FACILITY NAME AND PERMIT NUMBER:
Form Approved 1/14/99
OMB Number 2040-0086
FORM
2S
NPDES
NPDES FORM 2S APPLICATION OVERVIEW
PRELIMINARY INFORMATION
This page is designed to indicate whether the applicant is to complete Part 1 or Part 2, Review each category,
and then complete Part 1 or Part 2, as indicated. For purposes of this form, the term "you" refers to the
applicant, "This facility" and "your facility" refer to the facility for which application information is submitted.
FACILITIES INCLUDED IN ANY OF THE FOLLOWING CATEGORIES MUST COMPLETE PART 2
(PERMIT APPLICATION INFORMATION).
1. Facilities with a currently effective NPDES permit.
2. Facilities which have been directed by the permitting authority to submit a full permit application at this time.
ALL OTHER FACILITIES MUST COMPLETE PART 1 (LIMITED BACKGROUND INFORMATION).
EPA Form 3510-2S (Rev. 1-99)
Page 1 of 23
-------
FACILITY NAME AND PERMIT NUMBER:
Form Approved 1/14/99
OMB Number 2040-0086
PART 1: LIMITED BACKGROUND INFORMATION
This part should be completed only by "sludge-only" facilities - that is, facilities that do not currently have, and are not applying for, an
NPDES permit for a direct discharge to a surface body of water.
For purposes of this form, the term "you" refers to the applicant. "This facility" and "your facility" refer to the facility for which application
information is submitted.
1. Facility Information.
a. Facility name
b. Mailing Address
c. Contact person
Title
Telephone number
d. Facility Address (not P.O. B ox)
e. Indicate the type of facility
Publicly owned treatment works (POTW) Privately owned treatment works
Federally owned treatment works Blending or treatment operation
Surface disposal site Sewage sludge incinerator
Other (describe)
2. Applicant Information.
a. Applicant name
b. Mailing Address
c. Contact person
Title
Telephone number
d. Is the applicant the owner or operator (or both) of this facility?
owner operator
e. Should correspondence regarding this permit be directed to the facility or the applicant?
facility applicant
EPA Form 3510-2S (Rev. 1 -99) Page 2 of 23
-------
FACILITY NAME AND PERMIT NUMBER:
3. Sewage Sludge Amount. Provide the total dry metric tons per 1
a. Amount generated at the facility
b. Amount received from off site
c. Amount treated or blended on site
d. Amount sold or given away in a bag or other container for ap
e. Amount of bulk sewage sludge shipped off site for treatmen
f. Amount applied to the land in bulk form
g. Amount placed on a surface disposal site
h. Amount fired in a sewage sludge incinerator
i. Amount sent to a municipal solid waste landfill
j. Amount used or disposed by another practice
Describe
Form Approved 1/14/99
OMB Number 2040-0086
atest 365 day period of sewage sludge handled under the following practices:
dry metric tons
plication to the land
t or blending
dry metric tons
dry metric tons
dry metric tons
dry metric tons
dry metric tons
dry metric tons
dry metric tons
dry metric tons
dry metric tons
4. Pollutant Concentrations. Using the table below or a separate attachment, provide existing sewage sludge monitoring data for the pollutants for
which limits in sewage sludge have been established in 40 CFR part 503 for this facility's expected use or disposal practices. If available, base data on
three or more samples taken at least one month apart and no more than four and one-half years old.
POLLUTANT
ARSENIC
CADMIUM
CHROMIUM
COPPER
LEAD
MERCURY
MOLYBDENUM
NICKEL
SELENIUM
ZINC
CONCENTRATION
(mg/kg dry weight)
ANALYTICAL METHOD
DETECTION LEVEL FOR ANALYSIS
5. Treatment Provided At Your Facility.
a. Which class of pathogen reduction does the sewage sludge meet at your facility?
Class A Class B Neither or unknown
b. Describe, on this form
or another sheet of paper, any treatment processes used at your facility to reduce pathogens in sewage sludge:
EPA Form 3510-2S (Rev. 1-99)
Page 3 of 23
-------
FACILITY NAME AND PERMIT NUMBER:
c. Which vector attraction reduction option is met for the sewage sludge at your facility?
Option 1 (Minimum 38 percent reduction in volatile solids)
Option 2 (Anaerobic process, with bench-scale demonstration)
Option 3 (Aerobic process, with bench-scale demonstration)
Option 4 (Specific oxygen uptake rate for aerobically digested sludge)
Option 5 (Aerobic processes plus raised temperature)
Option 6 (Raise pH to 12 and retain at 1 1 .5)
Option 7 (75 percent solids with no unstabilized solids)
Option 8 (90 percent solids with unstabilized solids)
Option 9 (Injection below land surface)
Option 10 (Incorporation into soil within 6 hours)
Option 1 1 (Covering active sewage sludge unit daily)
None or unknown
Form Approved 1/14/99
OMB Number 2040-0086
d. Describe, on this form or another sheet of paper, any treatment processes used at your facility to reduce vector attraction properties of sewage
sludge:
6. Sewage Sludge Sent to Other Facilities. Does the sewage sludge from your facility meet the Table 1
concentrations, Class A pathogen requirements, and one of the vector attraction options 1-8?
