3510-2A NPDES Application Form 2A

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United States
Environmental Protection Agency

Office of Water
Washington, D.C.

OMB No. 2040-0004
Expires MM/DD/YYYY

Water Permits Division

Application Form 2A
New and Existing Publicly
Owned Treatment Works
NPDES Permitting Program

Note: Complete this form if your facility is a new or existing publicly owned treatment works.

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3501 et seq. (OMB Control No. 2040-0004). Responses to this collection of information are mandatory
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FORM 2A—INSTRUCTIONS
General Instructions
Who Must Complete Form 2A?
All new and existing publicly owned treatment works (POTWs)
and other dischargers designated by the National Pollutant
Discharge Elimination System (NPDES) permitting authority
must complete Form 2A. If your facility is a federally owned or
privately owned treatment works that primarily treats domestic
sewage, contact your permitting authority to determine the
appropriate form(s) to submit (see 64 FR 42436). Note that you
may wish to consult the “General Instructions” of NPDES
Application Form 1 to determine if your treatment works is
required to submit any additional NPDES application forms.

You may not claim any information on Form 2A (or related
attachments) as confidential.
You may make a claim of confidentiality for any information that
you submit to EPA that goes beyond the information required by
Form 2A. If you do not assert a claim of confidentiality at the
time you submit your information to the NPDES permitting
authority, EPA may make the information available to the public
without further notice to you. EPA will handle claims of
confidentiality in accordance with its business confidentiality
regulations at Part 2 of Title 4 of the Code of Federal
Regulations (CFR).
Completion of Forms
Form 2A is divided into six major sections. It also contains five
effluent monitoring tables (Tables A through E) and an industrial
discharge information table (Table F), all located at the end of
the form. Note that not all applicants are required to complete
each section of the form or all of the tables. The questions on
the form will direct you to the items and tables you must
complete.

At the state level, either the U.S. Environmental Protection
Agency (EPA) or an approved state agency administers the
NPDES permit program. If you are located in a jurisdiction in
which an EPA regional office administers the NPDES permit
program, you should use Form 2A and all other applicable forms
described in these instructions. If you are located in a
jurisdiction where a state administers the NPDES permit
program, contact the state to determine the forms you should
complete. States often develop their own application forms
rather than use the federal forms. See
http://www.epa.gov/npdes/npdes-state-program-information for
a list of states that have approved NPDES permit programs and
those that do not.

Print or type in the specified areas only. If you do not have
enough space on the form to answer a question, you may
continue on additional sheets, as necessary, using a format
consistent with the form.
Do not leave any response areas blank unless the form directs
you to skip them. If the form directs you to respond to an item
that does not apply to your facility or activity, enter “NA” for “not
applicable” to show that you considered the item and
determined a response was not necessary for your facility.

Exhibit 2A–1 (see end of this section) provides contact
information for each of EPA’s 10 regional offices. Since the
exhibit’s content is subject to change, consult EPA’s website for
the latest information: http://www.epa.gov/aboutepa#regional.
Where to File Your Completed Form
• If you are in a jurisdiction with an approved state NPDES
permit program, file according to the instructions on the
state forms.
• If you are in a jurisdiction where EPA is the NPDES
permitting authority (i.e., the state is not an NPDESauthorized state), mail the completed application forms to
the EPA regional office that covers the state in which your
facility is located (see Exhibit 2A–1).

If you have previously submitted information that answers a
specific question to EPA or an approved state NPDES agency,
you may either repeat the information in the space provided or
attach a copy of the previous submission.
Note for New Dischargers
Provide all information available to you at the time you
complete Form 2A. If you do not have information to
respond to an item because your facility has yet to
discharge, write or type “data are not available” next to the
item on the form. Note that you are required to submit
actual data no later than 24 months after your facility
commences to discharge.

When to File Your Completed Form
Form 2A must be submitted at least 180 days before your
present NPDES permit expires or, if you are a new discharger,
at least 180 days before the date on which the discharge is to
commence, unless the NPDES permitting authority has granted
permission for a later date.

The NPDES permitting authority will consider your application
complete when it and any supplementary material are received
and completed according to the authority’s satisfaction. The
NPDES permitting authority will judge the completeness of any
application independently of the status of any other permit
application or permit for the same facility or activity.

Fees
EPA does not require applicants to pay a fee for applying for
NPDES permits. However, states that administer the NPDES
permit program may charge fees. Consult with state officials for
further information.

Definitions
The legal definitions of all key terms used in the various NPDES
application forms are included in the “Glossary” at the end of
these instructions.

