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Special Discharge ApplicationRev. 1/4/2019 Page 1 of 2 APPLICATION FOR SPECIAL DISCHARGE APPROVAL I. WASTEWATER SOURCE IDENTIFICATION: II. APPLICANT (mailing information): Site Name: Applicant Name: Premise Address: Company Name: City: State: Zip: Mailing Address: Owner: Contact Person: City: State: Zip: Email: Email: Phone: Fax: Phone: Fax: III. A. MATERIAL TO BE DISCHARGED (check all applicable boxes): 1. Wastewater description/location: 2. Process/activity generating wastewater: _________________________________________________________________________________________________________ 3. Physical and chemical composition: List all constituents, and known or potentially present regulated contaminants below. See separate listing enclosed, and/or See analytical results enclosed, and/or Material Safety Data Sheet enclosed. 4. Is this wastewater from a process subject to EPA’s categorical standards in 40 CFR Subchapter N? Yes No a. If yes, the applicable standards are in: 40 CFR Part __________, Subpart __________ Existing source New source 5. Does this wastewater contain polychlorinated biphenyls, asbestos or radioactive material? Yes No a. If yes, describe: 6. Representative sample: Laboratory results attached, and/or Sample provided (1/2 gallon minimum, clear container) a. Sample collection point/location: Collection method: b. Sampler’s name/Co.: Sample date/time: c. Attach chain of custod y as available 7. Discharge will occur over the following time period: < 30 days ≥ Two years Other: a. Expected total volume of wastewater to be discharged over the time period abo ve: __________ Gallons b. Proposed discharge volume: __________ Gallons, at a frequency of: One time Daily Weekly Monthly Once/three months Once/six months Other: 8. Pretreatment of wastewater prior to discharge: None Yes, describe: a. If yes, attach site plan, pretreatment system schematic, and design specifications. 9. Wastewater from a remediation project under: Superfund/CERCLA RCRA Voluntary program UST Not applicable a. If from a remediation project, briefly describe the past and present utilization of the property: DESCRIPTION RANGE UNIT DESCRIPTION (continued) RANGE UNIT Metropolitan St. Louis Sewer District 10 East Grand Ave., St. Louis, MO 63147 Fax: 314-436-8766 email: spdisch@stlmsd.com Rev. 1/4/2019 Page 2 of 2 III.B. MATERIAL FROM UNDERGROUND STORAGE TANK SOURCE Not applicable (go to Section IV) Please answer the following questions if you are requesting to discharge wastewater associated with an underground storage tank system. 1. a. Wastewater from: Inside UST(s) UST system pit Excavation outside UST system pit Monitoring well Groundwater remediation system b. UST project involves wastewater from: UST(s) closed in place UST(s) removed Remediation Upgrade Maintenance activities Well monitoring Other, explain: c. If wastewater is from a closure project, how long has UST(s) been out of service: __________ years 2. a. State assigned UST site identification number: Not applicable b. Number of USTs affected: __________ Unknown c. For the UST(s) involved, their state identification number(s): Not applicable d. Service Station Identification Number, as applicable: 3. Tank contents/former contents: Gasoline #2 diesel Used oil Unknown Other: IV. DISCHARGE LOCATION 1. On-site. Describe proposed point of entry to sewer and the discharge rate (must be a sanitary or combined sewer): __________ Note: Range of discharge must not surcharge sewer line. 2. Haul to MSD Bissell Point Hauled Waste Receiving Station at 10 E. Grand, St. Louis, MO. a. Transporters Name: and MSD Hauler ID Number: b. Hazardous Waste Certification: For wastewater which is hauled to MSD’s Bissell Point Hauled Waste Receiving Station, I hereby certify that to the best of my knowledge and belief, the above hauled waste is not classified as a RCRA “hazardous waste” as defined by the MDNR in 10 CSR 25 or USEPA in 40 CFR Part 261. Applicant Name (print): _________________________________________________________________________________ Signature: _____________________________________________________________Date: ___________________________ ADDITIONAL INFORMATION: V. APPLICANT SIGNATURE AND CERTIFICATION This application must be signed by the applicant: either the source contact, or a contractor or agent directly responsible fo r site activities. I hereby certify that I am directly responsible for activities at the site regarding the wastewater to be discharged, and to the best of my knowledge and belief, based on appropriate inquiry, the information in this application is true, complete, and accurate. The samples or analyses submitted are representative of the materials to be discharged. If granted approval to discharge, I agree to abide by the MSD Ordinances, and all applicable federal, state and local regulations. I agree to pay the costs of any pre -approval analyses performed by MSD and to pay any applicable disposal charges fo r the volume and strength of the wastes discharged. Applicant Name (print): Signature: Date: FOR MSD USE ONLY: File Name:_________________________________________ ID No.