Yes No
If yes, go to question 8 (Certification).
If no, is sewage sludge from your facility provided to another facility for treatment, distribution,
Yes No
If no, go to question 7 (Use and Disposal Sites).
If yes, provide the following information for the facility receiving the sewage sludge:
a. Facility name
b. Mailing address
c. Contact person
Title
Telephone number
d. Which activities does the receiving facility provide? (Check all that apply)
Treatment or blending Sale or give-away in bag or other container
Land application Surface disposal
Incineration Other (describe):
ceiling concentrations, the Table 3 pollutant
use, or disposal?
EPA Form 3510-2S (Rev. 1 -99) Page 4 of 23
-------
FACILITY NAME AND PERMIT NUMBER:
Form Approved 1/14/99
OMB Number 2040-0086
7. Use and Disposal Sites. Provide the following information for each site on which sewage sludge from this facility is used or disposed:
a. Site name or number
b. Contact person
Title
Telephone
c. Site location (Complete 1 or 2)
1. Street or Route #
County
City or Town
2. Latitude
State
Zip
Longitude_
d. Site type (Check all that apply)
Agricultural
Surface disposal
Reclamation
. Lawn or home garden
. Public Contact
. Municipal Solid Waste Landfill
Forest
. Incineration
. Other (describe):
8. Certification. Sign the certification statement below. (Refer to instructions to determine who is an officer for purposes of this certification.)
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with the 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 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 and official title
Signature
Telephone number
Date signed
SEND COMPLETED FORMS TO:
EPA Form 3510-2S (Rev. 1-99)
Page 5 of 23
-------
FACILITY NAME AND PERMIT NUMBER:
Form Approved 1/14/99
OMB Number 2040-0086
PART 2: PERMIT APPLICATION INFORMATION
Complete this part if you have an effective NPDES permit or have been directed by the permitting authority to submit a full permit application
at this time. In other words, complete this part if your facility has, or is applying for, an NPDES permit
For purposes of this form, the term "you" refers to the applicant, "This facility" and "your facility" refer to the facility for which application
information is submitted.
APPLICATION OVERVIEW — SEWAGE SLUDGE USE OR DISPOSAL
INFORMATION
Part 2 is divided into five sections (A-E). Section A pertains to all applicants. The applicability of Sections B, C, D, and E depends on your
facility's sewage sludge use or disposal practices. The information provided on this page indicates which sections of Part 2 to fill out
1. SECTION A: GENERAL INFORMATION.
Section A must be completed by all applicants
2. SECTION B: GENERATION OF SEWAGE SLUDGE OR PREPARATION OF A MATERIAL DERIVED FROM SEWAGE SLUDGE.
Section B must be completed by applicants who either:
1) Generate sewage sludge, or
2) Derive a material from sewage sludge.
3. SECTION C: LAND APPLICATION OF BULK SEWAGE SLUDGE.
Section C must be completed by applicants who either:
1) Apply sewage to the land, or
2) Generate sewage sludge which is applied to the land by others.
NOTE: Applicants who meet either or both of the two above criteria are exempted from this requirement if ajj sewage sludge from their facility falls
into one of the following three categories:
1) The sewage sludge from this facility meets the ceiling and pollutant concentrations, Class A pathogen reduction requirements, and one of vector
attraction reduction options 1-8, as identified in the instructions, or
2) The sewage sludge from this facility is placed in a bag or other container for sale or give-away for application to the land, or
3) The sewage sludge from this facility is sent to another facility for treatment or blending.
4. SECTION D: SURFACE DISPOSAL
Section D must be completed by applicants who own or operate a surface disposal site.
5. SECTION E: INCINERATION
Section E must be completed by applicants who own or operate a sewage sludge incinerator.
EPA Form 3510-2S (Rev. 1 -99) Page 6 of 23
-------
FACILITY NAME AND PERMIT NUMBER:
A. GENERAL INFORMATION
All applicants must complete this section.