Public Availability of Submitted Information
EPA will make information from NPDES permit application forms
available to the public for inspection and copying upon request.
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FORM 2A—INSTRUCTIONS (CONTINUED)
Exhibit 2A–1. Addresses of EPA Regional Contacts and Covered States
REGION 1
U.S. Environmental Protection Agency, Region 1
5 Post Office Square, Suite 100, Boston, MA 02109-3912
Phone: (617) 918-1111; toll free: (888) 372-7341
Fax: (617) 918-0101
Website: http://www.epa.gov/aboutepa/epa-region-1-new-england
Covered states: Connecticut, Maine, Massachusetts, New Hampshire, Rhode
Island, and Vermont

REGION 6
U.S. Environmental Protection Agency, Region 6
1445 Ross Avenue, Suite 1200, Dallas, TX 75202-2733
Phone: (214) 665-2200; toll free: (800) 887-6063
Fax: (214) 665-7113
Website: http://www.epa.gov/aboutepa/epa-region-6-south-central
Covered states: Arkansas, Louisiana, New Mexico, Oklahoma, and Texas

REGION 2
U.S. Environmental Protection Agency, Region 2
290 Broadway, New York, NY 10007-1866
Phone: (212) 637-3000; toll free: (877) 251-4575
Fax: (212) 637-3526
Website: http://www.epa.gov/aboutepa/epa-region-2
Covered states: New Jersey, New York, Virgin Islands, and Puerto Rico

REGION 7
U.S. Environmental Protection Agency, Region 7
11201 Renner Boulevard, Lenexa, KS 66219
Phone: (913) 551-7003; toll free: (800) 223-0425
Website: http://www.epa.gov/aboutepa/epa-region-7-midwest
Covered states: Iowa, Kansas, Missouri, and Nebraska

REGION 3
U.S. Environmental Protection Agency, Region 3
1650 Arch Street, Philadelphia, PA 19103-2029
Phone: (215) 814-5000; toll free: (800) 438-2474
Fax: (215) 814-5103
Website: http://www.epa.gov/aboutepa/epa-region-3-mid-atlantic
Covered states: Delaware, District of Columbia, Maryland, Pennsylvania, Virginia,
and West Virginia

REGION 8
U.S. Environmental Protection Agency, Region 8
1595 Wynkoop Street, Denver, CO 80202-1129
Phone: (303) 312-6312; toll free: (800) 227-8917
Fax: (303) 312-6339
Website: http://www.epa.gov/aboutepa/epa-region-8-mountains-and-plains
Covered states: Colorado, Montana, North Dakota, South Dakota, Utah, and
Wyoming

REGION 4
U.S. Environmental Protection Agency, Region 4
Sam Nunn Atlanta Federal Center
61 Forsyth Street, SW, Atlanta, GA 30303-8960
Phone: (404) 562-9900; toll free: (800) 241-1754
Fax: (404) 562-8174
Website: http://www.epa.gov/aboutepa/about-epa-region-4-southeast
Covered states: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina,
South Carolina, and Tennessee

REGION 9
U.S. Environmental Protection Agency, Region 9
75 Hawthorne Street, San Francisco, CA 94105
Phone: (415) 947-8000; toll free: (866) EPA-WEST
Fax: (415) 947-3553
Website: http://www.epa.gov/aboutepa/epa-region-9-pacific-southwest
Covered states: Arizona, California, Hawaii, Nevada, Guam, American Samoa,
and Trust Territories

REGION 5
U.S. Environmental Protection Agency, Region 5
77 West Jackson Boulevard, Chicago, IL 60604-3507
Phone: (312) 353-2000; toll free: (800) 621-8431
Fax: (312) 353-4135
Website: http://www.epa.gov/aboutepa/epa-region-5
Covered states: Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin

REGION 10
U.S. Environmental Protection Agency, Region 10
1200 Sixth Avenue, Suite 900, Seattle, WA 98101
Phone: (206) 553-1200; toll free: (800) 424-4372
Fax: (206) 553-2955
Website: http://www.epa.gov/aboutepa/epa-region-10-pacific-northwest
Covered states: Alaska, Idaho, Oregon, and Washington

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FORM 2A—INSTRUCTIONS (CONTINUED)
status. Finally, indicate the total percentage of sewer line each
type comprises.

Line-By-Line Instructions
EPA Identification Number, NPDES Permit Number, Facility
Name, and Outfall Number
Provide your EPA Identification Number from the Facility
Registry Service, NPDES permit number, and facility name at
the top of each page of Form 2A and any attachments. If your
facility is new (i.e., not yet constructed), write or type “New
Facility” in the space provided for the EPA Identification Number
and NPDES permit number. If you do not know your EPA
Identification Number, contact your NPDES permitting authority.
See Exhibit 2A–1 for contact information. Additionally, for
Tables A through E, provide the applicable outfall number at the
top of each page.

Do not report privately owned collection systems discharging
industrial waste to the treatment works in Item 1.7. Those
facilities must be reported in Table F.
Indian Country
Item 1.8. Indicate if the POTW is located in Indian Country.
Item 1.9. Note whether the treatment works discharges to a
receiving stream that flows through Indian Country.
Design and Actual Flow Rates
Item 1.10. Provide the facility’s design flow rate in million
gallons per day (mgd). Next, specify the facility’s actual annual
average daily flow rate and maximum daily flow rate for each of
the previous three years (in mgd).

Section 1. Basic Application Information for All Applicants
Facility Information
Item 1.1. Enter the facility’s official or legal name. Do not use a
colloquial name. Provide the mailing address of the facility.
Next, give the name (first and last), title, work telephone
number, and email address of the person who is thoroughly
familiar with the operation of the facility and with the facts
reported in this application.

