Form 2M1 Major Discharge Application for Permit to Discharge Municipal Domestic Wastewater

              Form 2M1 Instructions - Page 1
Return to:
Oklahoma Department of 707 N. Robinson Revised June 2008
Environmental Quality P.O. Box 1677 previous editions
Water Quality Division Oklahoma City, OK 73101-1677 are obsolete
Municipal Permitting Section
Oklahoma DEQ Application for Permit to Discharge Municipal/Domestic
Wastewater
Form 2M1 – Major Discharge
PLEASE DETACH THESE INSTRUCTIONS AND RETURN ONLY THE
COMPLETED APPLICATION FORM ITSELF.
This form must be completed by all major facilities applying for a permit to discharge under
DEQ’s Municipal OPDES Permit Program.
See instructions for the submittal of applications and the public notice requirements.
Form 2M1 Instructions - Page 2
OKLAHOMA DEPARTMENT OF ENVIRONMENTAL QUALITY
INSTRUCTIONS - DEQ FORM 2M1 (major)
APPLICATION FOR PERMIT TO DISCHARGE
MUNICIPAL/DOMESTIC WASTEWATER
Form 2M1 must be completed by the owner/responsible official of a major
municipal/domestic wastewater facility that wishes to discharge pollutants to waters of
the State of Oklahoma. A major municipal/domestic wastewater facility is defined as a
facility that discharges one million gallons per day (mgd) or greater. Please read the
instructions below while completing Form 2M1 and respond to each item. The Oklahoma
Department of Environmental Quality (DEQ) cannot evaluate an application until it is
complete. If a particular item does not apply to the facility for which the application is
being prepared, or if the correct answer is "NA" (for not applicable) indicate this on the
application. If you have questions about any of the items, please contact DEQ or your
local DEQ office for assistance. DO NOT attempt to complete the application form before
reading these instructions.
NOTE: DO NOT write in box marked " FOR DEQ USE ONLY".
SECTION I
1. Give the legal name of the town, city, public entity or name of the person (if
privately owned) legally responsible for operating and maintaining the facility.
2. Give the street address, P.O. Box, city, county, state, zip code, telephone number
fax number, and e-mail address if applicable of the main office for the applicant in
Item 1. This may or may not be the same location of the facility.
3. Give the name of the facility, the street address, telephone number fax number,
and e-mail address if applicable and if it is different from the address in Items 1
and 2.
4. Give the physical location of the facility – longitude/latitude and legal description
to a 10 acre tract, 1/4,1/4,1/4, Section, Township and Range. Note: This is the
location of the treatment plant and it is not necessarily the same as the point of
discharge.
5. Indicate whether this is a Public, Private, Federal or State owned facility.
6. Give the name, title, address, and telephone number, cell phone number, fax
number, and e-mail address of a person who is familiar with the facility and
information in the application and who may be contacted concerning the
application.
Form 2M1 Instructions - Page 3
7. Indicate whether the discharge is wastewater from a lagoon system, mechanical
plant or, if other, explain.
8. Below is a list of definitions of the types of treatment listed in Item #8. Check more
than one item if needed.
Lagoon systems:
A. Total Retention by Evaporation - Wastewater goes to a lagoon or series of
lagoons which have no outlet or any other way to discharge. Lagoons
cannot be classified total retention if they have any kind of operable outlet
structure, even if it is not used. See DEQ Form 530E for Total Retention
Facilities.
B. Land Application - Wastewater is given preliminary treatment then applied to
land (example: irrigation) in such a manner to insure that no runoff enters
surface waters.
C. Discharge to Receiving Water - Wastewater goes to a lagoon or series of
lagoons and then to a receiving water through a designed outlet structure.
Check this box even if the outlet structure is not being used.
Mechanical Treatment Plants - Please name and describe the mechanical treatment
process used at your facility. (Examples: trickling filter, activated sludge,
extended air, sequential batch reactor, oxidation ditch)
Other - Please name and explain any process used at your facility other than those
listed above.
9. If the facility uses chlorine or any other halogen, indicate whether the facility
dechlorinates or dehalogenates before discharging to a receiving water.
If chlorine or any other halogen is used as a disinfecting agent to meet bacteria
limits, or for other purposes, a residual limit of no-measurable value will be
included in the permit. Dechlorination or dehalogenation will be necessary to meet
the limit. Please indicate whether dechlorination or dehalogenation is provided at
your facility.
10. Design flow is established when the construction permit is approved. Design
Flow: the quantity of wastewater in million gallons per day (mgd) the facility was
designed to treat in one day. List up to 3 decimal places. Example: 3.120 = 3
million one hundred twenty thousand gallons per day.
11. Enter the number for each discharge point and the average quantity of treated
wastewater discharged each day from each pipe.
12. Name the body of surface water that receives treated wastewater. If the receiving
stream does not have a name, please indicate what named creek or river
downstream receives the tributary flow, and fill out as "tributary of ________ Creek
Form 2M1 Instructions - Page 4
or River."