Form Approved 1/14/99
OMB Number 2040-0086
A.1. Facility Information.
a. Facility name
b. Mailing Address
c. Contact person
Title
Telephone number
d. Facility Address (not P.O. Box)
e. Is this facility a Class I sludge management facility?
f. Facility design flow rate: mgd
g. Total population served:
h. Indicate the type of facility:
Publicly owned treatment works (POTW)
Yes
No
. Privately owned treatment works
Federally owned treatment works
Surface disposal site
Other (describe)
Blending or treatment operation
Sewage sludge incinerator
A.2. Applicant Information. If the applicant is different from the above, provide the following:
a. Applicant name
b. Mailing Address
c. Contact person
Title
Telephone number
d. Is the applicant the owner or operator (or both) of this facility?
owner operator
e. Should correspondence regarding this permit should be directed to the facility or the applicant.
facility applicant
EPA Form 3510-2S (Rev. 1-99)
Page 7 of 23
-------
FACILITY NAME AND PERMIT NUMBER:
Form Approved 1/14/99
OMB Number 2040-0086
A.3. Permit Information.
a. Facility's NPDES permit number (if applicable):
b. List, on this form or an attachment, all other Federal, State, and local permits or construction approvals received or applied for that regulate this
facility's sewage sludge management practices:
Permit Number Type of Permit
A.4. Indian Country. Does any generation, treatment, storage, application to land, or disposal of sewage sludge from this facility occur in Indian Country?
Yes No If yes, describe:
A.5. Topographic Map. Provide a topographic map or maps (or other appropriate map(s) if a topographic map is unavailable) that show the following
information. Map(s) should include the area one mile beyond all property boundaries of the facility:
a. Location of all sewage sludge management facilities, including locations where sewage sludge is stored, treated, or disposed.
b. Location of all wells, springs, and other surface water bodies, listed in public records or otherwise known to the applicant within 1/4 mile of the
facility property boundaries.
A.6. Line Drawing. Provide a line drawing and/or a narrative description that identifies all sewage sludge processes that will be employed during the term
of the permit, including all processes used for collecting, dewatering, storing, or treating sewage sludge, the destination(s) of all liquids and solids
leaving each unit, and all methods used for pathogen reduction and vector attraction reduction.
A.7. Contractor Information.
Are any operational or maintenance aspects of this facility related to sewage sludge generation, treatment, use or disposal the responsibility of a
contractor? Yes No
If yes, provide the following for each contractor (attach additional pages if necessary):
a. Name
b. Mailing Address
c. Telephone Number
d. Responsibilities of contractor
EPA Form 3510-2S (Rev. 1 -99) Page 8 of 23
-------
FACILITY NAME AND PERMIT NUMBER:
Form Approved 1/14/99
OMB Number 2040-0086
A.8. Pollution Concentrations: Using the table below or a separate attachment, provide sewage sludge monitoring data for the pollutants for which limits
in sewage sludge have been established in 40 CFR Part 503 for this facility's expected use or disposal practices. All data must be based on three or
more samples taken at least one month apart and must be no more than four and one-half years old.
POLtJUTAN?
CONCENTRATION
(mg/kg dry weight)
ANALYTICAL METHOD
DETECTION LEVEL FOR ANALYSIS
ARSENIC
CADMIUM
CHROMIUM
COPPER
LEAD
MERCURY
MOLYBDENUM
NICKEL
SELENIUM
ZINC
A.9. Certification. Read and submit the following certification statement with this application. Refer to the instructions to determine who is an officer for
purposes of this certification. Indicate which parts of Form 2S you have completed and are submitting:
. Part 1 Limited Background Information packet
Part 2 Permit Application Information packet:
Section A (General Information)
. Section B (Generation of Sewage Sludge or Preparation of
a Material Derived from Sewage Sludge)
. Section C (Land Application of Bulk Sewage Sludge)
. Section D (Surface Disposal)
. Section E (Incineration)
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with the
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 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 and official title
Signature
Telephone number
Date signed.
Upon request of the permitting authority, you must submit any other information necessary to assess sewage sludge use or disposal practices at your
facility or identify appropriate permitting requirements.
SEND COMPLETED FORMS TO:
EPA Form 3510-2S (Rev. 1-99)
Page 9 of 23
-------
FACILITY NAME AND PERMIT NUMBER:
Form Approved 1/14/99
OMB Number 2040-0086
B. GENERATION OF SEWAGE SLUDGE OR PREPARATION OF
A MATERIAL DERIVED FROM SEWAGE SLUDGE
Complete this section if your facility generates sewage sludge or derives a material from sewage sludge.
B.1. Amount Generated On Site.
Total dry metric tons per 365-day period generated at your facility: dry metric tons
B.2. Amount Received from Off Site. If your facility receives sewage sludge from another facility for treatment, use, or disposal, provide the following
information for each facility from which sewage sludge is received. If you receive sewage sludge from more than one facility, attach additional pages
as necessary.
a. Facility name
b. Mailing Address
c. Contact person
Title
Telephone number
d. Facility Address (not P.O. Box).
e. Total dry metric tons per 365-day period received from this facility: dry metric tons
f. Describe, on this form or on another sheet of paper, any treatment processes known to occur at the off-site facility, including blending activities
and treatment to reduce pathogens or vector attraction characteristics.