Discharge Points by Type
Item 1.11. Provide the facility’s total number of effluent
discharge points to waters of the United States by type (e.g.,
treated effluent, untreated effluent, combined sewer overflows,
bypasses, and constructed emergency overflows).
Outfalls and Other Discharge or Disposal Methods
Outfalls Other Than to Waters of the United States
Item 1.12. Indicate whether the POTW discharges wastewater
to basins, ponds, or other surface impoundments that do not
have outlets for discharge to waters of the United States. If yes,
continue to Item 1.13. If no, skip to Item 1.14.

Include a complete location address for the facility if different
from the mailing address. If the facility lacks a street name or
route number, give the most accurate, alternative geographic
information (e.g., section number or quarter section number
from county records or “at intersection of Routes 425 and 22”).
Item 1.2. Indicate whether the application is for a facility that has
not yet commenced discharge. If yes, be advised that you are
required to submit actual data no later than 24 months after your
facility commences to discharge.

Item 1.13. Specify the location of each surface impoundment,
the average daily volume discharged to each surface
impoundment in gallons per day (gpd), and whether the
discharge is continuous or intermittent.

Applicant Information
Item 1.3. Indicate if the applicant is different from the entity
listed under Item 1.1. If so, specify the applicant name and
address. Provide the name (first and last) of a contact, including
his/her title, telephone number, and email address.

Item 1.14. Indicate if the facility applies wastewater to land. If
yes, continue to Item 1.15. If no, skip to Item 1.16.
Item 1.15. Provide the location of each land application site; the
size of each land application site (in acres); the average daily
volume applied to each land application site (in gpd), and
whether the land application is continuous or intermittent.

Item 1.4. Indicate if the applicant is the facility’s owner, operator,
or both.

Item 1.16. Note whether the facility’s effluent is transported to
another facility for treatment prior to discharge. If yes, continue
to Item 1.17. If no, skip to Item 1.21.

Item 1.5. Specify whether the NPDES permitting authority
should send correspondence to the facility or the applicant.
Existing Environmental Permits
Item 1.6. Indicate all environmental permits or construction
approvals received or applied for (including dates) under the
noted programs. Print or type the corresponding permit number
for each.

Item 1.17. Describe the means by which the effluent is
transported, such as by tank truck or pipe.
Item 1.18. Specify whether the facility’s effluent is transported
by a party other than the applicant. If yes, continue to Item 1.19.
If no, skip to Item 1.20.

Collection System and Population Served
Item 1.7. Specify the municipalities served by the treatment
works, including unincorporated connector districts. For each
municipality, indicate the population served, the percentage of
each collection system type if known (e.g., separate sanitary or
combined storm and sanitary), and collection system ownership

Item 1.19. Provide the name, mailing address, contact person,
phone number, and email address of the entity that transports
the discharge.
Item 1.20. Provide the name, mailing address, contact person,
phone number, email address, and NPDES permit number (if
any) of the receiving facility. Also specify the average daily flow
rate from the facility into the receiving facility in mgd.
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FORM 2A—INSTRUCTIONS (CONTINUED)
Item 1.21. Indicate if wastewater is disposed of in a manner
other than those already mentioned in Items 1.14 through 1.21
that do not have outlets to waters of the United States, such as
underground percolation and underground injections. If yes,
continue to Item 1.22. If no, skip to Item 1.23.

(including onsite treatment, storage, and disposal sites); and (6)
location at which waste classified as hazardous under the
Resource Conservation and Recovery Act (RCRA) enters the
treatment plant by truck, rail, or dedicated pipe.
On each map, include the map scale, a meridian arrow showing
north, and latitude and longitude to the nearest second or
equivalent decimal degrees (e.g., 38.893829, -77.029289).
Latitude and longitude coordinates may be obtained in a variety
of ways, including use of hand held devices (e.g., a GPS
enabled smartphone), internet mapping tools, geographic
information systems (e.g., ArcView), or paper maps from trusted
sources (e.g., U.S. Geological Survey or USGS).

Item 1.22. Provide a description of the disposal method,
including the location and size of each disposal site; the annual
average daily discharge volume (in gpd), and whether disposal
through this method is continuous or intermittent.
Variance Requests
Item 1.23. If known at the time of application, check all of the
authorized variances that you plan to request or renew. Note
that you are not being asked to submit any other information at
this time. Contact your NPDES permitting authority to determine
the specifics of what you should provide and when. The ability to
request a variance is not limited to the time of application, and
an applicant may request a variance consistent with statutory
and regulatory requirements.
Contractor Information
Item 1.24. Indicate if any of the operational or maintenance
activities associated with wastewater treatment and effluent
quality of the POTW are the responsibility of a contractor. If yes,
continue to Item 1.25. If no, skip to Section 2.