Check the item which indicates the frequency of wastewater discharges.
continuous: discharging without interruption
batch: discharging several times during the day (i.e. from a sequential
batch reactor facility
intermittent: sporadic discharges during the year
seasonal: discharging only during certain periods during the year
Give the location of the point of discharge to the receiving water. This may be
different than the location of the facility. In giving the legal description, provide
both the latitude-longitude and 1/4, 1/4, 1/4, Section, Township and Range. Attach
addition sheets if necessary to describe additional outfalls.
13. Indicate whether the higher influent flow caused by heavy rains is diverted and
discharged resulting in a bypass of partially or completely treated wastewater or if
it is stored for later treatment (as in a holding basin).
14. Number 14. A through B of the application concerns the treatment and disposal of
biosolids/sludge.
A. Common biosolids/sludge treatment processes are aeration, lime
stabilization, heat stabilization etc.
B 1. Sludge management plan numbers start with SMP and usually have 7
numbers. In giving the land application sites, provide the legal description
1/4, 1/4, 1/4, Section, Township and Range and County. Attach additional
sheet if facility has more than 3 sites.
B 2. The permittee shall be certain that all landfills used for sewage sludge
disposal comply with the state and federal regulations for landfills and solid
waste disposal.
15. State if any industries in the community discharge industrial wastewater to the
sewer system. If the answer to this question is yes, submit Section II of the
application form for each significant industrial facility. Identify any industrial
facilities that are “Categorical”. Categorical industries are listed at 40 CFR 122
Appendix A - NPDES Primary Industry Categories (See Attachment 1, page 6).
Indicate what type of controls are in place to deal with industrial discharges to the
treatment system.
16. Maps and Drawings - A schematic of wastewater flow through the facility
and a location map of the facility are required. All sheets should be letter
size with margins for filing and binding and on paper suitable for
reproduction. Discharge points should be identified with discharge serial
numbers. All sheets must include the applicant's name, facility location and
date of drawing.
Form 2M1 Instructions - Page 5
17. Any information, laboratory analysis, concerning the pollutants in Table 1 should
be entered in the table or results attached to the application.
18. Attachments 2 and 3 (Pages 6 through 10) are enclosed for your
convenience. Attachment 2 is 40 CFR 122 Appendix D listing all the priority
pollutants (Tables I, II, III, IV and V). Attachment 3 lists the approved test
methods for analyses of wastewater and associated minimum quantification
levels as required.
19. Table V, of 40 CFR 122, Appendix D is reproduced in attachment 2 (Page 7) of
these instructions
20. The results for any and all analysis of pollutants for the previous three years
should be put in a table and attached to the application.
21. If the answer to this question is yes a landowner notification form (found at
http://www.deq.state.ok.us/ ) must be sent to the landowner and the applicant’s
certifying official must initial the box certifying that this has been done.
22. All other information regarding the facility having to do with the
environmental/operational permits including maps, process diagrams, or chemical
analysis should be included with the permit application.
SECTION II
1. Give the name, title, address, and telephone number, cell phone number, fax
number, and e-mail address of a person who is familiar with the industrial facility
and information in the application and who may be contacted concerning the
application.
2. All products and by-products for this facility should be listed.
3. Identify any industrial facilities that are “Categorical”. Categorical industries are
listed at 40 CFR 122 Appendix A - NPDES Primary Industry Categories (See
Attachment 1, page 6). The SIC codes can be found in or should be obtained from
the contact described above.
4. Please specify the product produced or raw materials used to produce the final
product, how many are produced, and the unit of measurement in which the final
product or raw materials are measured.
5. Indicate the volume of wastewater discharged into the municipal system in gallons
per day and check the item which indicates the frequency of wastewater
discharges.
continuous: discharging without interruption
Form 2M1 Instructions - Page 6
intermittent: sporadic discharges during the year
6. Indicate if the industrial facility pretreats its wastewater prior to entering the
municipal collection system.
7. List the pollutants and maximum concentrations of the pollutants in the industrial
facilities wastewater.
The information provided in the application will be considered in the evaluation and
processing of a discharge permit for the referenced facility. Be advised that test
procedures used in the analyses of influents, effluents and sludge, must conform to
approved EPA methodology or it will not be accepted for the discharge permit evaluation.
Please note that the application must be signed by the authorized chief elective or
executive officer of the applicant, or by the applicant if an individual. The authorized
signature must be notarized. An example of a common mistake is when a Public Works
Authority Chairman signs the application as - John Doe, Mayor. The Mayor is not the
legal official of the PWA, the chairman is, even if the individual holds both positions.
Please read the certification carefully. There are significant penalties for submitting false
information on this application form.
Form 2M1 may be separated from the instruction before mailing.