B.3. Treatment Provided At Your Facility.
a. Which class of pathogen reduction is achieved for the sewage sludge at your facility?
Class A Class B Neither or unknown
b. Describe, on this form or another sheet of paper, any treatment processes used at your facility to reduce pathogens in sewage sludge:
c. Which vector attraction reduction option is met for the sewage sludge at your facility?
Option 1 (Minimum 38 percent reduction in volatile solids)
Option 2 (Anaerobic process, with bench-scale demonstration)
Option 3 (Aerobic process, with bench-scale demonstration)
Option 4 (Specific oxygen uptake rate for aerobically digested sludge)
Option 5 (Aerobic processes plus raised temperature)
Option 6 (Raise pH to 12 and retain at 11.5)
Option 7 (75 percent solids with no unstabilized solids)
Option 8 (90 percent solids with unstabilized solids)
None or unknown
EPA Form 3510-2S (Rev. 1 -99) Page 10 of 23
-------
FACILITY NAME AND PERMIT NUMBER:
Form Approved 1/14/99
OMB Number 2040-0086
B.3. Treatment Provided At Your Facility, (con't)
d. Describe, on this form or another sheet of paper, any treatment processes used at your facility to reduce vector attraction properties of sewage
sludge:
e. Describe, on this form or another sheet of paper, any other sewage sludge treatment or blending activities not identified in (a) - (d) above:
Complete Section B.4 if sewage sludge from your facility meets the ceiling concentrations in Table 1 of 40 CFR 503.13, the pollutant
concentrations in Table 3 of §503.13, the Class A pathogen reduction requirements in §503.32(3), and one of the vector attraction reduction
requirements in § 503.33(b)(1)-(8) and is land applied. Skip this section if sewage sludge from your facility does not meet all of these criteria.
B.4. Preparation of Sewage Sludge Meeting Ceiling and Pollutant Concentrations, Class A Pathogen Requirements, and One of Vector
Attraction Reduction Options 1-8.
a. Total dry metric tons per 365-day period of sewage sludge subject to this section that is applied to the land: dry metric tons
b. Is sewage sludge subject to this section placed in bags or other containers for sale or give-away for application to the land?
Yes No
Complete Section B.5. if you place sewage sludge in a bag or other container for sate or give-away for land application. Skip this section if
the sewage sludge is covered in Section B.4.
B.5. Sale or Give-Away in a Bag or Other Container for Application to the Land.
a. Total dry metric tons per 365-day period of sewage sludge placed in a bag or other container at your facility for sale or give-away for application to
the land: dry metric tons
b. Attach, with this application, a copy of all labels or notices that accompany the sewage sludge being sold or given away in a bag or other
container for application to the land.
Complete Section B.6 if sewage sludge from your facility is provided to another facility that provides treatment or blending. This section
does not apply to sewage sludge sent directly to a land application or surface disposal site. Skip this section if the sewage sludge is covered
in Sections B.4 or B.5. If you provide sewage sludge to more than one facility, attach additional pages as necessary.
B.6. Shipment Off Site for Treatment or Blending.
a. Receiving facility name
b. Mailing address
c. Contact person
Title
Telephone number
d. Total dry metric tons per 365-day period of sewage sludge provided to receiving facility:
EPA Form 3510-2S (Rev. 1-99) Page 11 of 23
-------
FACILITY NAME AND PERMIT NUMBER:
Form Approved 1/14/99
OMB Number 2040-0086
B.6. Shipment Off Site for Treatment or Blending, (con't)
e. Does the receiving facility provide additional treatment to reduce pathogens in sewage sludge from your facility? Yes No
Which class of pathogen reduction is achieved for the sewage sludge at the receiving facility?
Class A Class B Neither or unknown
Describe, on this form or another sheet of paper, any treatment processes used at the receiving facility to reduce pathogens in sewage sludge:
f. Does the receiving facility provide additional treatment to reduce vector attraction characteristics of the sewage sludge?
Yes No
Which vector attraction reduction option is met for the sewage sludge at the receiving facility?