On all maps of rivers, show the direction of the current. In tidal
waters, show the directions of ebb and flow tides.
You may develop your map by going to USGS’s National Map
website at http://nationalmap.gov/. (For a map from this site, use
the traditional 7.5-minute quadrangle format. If none is available,
use a USGS 15-minute series map.) You may also use a plat or
other appropriate map. Briefly describe land uses in the map
area (e.g., residential, commercial). An example of an
acceptable location map is shown as Exhibit 2A–2 at the end of
these instructions. Note: Exhibit 2A–2 is provided for illustration
only; it does not show an actual facility. Note that you have
completed your topographic map and attached it to the
application.

Item 1.25. Provide a listing of all contractors (by company
name). For each, specify the mailing address, a contact name,
telephone number, and email address. Also summarize the
operational and maintenance responsibilities of each contractor.

Flow Diagram
Item 2.4. Provide a process flow diagram or schematic showing
the processes of the treatment plant, including all bypass piping
and all backup power sources or redundancy in the system. This
includes a water balance showing all treatment units, including
disinfection (e.g., chlorination and dechlorination), and showing
daily average flow rates at influent and discharge points, and
approximate daily flow rates between treatment units. Also
provide a narrative description of the diagram/schematic. An
example of an acceptable flow diagram is shown as Exhibit 2A–
3 at the end of these instructions. Note: Exhibit 2A–3 is
provided for illustration only; it does not represent an actual
facility. Answer “Yes” to Item 2.4 once you have completed and
attached your diagram to the application.

Section 2. Additional Information
Outfalls to Waters of the United States
Design Flow
Item 2.1. Indicate whether the treatment works has a design
flow greater than or equal to 0.1 mgd. If yes, continue to Item
2.2. If no, skip to Section 3.
Inflow and Infiltration
Item 2.2. Specify the POTW’s current average daily volume of
inflow and infiltration (in gpd) and steps the facility is taking to
minimize inflow and infiltration.
Topographic Map
Item 2.3. Prepare a topographic map (or other map if a
topographic map is unavailable) extending at least one mile
beyond property boundaries of the treatment plant, including all
unit processes and showing the following: (1) treatment plant
area and unit processes; (2) major pipes or other structures
through which wastewater enters the treatment plant and the
pipes or other structures through which treated wastewater is
discharged from the treatment plant (include outfalls from
bypass piping, if applicable); (3) each well where fluids from the
treatment plant are injected underground; (4) wells, springs, and
other surface water bodies listed in public records or otherwise
known to the applicant within ¼ mile of the treatment works’
property boundaries; (5) sewage sludge management facilities

Scheduled Improvements and Schedules of Implementation
Item 2.5. Indicate whether any improvements to the facility are
scheduled. If yes, list and briefly describe each scheduled
improvement and continue to Item 2.6. If no, skip to Section 3.
Item 2.6. For each scheduled improvement, indicate the outfall
number of each outfall affected and the scheduled or actual
dates of completion for the following: (1) commencement of
construction, (2) completion of construction, (3) commencement
of discharge, and (4) attainment of operational level.
Item 2.7. Note whether the appropriate permits/clearances
concerning other federal/state requirements have been obtained
and briefly explain your response.

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FORM 2A—INSTRUCTIONS (CONTINUED)
General Instructions for Reporting, Sampling, and Analysis
Important note: Read these instructions before completing
Tables A through E and Section 3 of Form 2A.

•

General Items
Complete the applicable tables for each outfall at your facility. Be
sure to note the EPA Identification Number, NPDES permit
number, facility name, and applicable outfall number at the top of
each page of the tables and any associated attachments.

•

You may report some or all of the required data by attaching
separate sheets of paper instead of completing Tables A through
E for each of your outfalls, so long as the sheets contain all of the
required information and are similar in format to Tables A through
E. For example, you may be able to print a report in a compatible
format from the data system used in your analysis of metals
completed under Table C.

Consistent with 40 CFR 136, you may provide matrix- or samplespecific MLs rather than the published levels. Further, where you
can demonstrate that, despite a good faith effort to use a method
that would otherwise meet the definition of “sufficiently sensitive,”
the analytical results are not consistent with the quality assurance
(QA)/quality control (QC) specifications for that method, then the
NPDES permitting authority may determine that the method is not
performing adequately and the NPDES permitting authority should
select a different method from the remaining EPA-approved
methods that is sufficiently sensitive consistent with 40 CFR
122.21(e)(3)(i). Where no other EPA-approved methods exist, you
must select a method consistent with 40 CFR 122.21(e)(3)(ii).