NOTICE FOR ALL APPLICANTS
Upon filing an application for a new permit, renewal of an existing permit, or major modification of an existing
permit with the Department, the applicant shall publish a notice of the filing in a local newspaper which
contains:
(1) Date of filing;
(2) Name and address of the applicant;
(3) Type of wastewater discharge and permit sought;
(4) Location, including legal description and street address of
facility and discharging point or points;
(5) Name of receiving water;
(6) Name, address and telephone number of contact person for
applicant; and
(7) Locations where application may be reviewed.
Form 2M1 Instructions - Page 7
Attachment 1
40 CFR Ch. 1 Pt. 122
APPENDIX A-NPDES Primary
INDUSTRY CATEGORIES
Any permit issued after June 30, 1981 to dischargers in
the following categories shall include effluent limitations
and a compliance schedule to meet the requirements of
section 301(b)(2)(A),(C),(D),(E), and (F) of CWA,
whether or not applicable effluent limitations guidelines
have been promulgated See §§ 122.44 and 122.46.
Industry Category
Adhesives and sealants
Aluminum forming
Auto and other laundries
Battery manufacturing
Coal mining
Coil coating
Copper forming
Electrical and electronic components
Electroplating
Explosives manufacturing
Foundries
Gum and wood chemicals
Inorganic chemicals manufacturing
Iron and steel manufacturing
Leather tanning and finishing
Mechanical products manufacturing
Ore mining
Organic chemicals manufacturing
Paint and ink formulation
Pesticides
Petroleum refining
Pharmaceutical preparations
Photographic equipment and supplies
Plastics processing
Plastic and synthetic materials manufacturing
Porcelain enameling
Printing and Publishing
Pulp and paper mills
Rubber processing
Soap and detergent manufacturing
Steam electric power plants
Textile mills
Timber products processing
40CFR 261.20
Subpart C-Characteristics of Hazardous Waste
§ 261.20 General
(a) A solid waste, as defined in § 261.2, which is not
excluded from regulation as a hazardous waste under §
261.4(b), is a hazardous waste if it exhibits any of the
characteristics identified in this subpart.
{Comment: § 262.11 of this chapter sets forth the
generator’s responsibility to determine whether his waste
exhibits one or more of the characteristics identified in
this subpart}
(b) A hazardous waste which is identified by a
characteristic in this subpart is assigned every EPA
Hazardous Waste Number that is applicable as set forth
in this subpart. This number must be in compliance with
the notification requirements of section 3010 of the Act
and all applicable recordkeeping and reporting
requirements under parts 262 through 265, 268, and 270
of this chapter.
(c) For purposes of this subpart, the Administrator will
consider a sample obtained using any of the applicable
sampling methods specified in Appendix I to be a
representative sample within the meaning of Part 260 of
this chapter.
{Comment: Since the Appendix I sampling methods are
not being formally adopted by the Administrator, a
person who desires to employ an alternative sampling
method is not required to demonstrate the equivalency of
his method under the procedures set forth in §§ 260.20
and 260.21.}
{45FR 33119.May 1980. As amended at 51 FR 40636.
Nov. 7, 1986: 55 FR 22684. June 1, 1990}
Form 2M1 Instructions - Page 8
Attachment 2
Appendix D to Part 122 – NPDES Permit Application Testing Requirements
(§ 122.21)
15B butylbenzyl phthalate Bryllium, Total Carbofuran
Table II - Organic Toxic Pollutants 16B 2 chloronaphthalene Cadmium, Total Carbon disulfide
In Each Of Four Fractions In 17B 4 chlorophenyl phenyl ether Chromium, Total Chloropyrifos
Analysis By Gas Chromatogra- 18B chrysene Copper, Total Coumaphos
phy/Mass Spectroscopy (GS/MS) 19B dibenzo(a,h)anthracene Lead, Total Cresol
Volatiles 20B 1,2 dichlorobenzene Mercury, Total Crotonaldehyde
IV acrolein 21B 1,3 dichlorobenzene Nickel, Total Cyclohexane
2V acrylonitrile 22B 1,4 dichlorobenzene Selenium, Total 2,4-D (2,4-Dichlorophenoxy acetic acid)
