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RUCTIONS FOR FLUNG I-OR NEW WATER FOLLUTION CONTkOL FACILITIES GENERAL PERlqlT. A. REFERENCE INFORMATION .~ 1 ~ - Enter, the applicant's ot)~cial or lega{ name. Do not use a colloquial name· If a pannership. {(st each partner. ' ,-~?:. ~Enter 'th~ f~iling address where the permit and related correspondence should go. Give the name of the responsible official we should contact if we have questions about the application or the ~cility. 4. List an aimrnate to the official name in 3. Enter the add.ss of the facility if different from the mailing address in 2. 6. Enter site location by latitude and longitude. B. GENERAL DE:~CI~n-]ION OF FACILITY': Pleaze enter a general description of the fncilky and the primary methyl of handling wastewat~rs. 1. A facility description should include all aspects of the f~ility including, services m be rendered, or activities to be couducted. 2. A facility description should include a map which not only shows the location and expanse of the project but also the location of adjacent waterways, drainage ways~ residential ase~ and industrial or commercial facilities. Please locate project by Township. Range, and 1/4 -- 1/4 :3. The proposed development and construction schedule should be az complete and accurate az possible. This should include future expansion plans or potential. Schematics should include each wnste stream (including a v/.a~t balance), collection facilities, treatment and control facitizios, and ultimate disposal means of e~ch waste product or effluent. Aitema~ivos for troaimenL if being considered, should also be included. Where possible. the quantity and qnaUty of each wazte s~e~m should be eoted. 5. T~ site evaluation repot: should be printed by the Agent, or a qualified Consultant. The rapon shall contain, at a minimum, a site diagram and. observations of thc site characte~stics az out((dud ~ OAR 6. Opcration and Malntenanne Plan should specify the normal operating parlmeters of the system(s). Include. for example, the length and spacing of dose cycles, gs-ifunage of a dose cycle, a~d nal~bratiou of flow mese~ or ela~se~ time r~ters. The mainte~tance schadnle should a&dres~ ALL components to be inspomed and n~in~ined, together with prncedure~ for doing so. For tach item. include the frequency for inspncti it and the maintenance prncedure. If ~vaiiable. include the manufacturer's O&M ~iteraturo for system components, a. The WPCF permit requires d~at monitoring reports and maintenance reports be submi~ed. The Ck~Vl Plan must include a repor~ form developed for Schedule B reporting requirements. b. Describe the spill condngcocy plan. including prncadure~ or conminmem and rcmediation. ~d. phone numbers to call for help. c. The collection. S~orage. and disposal of solids w~te and sludgos should be uddressed. Jncludin~ volume an~ quality where possible. 7. Groundwater idformazion must be provided for ail areas where *.va.~water or sludge will be stored or diq2osud. The following minimum th formaUon is required.: (In areas of shallow, unprotected aquifers or other azeas with high potemiai for groundwater con,'ninon(on, additional informanon may be required.) a. Ciid'afic information. b. Topography and soil profile description. c. F~oociing and erosion potemiai. d. Groundwater aquifer cha~cter~tics, including quality and grad~cot. e. Location of ail walls and springs within 1/2om(lc radius. 8. P~ovide information det2iling stops m be taken in protecLing surface and grouudwaters during conslruudon 2fid opez~.ion of tho ~cility. LA, IqO LISK ~OVAL: The Deparun~t wi)l not procc~ a permit application withouz ev~dp,aee provided thai the pregosai is approved by local land use planning agencies and mee~ sratexvide planing goals. The at~achad comtratib-;lity sutemem may be ns~ for that er(dance. In order for thc Depa..'m~nt to coordinate with o~her agent(ns a~d other Divisions within the agency, it is impocaflt to provide intbrrn~on regarding the status of other applications or permits. Appropriate fees muat accompany every application. Pleaze s~e a~ached fee schedule. · ~ -- By a pr~cipal exec~ve o~cer or at ]m t~e ~evei orvtce prestde~ · ~ ~r Soae ~,,~*,-~me-- ay a geue~ parmer ~ u~ ~oprl~or, respe~ive~y; or · ~.~'~, ~ Federal, m' oO~e~ ~ Fa~l~7 ~ B7 alt~r a prin~pM execu~e nlTscer or t~nel~g elec~d ofllcLM. DEQ-WQ-IW~ W~I4445A.5 (05/95)