Option 1 (Minimum 38 percent reduction in volatile solids)
Option 2 (Anaerobic process, with bench-scale demonstration)
Option 3 (Aerobic process, with bench-scale demonstration)
Option 4 (Specific oxygen uptake rate for aerobically digested sludge)
Option 5 (Aerobic processes plus raised temperature)
Option 6 (Raise pH to 12 and retain at 11.5)
Option 7 (75 percent solids with no unstabilized solids)
Option 8 (90 percent solids with unstabilized solids)
None
Describe, on this form or another sheet of paper, any treatment processes used at the receiving facility to reduce vector attraction properties of
sewage sludge.
g. Does the receiving facility provide any additional treatment or blending activities not identified in (c) or (d) above? Yes No
If yes, describe, on this form or another sheet of paper, the treatment or blending activities not identified in (c) or (d) above:
h. If you answered yes to (e), (f), or (g), attach a copy of any information you provide the receiving facility to comply with the "notice and necessary
information" requirement of 40 CFR 503.12(g).
i. Does the receiving facility place sewage sludge from your facility in a bag or other container for sale or give-away for application to the land?
Yes No
If yes, provide a copy of all labels or notices that accompany the product being sold or given away.
Complete Section B.7 if sewage sludge from your facility is applied to the land, unless the sewage sludge is covered in:
* Section B,4 (it meets Table 1 ceiling concentrations, Table 3 pollutant concentrations, Class A pathogen requirements, and one of
vector attraction reduction options 1-8); or
• Section B.5 (you place it in a bag or other container for sale or give-away for application to the land); or
• Section B.6 (you send it to another facility for treatment or blending).
B.7. Land Application of Bulk Sewage Sludge.
a. Total dry metric tons per 365-day period of sewage sludge applied to all land application sites: dry metric tons
EPA Form 3510-2S (Rev. 1 -99) Page 12 of 23
-------
FACILITY NAME AND PERMIT NUMBER:
Form Approved 1/14/99
OMB Number 2040-0086
B.7. Land Application of Bulk Sewage Sludge, (con't)
b. Do you identify all land application sites in Section C of this application? Yes No
If no, submit a copy of the land application plan with application (see instructions).
c. Are any land application sites located in States other than the State where you generate sewage sludge or derive a material from sewage sludge?
Yes No
If yes, describe, on this form or another sheet of paper, how you notify the permitting authority for the States where the land application sites
are located. Provide a copy of the notification.
Complete Section B,S if sewage sludge from your facility is placed on a surface disposal site.
B.8. Surface Disposal.
a. Total dry metric tons of sewage sludge from your facility placed on all surface disposal sites per 365-day period: dry metric tons
b. Do you own or operate all surface disposal sites to which you send sewage sludge for disposal?
Yes No
If no, answer B.S.c through B.S.f for each surface disposal site that you do not own or operate. If you send sewage sludge to more than one
such surface disposal site, attach additional pages as necessary.
c. Site name or number
d. Contact person
Title
Telephone number
Contact is Site owner Site operator
e. Mailing address
f. Total dry metric tons of sewage sludge from your facility placed on this surface disposal site per 365-day period: dry metric tons
Complete Section B.9 if sewage sludge from your facility is fired in a sewage sludge Incinerator.
B.9. Incineration.
a. Total dry metric tons of sewage sludge from your facility fired in all sewage sludge incinerators per 365-day period: dry metric tons
b. Do you own or operate all sewage sludge incinerators in which sewage sludge from your facility is fired? Yes No
If no, complete B.9.C through B.9.f for each sewage sludge incinerator that you do not own or operate. If you send sewage sludge to more than
one such sewage sludge incinerator, attach additional pages as necessary.
c. Incinerator name or number:
d. Contact person:
Title:
Telephone number:
Contact is: Incinerator owner Incinerator operator
EPA Form 3510-2S (Rev. 1 -99) Page 13 of 23
-------
FACILITY NAME AND PERMIT NUMBER:
Form Approved 1/14/99
OMB Number 2040-0086
B.9. Incineration, (con't)
e. Mailing address:
f. Total dry metric tons of sewage sludge from your facility fired in this sewage sludge incinerator per 365-day period: dry metric tons
Complete Section B.10 if sewage sludge from this facility is placed on a municipal solid waste landfill.
B.10. Disposal in a Municipal Solid Waste Landfill. Provide the following information for each municipal solid waste landfill on which sewage
sludge from your facility is placed. If sewage sludge is placed on more than one municipal solid waste landfill, attach additional pages as
necessary.
a. Name of landfill
b. Contact person
Title
Telephone number
Contact is Landfill owner Landfill operator
c. Mailing address
d. Location of municipal solid waste landfill:
Street or Route #
County
City or Town State Zip
e. Total dry metric tons of sewage sludge from your facility placed in this municipal solid waste landfill per 365-day period:
dry metric tons
f. List, on this form or an attachment, the numbers of all other Federal, State, and local permits that regulate the operation of this municipal
solid waste landfill.
Permit Number Type of Permit
g. Submit, with this application, information to determine whether the sewage sludge meets applicable requirements for disposal of sewage
sludge in a municipal solid waste landfill (e.g., results of paint filter liquids test and TCLP test)
h. Does the municipal solid waste landfill comply with applicable criteria set forth in 40 CFR Part 258?