3V benzene 23B 3,3 dichlorobenzidine Silver, Total Diazinon
5V bromoform 24B diethyl phthalate Thallium, Total Dicamba
6V carbon tetrachloride 25B dimethyl phthalate Zinc, Total Dichlobenil
7V chlorobenzene 26B di-n-butyl phthalate Cyanide, Total Dichlone
8V chlorodibromomethane 27B 2,4 dinitrotoluene Phenols, Total 2,2-Dichloropropionic acid
9V chloroethane 28B 2,6 dinitrotoluene Dichlorvos
10V 2-chloroethylviny ether 29B di-n-octyl phthalate Table IV-Conventional and Noncon- Diethyl amine
11V chloroform 30B 1,2-diphenylhydrazine(as azobenzene) ventional Pollutants Required Dimethyl amine
12V dichlorobromomethane 31B fluroranthene to be tested by existing Dis- Dintrobenzene
14V 1,1 dichloroethane 32B fluorene chargers if expected to be present Diquat
15V 1,2 dichloroethane 33B hexachlorobenzene Disulfoton
16V 1,1 dichloroethylene 34B hexachlorobutadiene Bromide Diuron
17V 1,2 dichloropropane 35B hexachlorocyclopentadiene Chlorine, Total Residual Epichlorohydrin
18V 1,3 dichloropropylene 36B hexachloroethane Color Ethion
19V ethylbenzene 37B indeno(1,2,3-cd)pyrene Fecal Colliform Ethylene diamine
20V methyl bromide 38B isophorone Fluoride Ethylene dibromide
21V methyl chloride 39B napthalene Nitrate-Nitrite Formaldehyde
22V methylene chloride 40B nitrobenzene Nitrogen, Total Organic Furfural
23V 1,1,2,2 tetrachloroethane 41B N-nitrosodinethylamine Oil and Grease Guthion
24V tetrachloroethylene 42B N-nitrosodi-n-propylamine Phosphorus, Total Isoprene
25V toluene 43B N-nitrosodiphenylamine Radioactivity Isopropanolamine Dodecylbenzenesulfonate
26V 1,2-trans-dichloroethylene 44B phenanthrene Sulfate Kelthane
27V 1,1,1 trichloroethane 45B pyrene Sulfide Kepone
28V 1,1,2 trichloroethane 46B 1,2,4 trichlorobenzene Sulfitee Malathion
29V trichloroethylene Pesticides Surfactants Mercaptodimethur
31V vinyl chloride 1P aldrine Aluminum, Total Methoxychior
Acid Compounds 2P alpha-BHC Barlum, Total Methyl mercaptan
1A 2 chlorophenol 3P beta-BHC Boron, Total Methyl methacrylate
2A 2,4 dichlorophenol 4P gamma-BHC Cobalt, Total Methyl parathion
3A 2,4 dimethylphenol 5P delta/BHC Iron, Total Mevinphos
4A 4,6 dinitro-o-cresol 6P chlordane Magnesium, Total Mexacarbate
5A 2,4 dinitrophenol 7P 4,4 DDT Molybdenum, Total Monoethyl amine
6A 2 nitrophenol 8P 4,4 DDE Manganese, Total Monomethyl amine
7A 4 nitrophenol 9P 4,4 DDD Tin, Total Naled
8A p-chloro-m-cresol 10P dieldrin Titanium, Total Mapthenic acid
9A pntachlorophenol 11P alpha-endosulfan Nitrotoluene
10A phenol 12P beta-endosulfan Table V-Toxic Pollutants and Haz- Parathion
11A 2,4,6 trichlorophenol 13P endosulfan sulfate ardous Subtances Required To Phenolsulfanate
Base/Neutral 14P endrin Be Identified By Existing Dis- Phosgene
1B acenaphthene 15P endrin aldehide chargers if expected to be present Propargite
2B acenaphthylene 16P heptachlor Propylene oxide
3B anthracene 17P heptachlor epoxide Toxic Pollutants Pyrethrins
4B benzidine 18P PCB-1242 Quinoline
5B benzo(a)anthracene 19P PCB-1254 Asbestos Resorcinol
6B benzo(a)pyrene 20P PCB-1221 Hazardous Subtances Strontium
7B 3,4 benzofluoranthene 21P PCB-1232 Acetaldehyde Strychnine
8B benzo(ghi)perylene 22P PCB-1248 Allyl alcohol Styrene
9B benzo(k)fluoranthene 23P PCB-1260 Allyl chloride 2,4,5-T (2,4,5-Trichlorophenoxy acetic acid)
10B bis(2-chloroethoxy)methane 24P PCB-1016 Amyl acetate TDE (Tetrachlorodiphenylethane)
11B bis(2-chloroethyl)ether 25P toxaphene Anlline 2,4,5-TP {2(2,4,5-Trichlorophenoxy) propa-
12B bis(2-chloroisopropyl)ether Benzonitrile noci acid}
13B bis(2-ethylhexyl)phthalate Table III-Other Toxic Pollutants Benzyl chloride Trichlorofan
14B 4 bromophenyl phenyl ether (Metals and Cyanide) and Total Butyl chloride Triethanolamine dodecylbenzenesulfonate
Phenols Butyl acetate Triethylamine
Butylamine Trimethylamine
Antimony, Total Captan Uranium
Arsenic, Total Carbaryl Vanadium
Vinyl Acetate
Xylene
Xylenol
Zirconium
Form 2M1 Instructions - Page 9
ATTACHMENT 3
MINIMUM QUANTIFICATION LEVELS (MQLs)
REQUIRED MQL