Note for new dischargers. Provide all information available to
you at the time you complete Form 2A. If you do not have
information to respond to an item because your facility has yet to
discharge, write or type “data are not available” next to the item
on the form. Note that you are required to submit actual data no
later than 24 months after your facility commences discharge.
Reporting of Effluent Data
Where effluent data are requested, do not provide information on
CSOs. The latter information is requested instead under Section 5
of Form 2A.
Provide data for each outfall through which effluent is discharged.
When an applicant has two or more outfalls with substantially
identical effluents, the NPDES permitting authority may allow the
applicant to test only one outfall and report those quantitative data
as applying to the substantially identical outfall. If the permitting
authority grants your request, attach a separate sheet to the
application form identifying the outfall tested and describing why
the other outfall(s) are substantially identical.
At a minimum, effluent testing data must be based on at least
three samples taken within 4.5 years prior to the date of the
permit application. Samples must be representative of the
seasonal variation in the discharge from each outfall. Existing
data may be used, if available, in lieu of sampling done solely for
the purpose of this application.
All existing data for pollutants specified in Tables A through D that
are collected within 4.5 years of the application must be included
in the pollutant data summary that you submit. If, however, you
sampled for a specific pollutant on a monthly or more frequent
basis, it is only necessary, for such pollutant, to summarize all
data collected within 1 year of the application.
Except as specified below, all required quantitative data shall be
collected in accordance with sufficiently sensitive analytical
methods approved under 40 CFR 136 or required under 40 CFR
Chapter I, Subchapter N or O. A method is “sufficiently sensitive”
when:
• The method minimum level (ML) is at or below the level of
the applicable water quality criterion for the measured
pollutant or pollutant parameter.

The method ML is above the water quality criterion, but the
amount of the pollutant or pollutant parameter in the facility’s
discharge is high enough that the method detects and
quantifies the level of the pollutant or pollutant parameter in
the discharge.
The method has the lowest ML of the analytical methods
approved under 40 CFR 136 or required under 40 CFR
chapter I, subchapter N or O, for the measured pollutant or
pollutant parameter.

When there is no analytical method that has been approved under
40 CFR 136; required under 40 CFR Chapter I, Subchapter N or
O; or otherwise required by the NPDES permitting authority, you
may use any suitable method but shall provide a description of the
method. When selecting a suitable method, you may consider
other factors, such as a method’s precision, accuracy, or
resolution.
Effluent monitoring data must comply with the QA/QC
requirements of 40 CFR 136 (and other appropriate QA/QC
requirements for standard methods for analytes not addressed by
40 CFR 136).
Grab samples must be used for pH, temperature, cyanide, total
phenols, residual chlorine, oil and grease, fecal coliform (including
E. coli), and volatile organic compounds. For all other pollutants,
24-hour composite samples must be used. For a composite
sample, only one analysis of the composite of aliquots is required.
The effluent monitoring data provided must include at least the
following for each parameter: (1) the maximum daily discharge
based upon actual sample values, (2) average daily discharge for
all samples, expressed as concentration or mass, and the number
of samples used to obtain this value, (3) the analytical method
used, and (4) the threshold level (i.e., method detection limit,
minimum level, or other designated method endpoints) for the
analytical method used.
Metals must be reported as “total recoverable metal,” unless all
approved analytical methods for the metal inherently measure only
its dissolved form (e.g., hexavalent chromium) or otherwise
directed by the NPDES permitting authority.
Units of Measure
Clearly specify the units of measure in Tables A through E for
each parameter/pollutant analyzed. Values should be reported as

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FORM 2A—INSTRUCTIONS (CONTINUED)
General Instructions for Reporting, Sampling, and Analysis Continued
The time when you sample should be representative of your
normal operation, to the extent feasible, with your treatment
system operating properly with no system upsets. Collect samples
from the center of the flow channel, where turbulence is at a
maximum, at a site specified in your present NPDES permit, or at
any site adequate for the collection of a representative sample.

concentration or mass, except for flow, temperature, pH, color,
and fecal coliform organisms, unless otherwise requested or
required by the NPDES permitting authority. Flow, temperature,
pH, color, and fecal coliform organisms must be reported as mgd,
degrees Celsius (°C), standard units, color units, and most
probable number per 100 milliliters (MPN/100 mL), respectively.
Use the following abbreviations in the columns requiring “units” in
Tables A through D.
Concentration
ppm = parts per million

Mass
lbs. = pounds

mg/L = milligrams per liter

ton = tons (English tons)

ppb = parts per billion

mg = milligrams

µg/L = micrograms per liter

g = grams
kg = kilograms
T = tonnes (metric tons)

MPN = most probable number
per 100 milliliters

Further Requirements for Table E, Whole Effluent Toxicity
Testing
Each applicant required to perform WET testing must provide
results of a minimum of four quarterly tests for a year, from the
year preceding the permit application, or the results from four
tests performed at least annually in the 4.5-year period prior to the
application, provided the results show no appreciable toxicity
using a safety factor determined by the NPDES permitting
authority.

Sampling
The collection of samples for the reported analyses should be
supervised by a person experienced in performing sampling of
domestic wastewater. You may contact your NPDES permitting
authority for detailed guidance on sampling techniques and for
answers to specific questions. See Exhibit 2A–1 for contact
information. Any specific requirements in the analytical methods—
for example, for sample containers, sample preservation, holding
times, and the collection of duplicate samples—must be followed.

Applicants must conduct tests with multiple species (no less than
two species; e.g., fish, invertebrate, plant) and test for acute or
chronic toxicity, depending on the range of receiving water
dilution. See 40 CFR 122.21(j)(5)(v) for further details.
WET testing must be conducted using methods approved under
40 CFR 136. West Coast facilities in Washington, Oregon,
California, Alaska, Hawaii, and the Pacific Territories are
exempted from 40 CFR 136 chronic methods and must use
alternative guidance as directed by the NPDES permitting
authority.