Yes No
EPA Form 3510-2S (Rev. 1 -99) Page 14 of 23
-------
FACILITY NAME AND PERMIT NUMBER:
Form Approved 1/14/99
OMB Number 2040-0086
C. LAND APPLICATION OF BULK SEWAGE SLUDGE
Complete Section C for sewage sludge that is applied to the land, unless any of the following conditions apply:
* The sewage sludge meets the Table 1 ceiling concentrations, the Table 3 pollutant concentrations, Class A pathogen requirements,
and one of vector attraction reduction options 1-8 (fill out B.4 Instead); or
• The sewage sludge is sold or given away in a bag or other container for application to the land (fill out B.5 Instead); or
• You provide the sewage sludge to another facility for treatment or blending (fill out B.6 instead).
Complete Section C for every site on which the sewage sludge that you reported in Section B.7 is applied.
C.1. Identification of Land Application Site.
a. Site name or number
b. Site location (Complete 1 and 2).
1. Street or Route #
County
City or Town State Zip
2. Latitude Longitude
Method of latitude/longitude determination
USGS map Field survey Other
c. Topographic map. Provide a topographic map (or other appropriate map if a topographic map is unavailable) that shows the site location.
C.2. Owner Information.
a. Are you the owner of this land application site? Yes No
b. If no, provide the following information about the owner:
Name
Telephone number
Mailing Address
C.3. Applier Information.
a. Are you the person who applies, or who is responsible for application of, sewage sludge to this land application site?
Yes No
b. If no, provide the following information for the person who applies:
Name
Telephone number
Mailing Address
C.4. Site Type: Identify the type of land application site from among the following.
Agricultural land Forest Public contact site
Reclamation site Other. Describe:
EPA Form 3510-2S (Rev. 1 -99) Page 15 of 23
-------
FACILITY NAME AND PERMIT NUMBER:
Form Approved 1/14/99
OMB Number 2040-0086
C.5. Crop or Other Vegetation Grown on Site.
a. What type of crop or other vegetation is grown on this site?
b. What is the nitrogen requirement for this crop or vegetation?
C.6. Vector Attraction Reduction.
Are any vector attraction reduction requirements met when sewage sludge is applied to the land application site?
Yes No
If yes, answer C.6.a and C.6.b;
a. Indicate which vector attraction reduction option is met:
Option 9 (Injection below land surface)
Option 10 (Incorporation into soil within 6 hours)
b. Describe, on this form or another sheet of paper, any treatment processes used at the land application site to reduce vector attraction
properties of sewage sludge:
Complete Question C.7 only if the sewage sludge applied to this site since July 20,1993, is subject to the cumulative pollutant loading rates
(CPLRs) in 40 CFR 503.13(b)(2).
C.7. Cumulative Loadings and Remaining Allotments.
a. Have you contacted the permitting authority in the State where the bulk sewage sludge subject to CPLRs will be applied, to ascertain whether
bulk sewage sludge subject to CPLRs has been applied to this site on or since July 20, 1993? Yes No
If no, sewage sludge subject to CPLRs may not be applied to this site.
If yes, provide the following information:
Permitting authority
Contact Person
Telephone number
b. Based upon this inquiry, has bulk sewage sludge subject to CPLRs been applied to this site since July 20, 1993?
Yes No
If no, skip C.7.C.
EPA Form 3510-2S (Rev. 1 -99) Page 16 of 23
-------
FACILITY NAME AND PERMIT NUMBER:
Form Approved 1/14/99
OMB Number 2040-0086
c. Provide the following information for every facility other than yours that is sending, or has sent, bulk sewage sludge to CPLRs to this site since
July 20, 1993. If more than one such facility sends sewage sludge to this site, attach additional pages as necessary.
Facility name
Mailing Address
Contact person
Title
Telephone number
EPA Form 3510-2S (Rev. 1-99)
Page 17 of 23
-------
FACILITY NAME AND PERMIT NUMBER:
Form Approved 1/14/99
OMB Number 2040-0086
D. SURFACE DISPOSAL
Complete this section if you own or operate a surface disposal site.
Complete Sections D.1 - D.5 for each active sewage sludge unit.
D.1. Information on Active Sewage Sludge Units.
a. Unit name or number:
b. Unit location (Complete 1 and 2).