METALS AND CYANIDE (ug/L) EPA METHOD
Antimony (Total)1 60 200.7
Arsenic (Total)1 10 206.5
200.7 revision 4.4 (1994)
200.8 revision 5.4 (1994)
200.9 revision 2.2 (1994)
Beryllium (Total)1 5 200.7
Cadmium (Total) 1 200.7 revision 4.4 (1994)
200.8 revision 5.4 (1994)
200.9 revision 2.2 (1994)
Chromium (Total)1 10 200.7
Chromium (3+)1 10 200.7
Chromium (6+)1 10 200.7
Copper (Total) 10 200.7 revision 4.4 (1994)
200.8 revision 5.4 (1994)
200.9 revision 2.2 (1994)
Lead (Total) 5 200.7 revision 4.4 (1994)
200.8 revision 5.4 (1994)
200.9 revision 2.2 (1994)
Mercury (Total)1 0.2 245.1 revision 3.0 (1994)
Molybdenum (Total) 30 200.7
Nickel (Total)1 (Freshwater) 40 200.7
Nickel (Total) (Marine) 5 200.8 revision 5.4 (1994)
200.9 revision 2.2 (1994)
Selenium (Total)1 5 200.7 revision 4.4 (1994)
200.8 revision 5.4 (1994)
200.9 revision 2.2 (1994)
Silver (Total) 2 200.7 revision 4.4 (1994)
200.8 revision 5.4 (1994)
200.9 revision 2.2 (1994)
Thallium (Total)1 10 279.2 revision
Zinc (Total)1 20 200.7
Cyanide (Total)1 10 335.4
DIOXIN
2,3,7,8-Tetrachloro-dibenzo- p-dioxin (TCDD)2 0.00001 1613
VOLATILE COMPOUNDS
Acrolein3 50 624
Acrylonitrile3 50 624
Benzene3 10 624
Bromoform4 10 624
Carbon Tetrachloride4 10 624
Chlorobenzene4 50 624
Chlorodibromomethane4 10 624
Chloroethane 50 624
2-Chloroethylvinyl Ether3 10 624
Chloroform4 10 624
Dichlorobromomethane4 10 624
1,1-Dichloroethane4 10 624
1,2-Dichloroethane4 10 624
1,1-Dichloroethylene4 10 624
1,2-Dichloropropane4 10 624
1,3-Dichloropropylene4 10 624
Form 2M1 Instructions - Page 10
Ethylbenzene4 10 624
Methyl Bromide (Bromomethane) 50 624
Methyl Chloride (Chloromethane) 50 624
Methylene Chloride4 20 624
1,1,2,2-Tetrachloroethane4 10 624
Tetrachloroethylene4 10 624
Toluene4 10 624
1,2-Trans-Dichloroethylene4 10 624
1,1,1-Trichloroethane4 10 624
1,1,2-Trichloroethane4 10 624
Trichloroethylene4 10 624
Vinyl Chloride4 10 624
ACID COMPOUNDS
2-Chlorophenol4 10 625
2,4-Dichlorophenol4 10 625
2,4-Dimethylphenol1 10 625
4,6-Dinitro-o-Cresol1
(12 methyl 4,6-dinitrophenol)4 50 625
2,4-Dinitrophenol4 50 625
2-Nitrophenol4 20 625
4-Nitrophenol4 50 625
p-Chloro-m-Cresol
(4 chloro-3-methylphenol)1 10 625
Pentachlorophenol4 50 625
Phenol4 10 625
2,4,6-Trichlorophenol4 10 625
BASE/NEUTRAL COMPOUNDS
Acenaphthene4 10 625
Acenaphthylene4 10 625
Anthracene4 10 625
Benzidine3 50 625
Benzo (a) Anthracene4 10 625
Benzo (a) Pyrene4 10 625
3,4-Benzofluranthene4 10 625
Benzo (ghi) Perylene 20 625
Benzo (k) Fluranthene4 10 625
Bis (2-Chloroethoxy) Methane4 10 625
Bis (2-Chloroethyl) Ether4 10 625
Bis (2-Chloroisopropyl) Ether4 10 625
Bis (2-Ethylhexyl) Phthalate4 10 625
4-Bromophenyl Phenyl Ether4 10 625
Butylbenzyl Phthalate4 10 625
2-Chloronapthalene4 10 625
4-Chlorophenyl Phenyl Ether4 10 625
Chrysene4 10 625
Dibenzo (a,h) Anthracene4 20 625
1,2-Dichlorobenzene4 10 625
1,3-Dichlorobenzene4 10 625
1,4-Dichlorobenzene4 10 625
3,3’-Dichlorobenzidine 50 625
Diethyl Phthalate4 10 625
Dimethyl Phthalate4 10 625
Di-n-Butyl Phthalate4 10 625
2,4-Dinitrotoluene4 10 625
2,6-Dinitrotoluene4 10 625
Di-n-octyl Phthlate4 10 625
1,2-Diphenylhydrazine3 20 625
Fluoranthene4 10 625
Form 2M1 Instructions - Page 11
Fluorene4 10 625
Hexachlorobenzene4 10 625
Hexachlorobutadiene4 10 625
Hexachlorocyclopentadiene4 10 625
Hexachloroethane 20 625
Indeno (1,2,3-cd) Pyrene 20 625
(2,3-o-phenylene pyrane)
Isophorone4 10 625
Naphthalene4 10 625
Nitrobenzene4 10 625
N-nitrosodimethvlamine 50 625
N-nitrosodi-n-propylamine 20 625
N-nitrosodiphenylamine 20 625
Phenanthrane4 10 625
Pyrene4 10 625
1,2,4-Tricfhlorobenzene4 10 625
PESTICIDES
Aldrin1 0.05 608
Alpha-BHC1 0.05 608
Beta-BHC1 0.05 608
Gamma-BHC (Lindane)1 0.05 608
Delta-BHC1 0.05 608
Chlordane1 0.2 608
4,4’-DDT1 0.1 608
4,4’-DDE (p,p-DDX)1 0.1 608
4,4’-DDD (p,p-TDE)1 0.1 608
Dieldrin1 0.1 608
Alpha-endosulfan1 0.1 608
Beta-endosulfan1 0.1 608
Endosulfan sulfate1 0.1 608
Endrin1 0.1 608
Endrin aldehyde1 0.1 608
Heptachlor1 0.05 608
Heptachlor epoxide1 0.1 608
(BHC-hexachlorocyclohexane)
PCB-12421 1.0 608
PCB-1254 1.0 608
PCB-1221 1.0 608