Seasonal or Periodic Discharge Data
Item 3.2. Indicate whether any of the outfalls described under
Item 3.1 have seasonal or periodic discharges. If yes, continue
to Item 3.3. If no, skip to Item 3.4.

Section 3. Information on Effluent Discharges
Description of Outfalls
Item 3.1. Provide a description of each of the POTW’s
wastewater discharge outfalls. The application form provides
reporting space for three outfalls. If your facility has more than
this number, attach additional sheets as necessary.

Item 3.3. Specify the following for each applicable outfall:
(1) number of times per year discharge occurs, (2) average
duration of each discharge, (3) average flow of each discharge
in mgd, and (4) months in which discharge occurs.
Diffuser Type
Item 3.4. Note whether any of the outfalls listed under Item 3.1
are equipped with a diffuser. If yes, continue to Item 3.5. If no,
skip to Item 3.6.

For each outfall, provide the outfall number. Indicate the state,
county, and city or town where each outfall is located. Note the
distance from shore in feet and the depth below the surface in
feet. Specify the average daily flow rate through the outfall in
mgd. Also specify the latitude and longitude of each outfall to
the nearest second or equivalent decimal degrees (e.g.,
38.893829, -77.029289). Latitude and longitude coordinates
may be obtained in a variety of ways, including use of hand held
devices (e.g., a GPS enabled smartphone), internet mapping
tools, geographic information systems (e.g., ArcView), or paper
maps from trusted sources (e.g., USGS). The location of each
outfall (i.e., where the coordinates are collected) shall be the
point where the discharge is released into a water of the United
States. For further guidance, refer to
http://www.epa.gov/geospatial/latitudelongitude-data-standard.

Item 3.5. Briefly describe the diffuser type at each applicable
outfall.
Waters of the United States
Item 3.6. Note whether the POTW discharges or plans to
discharge wastewater to waters of the United States from one or
more discharge points. If yes, continue to Item 3.7. If no, skip to
Section 6.
Receiving Water Description
Item 3.7. Provide receiving water and related information in the
table provided on the form (if known): (1) name of receiving
water, (2) name of watershed/river/stream system and Natural
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FORM 2A—INSTRUCTIONS (CONTINUED)
Item 3.14 and Table B. Answer whether the treatment works
uses chlorine for disinfection, uses it elsewhere in the treatment
process, or otherwise has reasonable potential to discharge
chlorine in its effluent. If yes, complete Table B including
chlorine. If no, complete Table B, omitting chlorine.

Resources Conservation Service (formerly U.S. Soil
Conservation Service) 14-digit watershed code, (3) name of
state management/river basin and USGS 8-digit hydrologic unit
code, (4) acute and chronic critical low flow in cubic feet per
second (cfs) and total hardness of receiving stream at critical
low flow, in milligrams per liter (mg/L) of calcium carbonate, if
applicable.

Item 3.15. Answer “Yes” when you have completed monitoring
for all applicable Table B parameters and attached the results to
your application.

The watershed/hydrologic unit codes can be found at USGS’s
Watershed Boundary Dataset website at
https://www.usgs.gov/core-science-systems/ngp/nationalhydrography/watershed-boundary-dataset.

Item 3.16 and Screen for Tables C through E. Indicate
whether one or more of the conditions apply to your POTW. If
yes, continue to Item 3.17. If no, skip to Section 4.

Treatment Description

Item 3.17 and Table C. Answer “Yes” to indicate you have
completed monitoring for all Table C pollutants and attached the
results to your application package.

Item 3.8. Specify the highest level of treatment provided for
discharges from each outfall (e.g., primary, equivalent to
secondary, secondary, or advanced). Also indicate the following
design removals (in percent) for the following parameters for
each outfall: (1) biochemical oxygen demand (BOD5 or CBOD5),
(2) total suspended solids (TSS), (3) phosphorus (if applicable),
(4) nitrogen (if applicable), and (5) any other removals that an
advanced treatment system is designed to achieve.

Item 3.18 and Table D. Answer “Yes” to indicate you have
completed monitoring for all Table D pollutants required by your
NPDES permitting authority and attached the results to your
application package, or “No” if the NPDES permitting authority
has not required additional sampling for the pollutants in Table
D.

Item 3.9. Provide a description of the type(s) of disinfection used
for wastewater discharged through each outfall. Indicate the
seasons when the disinfection type is used. Note whether the
POTW dechlorinates if disinfection is accomplished through
chlorination. Otherwise, check “Not Applicable.”

Item 3.19 and Additional Screen for Table E. Answer whether
the POTW conducted either (1) a minimum of four quarterly
WET tests for one year preceding this permit application or (2)
at least four annual WET tests in the past 4.5 years. If yes,
continue to Item 3.20. If no, complete tests and Table E and
then skip to Item 3.26.