____________________________ Sample Point No._______ Rev. 1/4/2019 p-1 MSD APPLICATION FOR SPECIAL DISCHARGE APPROVAL INSTRUCTIONS This application is for requesting approval to discharge the following wastewater into the MSD sanitary system: (1) wastewate r hauled to MSD's Bissell Point treatment plant if it is of unusually high strength or from a commercial or industrial source, and (2) wastewater to be discharged on-site from a one time, infrequent, or otherwise special discharge which will significantly differ from the site's normal day-to-day discharge due to unusual: volume, strength, operations, pollutant constituents, discharge location, or monitoring. On-site discharges described above from industrial users may not require an application if the discharge is typical of the user’s operations, even though the proposed discharge exhibits some of the characteristics identified abov e. Section I: Identify the physical location where the wastewater actually originated. Owner, as used in this application, means the owner/operator of the source premise and the party ultimately responsible for the wastewater. The contact person is the owner/operator representative at the site most knowledgeable about the wastewater. If the wastewater is presently at a location other than where it origin ated, indicate this fact and provide the address of the current location also. Section II: Identify the person to whom the approval will be directed, and the mailing address for correspondence. The applicant will be the person signing the application in Section V, and can be the source contact person or an agent, such as the engineering firm o r subcontractor responsible for on-site activities generating the wastewater. An alternate billing address or providing a carbon copy of the approval to someone in addition to the applicant will be accommodated based on written request. Section III.A: Item 1: Identify the wastewater for which approval is requested by identifying the wastewater by name if it is a product or raw material, or by its source if it is from an interceptor, tank, pit, treatment system, etc. Examples of descriptions include: Salt water from specified manufacturing process, off-specification product XYZ, oil/water separator serving the maintenance shop, solid waste landfill leachate, groundwater remediation system, etc. Item 2: Identify why and how the wastewater is being generated. For ex ample, The raw material exceeded holding time, the clean out of solids accumulated in the separator using a pump truck, remediation system recovering groundwater contaminated with chemic al XYZ from leaking process lines, etc. Item 3: Describe the physical contents of the wastewater in a general way, such as sand and mud 10 -20%, oil from drips on the floor in trace amounts, and water 80-90%; or salt (NaCl) 10-12%, product XYZ 20%, and water 68-70%. Also identify regulated contaminants which are known or potentially present. Regulated contaminants include priority pollutants under the CWA (listed in MSD Industrial User Questionnaire Section E.8.), other pollutants identified in MSD Ordinance 15048, hazardous constituents in Appendix VIII of 40 CFR 261, OSHA chemicals, and pollutants with water quality standards in 10 CSR 20 -7.031. If the list of contaminants present is longer than space allows, check the first box and provide the information in an attached list. When the wastewater or a significant portion is represented by a material safety data sheet, this information must be provided. Where the regulated contaminants are specifically listed in an attached analytical report or Material Safety Data Sheet, there is no ne ed to duplicate the information provided. Check the appropriate box to indicate the inclusion of this information. Item 4: If this wastewater is subject to EPA’s categorical standards at its site of origin, check “yes” and indicate the applicable standard. The source categories and pretreatment standards are identified in 40 CFR Subchapter N, Effluent Guidelines and Standards. Indicate whether the wastewater is subject to the pretreatment standards for new sources or existing sources, as defined by the regulations. Item 5: Check “yes” if the wastewater contains or may potentially contain polychlorinated biphenyls, asbesto s or radioactivity. Provide known information concerning the wastewater and levels of pollutants in the wastewater. Also, describe the potential source of these pollutants. Rev. 1/4/2019 p-2 Item 6: MSD typically requires analysis of a representative sample of the wastewater to be discharged prior to approval to evaluate acceptance of the wastewater and to determine applicable disposal charges. You may provide MSD with analytical results from a laboratory using EPA approved wastewater methods (in 40 CFR 136), or p rovide a sample which MSD will analyze and bill you for the analysis fees listed in the current MSD rate Ordinance. In the space provided, indicate where the sample was collected, and indicate the collection method or sampling tools used to obtain a repre sentative sample. Also indicate the name and company of the person who collected the sample, and the date and time it was collected. Note that wastewater samples must be sent to the la boratory quickly due to