PCB-1232 1.0 608
PCB-1248 1.0 608
PCB-1260 1.0 608
PCB-1016 1.0 608
Toxaphene1 5.0 608
1 Based on Contract Required Quantitation Level (CRQL) developed
2 Dioxin National Strategy
3 No CRQL established
4 CRQL basis, equivalent to MQL
MQL based on 3.3 times Level of Detection (LOD) in 40 CFR 136, Appendix B
Form 2M1 - Page 1
OKLAHOMA DEPARTMENT OF ENVIRONMENTAL QUALITY
APPLICATION FOR PERMIT TO DISCHARGE MUNICIPAL/DOMESTIC WASTEWATER
UNDER THE OKLAHOMA POLLUTANT DISCHARGE ELIMINATION SYSTEM (OPDES)
FORM 2M1 (major)
FOR
DEQ
USE
ONLY
Application/Permit Number OK00____________________ Facility ID No. _________________
Date Received: ____________________________________
SIC Code: _________________________________________
If a proposed facility, give estimated date of completion: _________________________
DEQ PERMIT ENGINEER: ____________________________
DO NOT attempt to complete this application without reading the instructions!
SECTION I
1. Legal name of applicant:
___________________________________________________________________________________________________
2. Mailing address of applicant:
Street Address or PO Box ______________________________________________________________________________
City _______________________ County __________________ State ___________________ Zip Code ________________
Telephone (____)_______________________________ Fax (_____)____________________________________________
E-mail Address ______________________________________________________________________________________
3. Name and address of facility:
Facility Name________________________________________________________________________________________
Street Address _______________________________________________________________________________________
City ________________________ County _________________ State ___________ Zip Code________________________
Telephone (____)_______________________________ Fax (_____)____________________________________________
E-mail Address ______________________________________________________________________________________
4. Location of discharging facility (e.g., NE ¼ , SW ¼ , SE ¼ , Section 1, Township 2 North, Range 3 West):
Legal Description of Facility Location ______ __, ______ __, _____ __, Section ______, Township _____, Range ________
Latitude: _______________N Longitude: _______________W
5. Type Ownership: Public ( ) Private ( ) Federal ( ) State ( )
6. Contact Person:
Name and Title _______________________________________________________________________________________
Address ____________________________________________________________ City _____________________________
County _________________ State ______________ Zip Code _____________ Telephone (_____) ____________________
Fax (_____) ____________________ Cell Phone (_____) ____________________
E-mail Address _______________________________________________________________________________________
Form 2M1 - Page 2
7. Type of discharge:
______ A. Wastewater from lagoon system
______ B. Wastewater from mechanical plant
______ C. Other (specify) ____________________________________________________________________________
8. Type of treatment:
________ A. Lagoon system with total retention by evaporation (Does not require this form, it requires Form 583-B)
________ B. Lagoon system with effluent used for land application (Does not require this form, it requires Form 852-NIWP)
________ C. Lagoon system with effluent discharge to receiving water
________ D. Lagoon system with effluent discharge and effluent used for land application
________ E. Mechanical Plant: (please describe briefly) _____________________________________________________
___________________________________________________________________________________________________
9. Is chlorine or any other halogen used at this facility?
( ) Yes ( ) No
If yes, is dechlorination or dehalogenation used at this facility? (See instructions)
( ) Yes ( ) No
Is an ultraviolet (UV) system used at this facility?