Effluent Testing Data and Tables A through E
Items 3.10 to 3.26. These items require you to collect and report
data for the parameters and pollutants listed in Tables A through
E, located at the end of Form 2A. The instructions for completing
the tables are table-specific, as are the criteria for determining who
should complete them.

Item 3.20 and Additional Screen for Table E. Report whether
you have previously submitted the results of the WET tests
indicated in Item 3.19 to your NPDES permitting authority. If
yes, continue to Item 3.21. If no, provide the results in Table E
and skip to Item 3.26.

Important note: Read the “General Instructions for Reporting,
Sampling, and Analysis” later in these instructions before
completing Items 3.10 to 3.26 and Tables A through E.

Item 3.21. Report the dates the testing data were submitted to
your NPDES permitting authority and provide a summary of the
results.

Item 3.10 and Table A. All applicants that discharge wastewater
to waters of the United States must provide effluent data for
Table A parameters. Respond “Yes” to Item 3.10 when you have
completed Table A and attached it to your application.

Item 3.22. Regardless of how you may have provided the
results of previously conducted WET analyses to your NPDES
permitting authority, indicate if any of the tests resulted in
toxicity. If yes, continue to Item 3.23. If no, skip to Item 3.26.

Item 3.11. Answer whether the POTW has conducted any whole
effluent toxicity (WET) tests during the 4.5 years prior to the date
of the application on any of the facility’s discharges or on any
receiving water near the discharge points. If yes, continue to
Item 3.12. If no, skip to Item 3.13.

Item 3.23. Describe the cause(s) of toxicity.
Item 3.24. Indicate if the POTW has conducted a toxicity
reduction evaluation. If yes, continue to Item 3.25. If no, skip to
Item 3.26.
Item 3.25. Provide details of any toxicity reduction evaluations
performed.

Item 3.12. For each applicable outfall, note the number of acute
and chronic WET tests conducted since the last permit
reissuance of the facility’s discharges or of the receiving water
near the discharge points.

Item 3.26. Answer “Yes” when you have completed Table E for
all applicable outfalls and attached the results to the application
package, or answer “No” if the item is not applicable because
you previously submitted WET data to your NPDES permitting
authority.

Item 3.13. Note whether the POTW has a design flow greater
than or equal to 0.1 mgd. If yes, continue to Item 3.14. If no, skip
to Item 3.16.

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FORM 2A—INSTRUCTIONS (CONTINUED)
Section 4. Industrial Discharges, Table F, and Hazardous
Wastes
Item 4.1. Indicate if the POTW receives discharges from
significant industrial users (SIUs) or non-significant categorical
industrial users (NSCIUs), including SIUs and NSCIUs that truck
or haul waste. If yes, continue to Item 4.2. If no, skip to Item 4.7.
1.

Item 4.6 and Table F. Complete Table F by providing the
following information for each SIU that discharges to the POTW:
(1) name and mailing address; (2) description of all industrial
processes that affect or contribute to each SIU’s discharge; (3) a
list of the principal products and raw materials that affect or
contribute to the SIU’s discharge; (4) average daily volume of
wastewater discharged by each SIU, indicating the amount
attributable to process flow and non-process flow; (5) whether
the SIU is subject to local limits; (6) whether the SIU is subject
to categorical standards and the categories/subcategories under
which the SIU is subject; and (7) whether any problems (e.g.,
upsets, pass-through interference) have occurred at the POTW
that can be attributed to the SIU in the past 4.5 years. Answer
“Yes” to Item 4.6 when you have completed and attached Table
F to the application package.

SIUs are defined as:
a.
b.

2.

Item 4.5. Identify the title and date of the pretreatment program
annual report or pretreatment program referenced in Item 4.4
and skip to Item 4.7.

All industrial users subject to categorical pretreatment
standards under 40 CFR 403.6 and 40 CFR Chapter I,
Subchapter N (CIUs); and
Any other industrial user per 40 CFR 403.3 that:
i. Discharges an average of 25,000 gpd or more of
process wastewater to the treatment works (with
certain exclusions); or
ii. Contributes a process wastestream that makes
up 5 percent or more of the average dry weather
hydraulic or organic capacity of the treatment
plant; or
iii. Is designated as an SIU by the control authority.

Note: SIUs include users that truck or haul industrial waste to
the POTW. Information for these users must be provided in
Table F.

The control authority may determine that an Industrial User
subject to categorical Pretreatment Standards under 40
CFR 403.6 and 40 CFR Chapter I, Subchapter N is a
NSCIU rather than a SIU on a finding that the Industrial
User never discharges more than 100 gpd of total
categorical wastewater (excluding sanitary, non-contact
cooling and boiler blowdown wastewater, unless
specifically included in the Pretreatment Standard) and the
following conditions are met:
a.

The Industrial User, prior to the control authority's
finding, has consistently complied with all applicable
categorical Pretreatment Standards and
Requirements;

b.

The Industrial User annually submits the certification
statement required in 40 CFR 403.12(q) together with
any additional information necessary to support the
certification statement; and

c.