1. Street or Route #
County
City or Town State Zip
2. Latitude Longitude
Method of latitude/longitude determination: USGS map Field survey Other
c. Topographic map. Provide a topographic map (or other appropriate map if a topographic map is unavailable) that shows the site location.
d. Total dry metric tons of sewage sludge placed on the active sewage sludge unit per 365-day period: dry metric tons
e. Total dry metric tons of sewage sludge placed on the active sewage sludge unit over the life of the unit: dry metric tons
f. Does the active sewage sludge unit have a liner with a maximum hydraulic conductivity of 1 x 10"' cm/sec? Yes No
If yes, describe the liner (or attach a description):
g. Does the active sewage sludge unit have a leachate collection system? Yes No
If yes, describe the leachate collection system (or attach a description). Also describe the method used for leachate disposal and provide the
numbers of any Federal, State, or local permit(s) for leachate disposal:
h. If you answered no to either D.1.f. or D.1.g., answer the following question:
Is the boundary of the active sewage sludge unit less than 150 meters from the property line of the surface disposal site?
Yes No
If yes, provide the actual distance in meters:
Provide the following information:
Remaining capacity of active sewage sludge unit, in dry metric tons: dry metric tons
Anticipated closure date for active sewage sludge unit, if known: (MM/DD/YYYY)
Provide, with this application, a copy of any closure plan that has been developed for this active sewage sludge unit.
EPA Form 3510-2S (Rev. 1 -99) Page 18 of 23
-------
FACILITY NAME AND PERMIT NUMBER:
Form Approved 1/14/99
OMB Number 2040-0086
D.2. Sewage Sludge from Other Facilities. Is sewage sent to this active sewage sludge unit from any facilities other than your facility?
Yes No
If yes, provide the following information for each such facility. If sewage sludge is sent to this active sewage sludge unit from more than one such
facility, attach additional pages as necessary.
a. Facility name
b. Mailing Address
c. Contact person
Title
Telephone number
d. Which class of pathogen reduction is achieved before sewage sludge leaves the other facility?
Class A Class B None or unknown
e. Describe, on this form or another sheet of paper, any treatment processes used at the other facility to reduce pathogens in sewage sludge:
f. Which vector attraction reduction option is met for the sewage sludge at the receiving facility?
Option 1 (Minimum 38 percent reduction in volatile solids)
Option 2 (Anaerobic process, with bench-scale demonstration)
Option 3 (Aerobic process, with bench-scale demonstration)
Option 4 (Specific oxygen uptake rate for aerobically digested sludge)
Option 5 (Aerobic processes plus raised temperature)
Option 6 (Raise pH to 12 and retain at 11.5)
Option 7 (75 percent solids with no unstabilized solids)
Option 8 (90 percent solids with unstabilized solids)
None or unknown
g. Describe, on this form or another sheet of paper, any treatment processes used at the receiving facility to reduce vector attraction properties of
sewage sludge
h. Describe, on this form or another sheet of paper, any other sewage sludge treatment activities performed by the other facility that are not
identified in (d) - (g) above:
D.3. Vector Attraction Reduction
a. Which vector attraction option, if any, is met when sewage sludge is placed on this active sewage sludge unit?
Option 9 (Injection below and surface)
Option 10 (Incorporation into soil within 6 hours)
Option 11 (Covering active sewage sludge unit daily)
EPA Form 3510-2S (Rev. 1 -99) Page 19 of 23
-------
FACILITY NAME AND PERMIT NUMBER:
Form Approved 1/14/99
OMB Number 2040-0086
D.3. Vector Attraction Reduction, (con't)
b. Describe, on this form or another sheet of paper, any treatment processes used at the active sewage sludge unit to reduce vector attraction
properties of sewage sludge:
D.4. Ground-Water Monitoring.
a. Is ground-water monitoring currently conducted at this active sewage sludge unit, or are ground-water monitoring data otherwise available for this
active sewage sludge unit?
Yes No
If yes, provide a copy of available ground-water monitoring data. Also, provide a written description of the well locations, the approximate depth to
ground-water, and the ground-water monitoring procedures used to obtain these data.
b. Has a ground-water monitoring program been prepared for this active sewage sludge unit? Yes No
If yes, submit a copy of the ground-water monitoring program with this permit application.
c. Have you obtained a certification from a qualified ground-water scientist that the aquifer below the active sewage sludge unit has not been
contaminated? Yes No
If yes, submit a copy of the certification with this permit application.
D.5. Site-Specific Limits. Are you seeking site-specific pollutant limits for the sewage sludge placed on the active sewage sludge unit?
Yes No
If yes, submit information to support the request for site-specific pollutant limits with this application.
EPA Form 3510-2S (Rev. 1-99) Page 20 of 23
-------
FACILITY NAME AND PERMIT NUMBER: Form Approved 1/14/99
OMB Number 2040-0086
E. INCINERATION
Complete this section if you fire sewage sludge in a sewage sludge incinerator.
Complete this section once for each incinerator in which you fire sewage sludge. If you fire sewage sludge in more than one sewage sludge
incinerator, attach additional copies of this section s necessary.