( ) Yes ( ) No
10. Design flow of facility in million gallons per day (mgd) ____________________________________________________
11. Discharge point number Total volume presently discharged
(List all outfalls) million gallons per day (mgd)
001 ________________
002 (if applicable) ________________
003 (if applicable) ________________
12. Legal description(s) of all discharge point(s):
Outfall 001:
Name of receiving water(s): ___________________________________________________________________________
Discharge is (check one) Continuous ( ) Intermittent ( ) Seasonal ( )
Latitude: _______________N Longitude: _______________W
Legal Description of discharge point ______ __, ______ __, _____ __, Section ______, Township _____, Range ________
Outfall 002 (if applicable):
Name of receiving water(s): ___________________________________________________________________________
Discharge is (check one) Continuous ( ) Intermittent ( ) Seasonal ( )
Latitude: _______________N Longitude: _______________W
Legal Description of discharge point ______ __, ______ __, _____ __, Section ______, Township _____, Range ________
Form 2M1 - Page 3
Outfall 003 (if applicable):
Name of receiving water(s): ___________________________________________________________________________
Discharge is (check one) Continuous ( ) Intermittent ( ) Seasonal ( )
Latitude: _______________N Longitude: _______________W
Legal Description of discharge point ______ __, ______ __, _____ __, Section ______, Township _____, Range ________
13. During periods of heavy rain, is the increased flow:
( ) Bypassed to the receiving stream with no treatment
( ) Given partial treatment and discharged
( ) Given complete treatment and discharged
( ) Stored for later treatment
14. Biosolids/Sludge generated by this facility:
A. Current biosolids/sludge treatment process. (Please explain)
___________________________________________________________________________________________
___________________________________________________________________________________________
B. Amount of biosolids/sludge produced (dry metric tons/year)____________________________________________
1. Land application of biosolids
Sludge management plan, if any:
Sludge management permit number ___________________ approved by the Department of Environmental Quality
or the Oklahoma State Department of Health on ___________________
Location(s) of current land application site(s) (legal description to the nearest 10 acres).
Site 1: ______, ______, _____, Section ______, Township _____, Range _______ County ________
Site 2 (if applicable): ______, ______, _____, Section ______, Township _____, Range _______ County _______
Site 3 (if applicable): ______, ______, _____, Section ______, Township _____, Range _______ County ________
2. Landfilled sludge
Sludge disposition plan, if any:
Sludge disposition permit number (if applicable) ___________________ approved by the Department of Environmental
Quality or the Oklahoma State Department of Health on ___________________
Name of Landfill ___________________________________________________________________________
Landfill permit number ______________________________________________________________________
15. Does this facility receive industrial wastewater? Yes ( ) No ( )
If "Yes", Submit Section II of this form (attached) for each significant industrial facility discharging to the sewer system.
Are industrial discharge(s) to the system(s) controlled by
Form 2M1 - Page 4
( ) Ordinance
( ) Pretreatment Program
Form 2M1 - Page 5
16. Maps and drawings - Attach all required maps and drawings to the back of this application.
(see instructions)
17. Complete attached Table 1 detailing both influent and effluent pollutants.
18. Submit test results of a composite sample of effluent, or when appropriate grab samples, for all pollutants listed in 40
CFR 122, Appendix D, Table II and Table III.
19. Submit quantitative data on pollutants listed in 40 CFR 122, Appendix D, Table V that are known or reasonably expected
to be discharged.
20. Tabulations of all results collected pertaining to the quality and quantity of all toxic pollutants identified as a constituent
in the publicly owned treatment works (POTW) effluent and regulated or prohibited by an Industrial Waste Ordinance
during the period from three years prior to the date of this application to the present.
21. Landowner Notification (THIS SECTION MUST BE COMPLETED PRIOR TO SUBMISSION OF THE APPLICATION – THE APPLICATION WILL
AUTOMATICALLY BE CONSIDERED INCOMPLETE IF IT IS NOT COMPLETED):
Is any part of the land on which the facility is located (including treatment units, discharge conveyances, stormwater
holding basins and/or flow equalization basins) owned by a person or entity other than the applicant?
( ) No
( ) Yes – the applicant or applicant’s certifying official must ensure that such landowner(s) have been notified of
the applicant’s intent to obtain an OPDES permit and initial the box to the right indicating that such notification
has been made.
22. List other information which should be brought to the attention of the Department of Environmental Quality (DEQ) in
regard to the issuance of a discharge permit for the facility.