requirements limiting the sample holding time. Attach the chain-of-custody used to transfer the sample to the laboratory. The following analyses are typically required for common wastewater sources: - Group 1 for common wastewater pollutants: pH, TS, TSS, VSS, COD, Cd, Cr, Cu, Fe, Pb, Ni, Zn and t he volatile organic priority pollutants. MSD’s current Group 1 analysis fee is $338.00. - Group 2 for gasoline UST sites: pH, TSS, COD, Pb, and BTEX (benzene, toluene, ethyl benzene, and xylene). MSD’s current Group 2 analysis fee is $147.00. For di esel and fuel oil USTs, analyze for Group 2 plus oil & grease. For used engine oil USTs, analyze for Group 2 plus oil & grease and zinc. - Additional analysis may be required based on the wastewater and the known or potential presence of pollutants in the wastewater. Typical additional parameters include: ammonia, phenol, arsenic, barium, mercury, silver, surfactants, semivolatile priority pollutants, TCLP, etc. High levels of TCLP constituents in total concentrations will require a TCLP analysis for hauled wastewater. Item 7: Indicate how long the special discharge is expected to occur. The discharge time period indicates the length of time for whi ch approval is requested. One time discharges are typically approved for 30 days, with two years being the maximum expiration time period provided. In item 7.b., the discharge volume and frequency indicate how much wastewater will be discharged at the spe cified frequency. Approval for a significant additional volume, over 20%, or a longer approval time pe riod may be granted through an approval extension, based on written request at a later time as the project progresses. Item 8: Indicate whether you will pretreat the wastewater prior to discharge or if the wastewater was already pretreated prior to sampling. MSD typically requires wastewater to be sampled after pretreatment to demonstrate compliance for acceptance. For pretreatment or remediation systems which will entail a continuous on-site discharge, provide additional information to demonstrate that the system is designed properly to treat the wastewater to meet MSD Ordinance 15048 standards on a continuous basis. Typical information required includes a site plan, pretreatment system schematic, design specifications, modeling data, and the level of pollutants in the untreated wastewater. Item 9: If the wastewater is from a site which is subject to remedial or corrective action required under one of the regulatory progr ams listed, check the applicable box. Describe the past use of the property when the environmental contamination was caused and indicate the present utilization of the property. Section III.B: Complete this section only if the wastewater is associated with an underground storage tank (UST) project (closure, upgrade, maintenance activities, remediation, well monitoring, etc). If this section is not applicable, skip it and go to Section IV. Section IV: Check the number 1 box if the discharge of the wastewater is to be on-site to a sanitary or combined sewer system. Indicate the proposed point of entry to the on-site sewer and proposed discharge rate if known. Check the number 2 box if the waste water is to be transported to MSD’s Bissell Point Hauled Waste Receiving Station (HWRS) located at 10 East Grand, St. Louis, Missouri. Prov ide the name of the transporter to be used, and note that only haulers which are authorized by MSD are allowed to di scharge at the station. For item 2.b., evaluate the wastewater under the hazardous waste regulations in 40 CFR 261 and under Missouri’s hazardous was te regulations in 10 CSR 25-4.261, and sign the hazardous waste certification. A signed hauled waste certification, indicating that the wastewater is not a hazardous waste, is required for wastewater approved for discharge at the HWRS. Section V: This certification must be signed by the applicant listed in Section II for the Application for Special Discharge Approval to be complete. Rev. 1/4/2019 p-3 GENERAL APPROVAL CONDITIONS/ CRITERIA FOR ALL WASTEWATER: 1) Clean water may not be added to the wastewater for the specific purpose of diluting it to meet standards. 2) The effect of the wastewater on the receiving collection system, MSD treatment facility and on the watercourse receiving the MSD facility effluent must be evaluated. 3) Wastewater from any operation which is subject to EPA’s federal categorical standards must comply with the applicable effl uent standards identified in 40 CFR Subchapter N, Effluent Guidelines and Standards. The discharge at MSD must meet the standards identified by EPA for discharges to publicly owned treatment works (POTWs), whether the wastewater will be discharged onsite or transported to MSD. 4) For any proposed discharge from a Superfund/CERCLA site or RCRA Corrective Action site, the USEPA or State oversight agenc y must provide a letter stating that the discharge to the District is an acceptable means of disposal of the wastewater. This permission may also be demonstrated by providing an Agency approved remedial action plan which specifically identifies the discharge to MSD, including a copy of the Agency’s plan approval. However, receipt of such a letter or plan does not guarantee accepta nce of the waste by the District. Applicants must identify all hazardous constituents as identified in Appendix VIII of 40 CFR 261, along wit h other regulated contaminants, as defined in Section III. A. (3). 