E.1. Incinerator Information.
a. Incinerator name or number:
b. Incinerator location (Complete 1 and 2).
1. Street or Route #
County
City or Town
2. Latitude Longitude
Method of latitude/longitude determination: USGS map
State.
Zip.
. Field survey
. Other
E.2. Amount Fired. Dry metric tons per 365-day period of sewage sludge fired in the sewage sludge incinerator:
. dry metric tons
E.3. Beryllium NESHAP.
a. Is the sewage sludge fired in this incinerator "beryllium-containing waste," as defined in 40 CFR Part 61.31? Yes No
Submit, with this application, information, test data, and description of measures taken that demonstrate whether the sewage sludge incinerated
is beryllium-containing waste, and will continue to remain as such.
b. If the answer to (a) is yes, submit with this application a complete report of the latest beryllium emission rate testing and documentation of
ongoing incinerator operating parameters indicating that the NESHAP emission rate limit for beryllium has been and will continue to be met.
E.4. Mercury NESHAP.
a. How is compliance with the mercury NESHAP being demonstrated?
Stack testing (if checked, complete E.4.b)
Sewage sludge sampling (if checked, complete E.4.c)
b. If stack testing is conducted, submit the following information with this application:
A complete report of stack testing and documentation of ongoing incinerator operating parameters indicating that the incinerator has met, and will
continue to meet, the mercury NESHAP emission rate limit.
Copies of mercury emission rate tests for the two most recent years in which testing was conducted.
c. If sewage sludge sampling is used to demonstrate compliance, submit a complete report of sewage sludge sampling and documentation of
ongoing incinerator operating parameters indicating that the incinerator has met, and will continue to meet the mercury NESHAP emission rate
limit.
E.5. Dispersion Factor.
a. Dispersion factor, in micrograms/cubic meter per gram/second:
b. Name and type of dispersion model:
c. Submit a copy of the modeling results and supporting documentation with this application.
EPA Form 3510-2S (Rev. 1-99)
Page 21 of 23
-------
FACILITY NAME AND PERMIT NUMBER:
Form Approved 1/14/99
OMB Number 2040-0086
E.6. Control Efficiency.
a. Control efficiency, in hundredths, for the following pollutants:
Arsenic: Chromium: Nickel:
Cadmium: Lead:
b. Submit a copy of the results or performance testing and supporting documentation (including testing dates) with this application.
E.7. Risk Specific Concentration for Chromium.
a. Risk specific concentration (RSC) used for chromium, in micrograms per cubic meter:
b. Which basis was used to determine the RSC?
Table 2 in 40 CFR 503.43
Equation 6 in 40 CFR 503,43 (site-specific determination)
c. If Table 2 was used, identify the type of incinerator used as the basis:
Fluidized bed with wet scrubber
Fluidized bed with wet scrubber and wet electrostatic precipitator
Other types with wet scrubber
Other types with wet scrubber and wet electrostatic precipitator
d. If Equation 6 was used, provide the following:
Decimal fraction of hexavalent chromium concentration to total chromium concentration in stack exit gas:
Submit results of incinerator stack tests for hexavalent and total chromium concentrations, including date(s) of test, with this application.
E.8. Incinerator Parameters
a. Do you monitor Total Hydrocarbons (THC) in the sewage sludge incinerator's exit gas? Yes No
Do you monitor Carbon Monoxide (CO) in the sewage sludge incinerator's exit gas? Yes No
b. Incinerator type:
c. Incinerator stack height, in meters:
Indicate whether value submitted is: Actual stack height Creditable stack height
E.9. Performance Test Operating Parameters
a. Maximum Performance Test Combustion Temperature:
b. Performance test sewage sludge feed rate, in dry metric tons/day:
indicate whether value submitted is:
Average use Maximum design
Submit, with this application, supporting documents describing how the feed rate was calculated.
c. Submit, with this application, information documenting the performance test operating parameters for the air pollution control device(s) used for
this sewage sludge incinerator.
EPA Form 3510-2S (Rev. 1-99) Page 22 of 23
-------
FACILITY NAME AND PERMIT NUMBER:
E.10. Monitoring Equipment. List the equipment in
a. Total hydrocarbons or carbon monoxide:
b. Percent oxygen:
c. Moisture content:
d. Combustion temperature:
e. Other:
E.11. Air Pollution Control Equipment. Submit, wi
incinerator.
Form Approved 1/14/99
OMB Number 2040-0086
place to monitor the following parameters:
:h this application, a list of all air pollution control equipment used with this sewage sludge
EPA Form 3510-2S (Rev. 1-99) Page 23 of 23
-------
Additional Information, if provided, will appear on the following pages
NPDES FORM 2S Additional Information
------- |