Form 2M1 - Page 6
Certification:
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 directly responsible for gathering the information, the information
submitted is, to the best of my knowledge and belief, true, accurate and complete. I also certify that I will provide for the operation of
this facility in accordance with the Oklahoma Discharge Permits and Pollution Control Regulations and will provide certified operators
as required by the Oklahoma Water and Wastewater Operators Certification Act. I further certify that I shall acquire or possess a right
to the use of the property or properties on which the discharging facilities, activities or discharge sources are located as well as the
property on which the proposed discharge point(s) are located, including the access route thereto. I understand I shall maintain such
right of use and access for the duration of the permit term. I am aware that there are significant penalties for submitting false
information, including revocation of the permit and the possibility of fine and imprisonment for knowing violations.
Note: Applications must be signed by the authorized chief elective or executive officer of the applicant, or by the applicant, if an individual.
Name (print) ______________________________________________
Title ______________________________________________
Date ______________________________________________
Signature ______________________________________________
Subscribed and sworn to before me this _______________day of____________, 20_____.
_________________________________ My commission expires____________________
Notary Public
The application shall be filed in duplicate with the original and one copy to be submitted to the DEQ, and one copy to be submitted to the
local DEQ office.
Please return completed form with attachments to:
Water Quality Division
Department of Environmental Quality
707 N. Robinson
P.O. Box 1677
Oklahoma City, Oklahoma 73101-1677
Form 2M1 - Page 7
TABLE I
DESCRIPTION OF INFLUENT AND EFFLUENT
Influent Effluent
Parameter and Code
214
Annual
Average
Value
(1)
Annual
Average
Value
(2)
Lowest
Monthly
Average
Value
(3)
Highest
Monthly
Average Value
(4)
Frequency
of Analysis
(5)
No. of
Samples
(6)
Sample
Type
(7)
Flow (millions gallons
per day)
50050
pH
00400
N/A N/A
Temperature - winter
(° F)
74028
Temperature - summer
(° F)
74027
Fecal Streptococci
Bacteria
(number/100 ml)
75054 (Provide if
available)
Fecal Coliform Bacteria
(number/100 ml)
75055 (Provide if
available)
Total Coliform Bacteria
(number/100 ml)
75056 (Provide if
available)
BOD 5-day
(mg/l)
00310
Chemical Oxygen
Demand (mg/l)
00340 (Provide if
available)
OR
Total Organic Carbon
(mg/l)
00680 (Provide if
available)
(Either analysis
acceptable)
Form 2M1 - Page 8
TABLE I (Continued)
DESCRIPTION OF INFLUENT AND EFFLUENT
Influent Effluent
Parameter and Code
214
Annual
Average
Value
(1)
Annual
Average
Value
(2)
Lowest
Monthly
Average
Value
(3)
Highest
Monthly
Average Value
(4)
Frequency
of Analysis
(5)
No. of
Samples
(6)
Sample
Type
(7)
Chlorine - Total Residual
(mg/l)
50060
Total Solids
(mg/l)
00500
Total Dissolved Solids
(mg/l)
70300
Total Suspended Solids
(mg/l)
00530
Settleable Matter
(Residue)
(mg/l)
00545
Kjedahl Nitrogen
(mg/l)
00625
(Provide if available)
Nitrate (as N)
(mg/l)
00620
(Provide if available)
Nitrite (as N)
(mg/l)
00620
(Provide if available)
Phosphorous, Total
(as P) (mg/l)
00665
(Provide if available)
Dissolved Oxygen (DO)
(mg/l)
00300
N/A
Form 2M1 - Page 9
SECTION II
INDUSTRIAL WASTEWATER CONTRIBUTION TO MUNICIPAL SYSTEM
Submit a description of each industrial facility discharging to the municipal system, using a separate Section
II for each. Indicate the 4 digit Standard Industrial Classification (SIC) Code for the industry, the major
product or raw material, the flow (in gallons per day), and the characteristics of the wastewater discharged
from the industrial facility into the municipal system.
1. Major Contributing Facility
Contact person __________________________________________________________________________
Name of facility __________________________________________________________________________
Address ________________________________________________________________________________
City ____________________________ County ________________________________________________
State ___________________________ ZIP Code ____________________
Telephone (_____) ______________ Fax (_____) __________________ Cell Phone (_____) _____________
E-mail Address ___________________________________________________________________________
2. Product or item produced at this facility _____________________________________________________
3. Primary Standard Industrial Classification (SIC) Code _________________________________________
4. Principal Product or Raw Material
Product or Raw Material Quantity Units
___________________________ ______________________ _____________________
___________________________ ______________________ _____________________
___________________________ ______________________ _____________________
5. Flow: Indicate the volume of wastewater discharged into the municipal system in gallons per day (gpd) and
whether this discharge is intermittent or continuous.
____________________GPD Intermittent ( ) Continuous ( )
6. Pretreatment Provided: Indicate if pretreatment is provided prior to entering the municipal collection system.
Yes ( ) No ( )
7. Characteristics of Wastewater: Please list the pollutants and maximum concentrations of the pollutants in the
table below.
Pollutant
Maximum
Concentration
Form 2M1 - Page 10