationcontinued B. PRELIMINARY INSPECTION FORM continued Does the business discharge a lot of process wastewater?More than 5% of the flow to the waste treatment facility?YesNoMore than 25,000 gallons per work day?YesNoDoes the business do any of the following or manufacture any of the following?AdhesivesAluminum FormingBattery ManufacturingCar WashCarpet CleanerCopper FormingDairyElectric & Electronic ComponentsExplosives ManufacturingFood ProcessorFoundriesHospitalIndustrial Porcelain Ceramic ManufacturingInorganic Chemicals Mfg. or PackagingIron & SteelLaundries Metal Finishing, Coating or Cleaning Mining Nonferrous Metals Manufacturing Organic Chemicals Manufacturing or Packaging Paint & Ink Manufacturing Pesticides Formulating or Packaging Petroleum Refining Pharmaceuticals Manufacturing or PackagingPhoto Lab Plastics ManufacturingRestaurant & Food Service Rubber ManufacturingSeptage HaulerSlaughter House Soaps & Detergents Manufacturing Steam Electric Generation Tanning Animal Skins Textile Mills Are any process changes or expansions planned during the next three years? Yes No If yes, attach a separate sheet to this form describing the nature of planned changes or expansions. Inspector Name Printed Wastewater Treatment Facility Any questions regarding the form or assistance with inspecting business please contact Jennifer Robinson Pretreatment Coordinator Division of Water Quality P. O. Box 144870 Salt Lake City, Utah 84114-4870 Phone:(801) 536-4383 Fax:(801) 536-4301E-Mail:jenrobinson@utah.gov Part VII. Pretreatment Informationcontinued Either list all businesses below or provide a list of business licenses issued in the facilities service area. Name of Business Jurisdiction SIC Codes Total Average Process Flow (gpd) Total Average Facility Flow (gpd) Facility Description (dentist, manufacturing [state product], dairy, assisted living facility, etc.) 1 2 3 4 5 6 7 8 9 10 11 Part VIII. Biosolids Information Will the facility produce or dispose of biosolids? YES NO If NO, skip to part IX. Was the Biosolids Annual Report submitted? YES NO N/A Service Connections? Provide the total dry metric tons per the latest 365-day period of sewage sludge generated, treated, used and disposed of: When were ponds last dredged? Where are solids sent to? Practice Dry Metric Tons per 365-day Period Amount generated at the facility Amount treated at the facility Amount used (i.e., received from offsite) at the facility Amount disposed of at the facility Treatment Provided at Your Facility Identify the treatment process(es) used at your facility to reduce pathogens in sewage sludge Preliminary operations (e.g., sludge grinding and degritting) Stabilization Composting Disinfection Heat drying Methane or biogas capture and recovery Thickening (concentration) Anaerobic digestion Conditioning Dewatering (e.g. centrifugation, sludge drying beds, sludge lagoons) Thermal reduction Processing Sewage Sludge Disposal Method Land Application of Bulk Sewage Sludge Is sewage sludge form your facility applied to the land? YES NO If No, Skip to next section Total dry metric tons per 365-day period of sewage sludge applied to all land sites: Surface Disposal of Sewage Sludge Is sewage sludge from your facility placed on a surface disposal site? YES NO If No, Skip to next section Total dry metric tons of sewage sludge from your facility placed on all surface disposal sites per 365-day period: Do you own or operate all surface disposal sites to which you send sewage sludge for disposal? YES NO If No, complete the below information Surface disposal site you do not operate Site name Mailing address City State Zip Contact Name Title Phone Number Email Address Part VIII. Biosolids Informationcontinued Disposal in a Municipal Solid Waste Landfill Is sewage sludge from your facility placed on a municipal solid waste landfill? YES NO If No, Skip to next section Total dry metric tons of sewage sludge from your facility placed in this municipal solid waste landfill per 365-day period: Do you own or operate the municipal solid waste landfill in which sewage sludge is disposed? YES NO If No, complete the below information Municipal Solid Waste Landfill you do not operate Site name Part IX. ReuseInformation Any effluent reused? YES NO Any effluent applied to land as irrigation? YES NO Any effluent discharged to surface water? YES NO Any effluent applied to land as disposal? YES NO Any effluent discharged to subsurface? YES NO Any treated effluent being soldfor reuse? YES NO If YES to any of the above questions, complete the below information. Land Application Site and Discharge Data Location Size Average Daily Volume Applied How often acres gpd Seasonal Continuous Intermittent acres gpd Seasonal Continuous Intermittent acres gpd Seasonal Continuous Intermittent Seasonal land application. Indicate months of seasonal land application January February March April May June July August September October November December Where is the Treated Effluent Distributed? Residential irrigation Urban uses Non-residential landscape irrigation Golf course irrigation Toilet flushing Fire protection Irrigation of food crops (direct contact with edible part) – spray irrigation Irrigation of food crops (Non direct contact with edible part) – no spray irrigation Irrigation Sod farms Silviculture Limited access highway rights of way Other areas where human access is restrict or unlikely to occur Irrigation of animal feed crops other than pasture for milking animals Impoundment of wastewater where direct human contact is not allowed or is unlikely to occur Cooling water Soil compaction or duct control in construction areas Other Attached an updated Project Plan for Reuse(See R317-3-11.3) An updated Reuse Project Plan is required during every permit renewal. Part X. Certification Statement and Signature I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with 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 of knowing violations. PRINT Signatory Authority Signature Title Date The Division of Water Quality may request addition information. Important: This NOI for Coverage Under the General Permit for UTOP00100, UTOP00200, UTOP00300, UTOP00400, or UTOP00500 will not be considered complete unless you answer every question. If an item does not apply to you, enter “Not Applicable” to show that you considered the question. The NOI for Coverage Under the General Permit for UTOP00100, UTOP00200, UTOP00300,UTOP00400, or UTOP00500, must be signed as follows: For a corporation, a responsible corporate officer shall sign the NOI, a responsible corporate officer means: 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 The manager of one or more manufacturing, production, or operating facilities, if The manager is authorized to make management decisions that 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 statutes 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 Authority to sign documents has been assigned or delegated to the manager in accordance with corporate procedures. For a partnership of sole proprietorship, the general partner or the proprietor, respectively; or For a municipality, state or other public agency, either a principal executive officer or ranking elected official shall sign the application; in this subsection, a principal executive officer of any agency means; The chief executive officer of the agency; or A senior executive officer having responsibility for the overall operations of a principal geographic unit or division of the agency. Where to File the NOI for Coverage Under the General Permit for UTOP00100, UTOP00200, UTOP00300, UTOP00400, or UTOP00500form: Please submit the original form with a signature in ink to the below address or digitally to the DWQ Electronic Portal. Remember to retrain a copy for your records.Mail to:Utah Department of Environmental Quality Division of Water Quality ATTN: Engineering PO Box 144870 Salt Lake City, UT 84114-4870 Upload NOI PDF to the DWQ Electronic Document Portal https://deq.utah.gov/water-quality/water-quality-electronic-submissions The system will email you a number like DWQ-2022-XXXXX Email this number to mor@utah.gov OFFICE USE ONLY Date received: / / Received by: Document No: via: Email Fax Webportal Mail Hand Delivery