5) A written approval or denial will be prepared following review of all applicable data and any MSD files on the source site. Approvals for one-time discharges will generally be valid for 30 days unless a longer period of time is justified. Approvals for routine on-going discharges will be approved generally for two years, and may contain conditions for submittal of self -monitoring reports. 6) All approvals for special discharge will contain the following condition: "This discharge has been approved based upon the information and sample or sample analyses you provided and is subject to the conditions stated above. This approval may be revoked by the District at any time if any of the information is found to be incorrect, or if the conditions of this approval are violated. Also, if the discharge causes any operational or maintenance problems within the District's treatment system or results in violations of any conditions of the District's NPDES permit, the applicant and source will be considered responsible for damages." ADDITIONAL CRITERIA FOR ONSITE DISCHARGES: 1) Discharge must be into a sanitary or combined sewer only and must be via the discharger's own lateral unless permission is granted to discharge into a District owned inlet. 2) Rate of discharge must be controlled to avoid sewer backups. 3) All Sewer Use Ordinance 15048 limits must be met. a. Pretreatment may be necessary to meet limits. b. For small quantities of highly concentrated waste, compliance with the MSD Ordinance limits will be determined based on th e site’s total discharge to MSD, including the site’s normal wastewater flow and the special discharge volume. If any of the pollutants in the special discharge waste stream are present in the normal flow, the total amount of the pollutants must be taken into a ccount. The rate of discharge may have to be limited. 4) There must be sufficient wastewater flow available in the receiving sewer to assure that toxic vapors and explosive condit ions do not occur in the sewer due to the discharge. MSD uses EPA’s “Guidance to Prote ct POTW Workers from Toxic and Reactive Gases and Vapors” as a reference to make these determinations. 5) If the wastewater discharge results from site operations fed by a metered water supply, no additional volume charges are a pplicable. If the discharge results from operations using water or waste brought in from an outside source or from non -metered operations (e.g. UST removal or groundwater remediation), the discharger may be billed for the volume discharged. If discharge is one -time and short-term, the volume for billing may be based on a reasonable estimate of the vessel volume or appropriate calculations. For longer term discharges, the discharge must be metered and the volumes reported periodically. Volume charges and/or high strength surcharges are applicable to special discharges to the District as per Sewer Service Charge Ordinance 13758. Rev. 1/4/2019 p-4 6) Under the domestic sewage exclusion, hazardous waste wastewater may be discharged to MSD onsite if approved by MSD and the standards in Ordinance 15048 are met. Note that Industrial Users need to comply with the hazardous waste discharge reporting requirements specified in MSD Ordinance 15048, Article VIII, Section 9. ADDITIONAL CRITERIA FOR TRANSPORTED WASTEWATER: 1) The provisions of the Hauled Waste Ordinance 13701 apply. 2) Arrangements for transportation by an MSD authorized transporter must be made by the applicant or source of the wastewater . 3) No hazardous waste as defined at 40 CFR 261 or 10 CSR 25-4.261 can be accepted as hauled waste. When routine wastewater analyses show the presence of TCLP pollutants in high concentrations, a TCLP analysis may be required. Applicant must sign t he certification statement on the application which states that the waste is not a listed or characteristic hazardous waste. 4) Quantities of petroleum based oil or grease, cutting oils or products of mineral oil origin must be kept to a minimum as p er Article V, Section One, Subsection A.11 of Sewer Use Ordinance 15048. Hauled waste containing a floating layer of oil will not be allowed to discharge. INSTRUCTION NOTES: For any questions or comments regarding hauled waste or on-site discharges, please call (314) 436-8755. Industrial users may contact the pretreatment staff supervisor at (314) 436 -8717 for additional guidance. Callers may also phone the main number of the Division of Environmental Compliance at (314) 436 -8710. Please mail, email, or fax your completed application to the mailing address or fax number on the front page of the application. Application Checklist: Laboratory analytical results or wastewater sample enclosed Material Safety Data Sheets enclosed Hazardous waste certification signed for hauled waste Signed and completed application Remediation Site Package, as applicable: ● Site plan and characterization ● Pretreatment system design information ● Oversight agency approval