Item 4.7. Indicate if the POTW receives or has been notified that
it will receive by truck, rail, or dedicated pipe any wastes that are
regulated as RCRA hazardous wastes pursuant to 40 CFR 261.
If yes, continue to Item 4.8. If no, skip to Item 4.9.
Item 4.8. For each hazardous waste received, provide the
hazardous waste number, the method by which the waste is
received (e.g., by truck, dedicated pipe, rail, etc.), and the
amount of waste received annually (specify units).
Item 4.9. Answer whether the POTW receives, or has been
notified that it will receive, wastewaters that originate from
remedial activities, including those undertaken pursuant to
Comprehensive Environmental Response, Compensation, and
Liability Act (CERCLA) and Sections 3004(u) or 3008(h) of
RCRA. If yes, continue to Item 4.10. If no, skip to Section 5.
Item 4.10. Answer whether the POTW receives (or expects to
receive) less than 15 kilograms per month of non-acute
hazardous wastes as specified at 40 CFR 261.30(d) and
261.33(e). If yes, skip to Section 5. If no, continue to Item 4.11.

The Industrial User never discharges any untreated
concentrated wastewater.

Item 4.11. In an attachment to the application, provide an
identification and description of the site(s) or facility(ies) at which
the wastewater originates; the identities of the wastewater’s
hazardous constituents, as listed in Appendix VII of 40 CFR
261, if known; and the extent of treatment, if any, the
wastewater receives or will receive before entering the POTW.
Answer “Yes” to Item 4.11 when you have completed and
attached the information to the application package.

Item 4.2. Indicate the number of SIUs and NSCIUs that
discharge to the POTW.
Item 4.3. Answer whether the POTW has an approved
pretreatment program, which is defined at 40 CFR 403.3 as a
program administered by a POTW that meets the criteria
established in 40 CFR 403.8 and 403.9 and that has been
approved by the NPDES permitting authority.

Section 5. Combined Sewer Overflows
CSO Map and Diagram
Item 5.1. Indicate if the treatment works has a combined sewer
system. If yes, continue to Item 5.2. If no, skip to Section 6.
Item 5.2. Attach a CSO system map to the application. The map
should indicate: (1) all CSO discharge points, (2) sensitive use
areas potentially affected by CSOs (e.g., beaches, drinking

Item 4.4. Answer whether you have submitted either of the
following to the NPDES permitting authority that contains
information substantially identical to that required in Table F:
(1) a pretreatment program annual report submitted within one
year of the application or (2) a pretreatment program. If yes,
continue to Item 4.5. If no, skip to Item 4.6.
2A-8

FORM 2A—INSTRUCTIONS (CONTINUED)
water supplies, shellfish beds, sensitive aquatic ecosystems,
and outstanding national resource waters), and (3) waters
supporting threatened and endangered species potentially
affected by CSOs. Answer “Yes” to Item 5.2 when you have
completed the map and attached it to the application package.
Item 5.3. Prepare a diagram of the CSO collection system. The
diagram should show the following: (1) the location of major
sewer trunk lines, both combined and separate sanitary; (2) the
locations of points where separate sanitary sewers feed into the
combined sewer system; (3) in-line and off-line storage
structures; (4) the locations of flow-regulating devices; and (5)
the locations of pump stations. Answer “Yes” to Item 5.3 when
you have completed the diagram and attached it to the
application package.
CSO Outfall Description
Item 5.4. Provide the following information for each CSO outfall:
(1) outfall number; (2) state, county, city or town, and ZIP code
in which the outfall is located; (3) latitude and longitude of the
outfall, to the nearest second or equivalent decimal degrees
(e.g., 38.893829, -77.029289); and (4) distance of the outfall
from shore and depth of the outfall below water surface. Latitude
and longitude coordinates may be obtained in a variety of ways,
including use of hand held devices (e.g., a GPS enabled
smartphone), internet mapping tools, geographic information
systems (e.g., ArcView), or paper maps from trusted sources
(e.g., USGS). The location of each CSO outfall (i.e., where the
coordinates are collected) shall be the point where the
discharge is released into a water of the United States.
CSO Monitoring
Item 5.5. Indicate whether the POTW has monitored any of the
following items in the past year for each of its CSO outfalls:
(1) rainfall, (2) CSO flow volume, (3) CSO pollutant
concentrations, (4) receiving water quality, (5) CSO frequency,
and (6) number of storm events.
CSO Events in Past Year
Item 5.6. For each CSO outfall, record (1) the number of CSO
events in the past year, (2) the average duration in hours per
event, (3) the average volume per CSO event in million gallons,
and (4) the minimum rainfall that caused a CSO event in inches
of rainfall in the past year. Note whether your responses for subitems (2) through (4) above are based on actual or estimated
data.
CSO Receiving Waters
Item 5.7. For each CSO outfall, record the following receiving
water information: (1) name of receiving water; (2) name of
watershed/stream system and the Natural Resources
Conservation Service (formerly U.S. Soil Conservation Service)
watershed (14-digit) code, if known; (3) name of the state
management/river basin and the USGS 8-digit hydrologic
cataloging unit code, if known; and (4) a description of any
known water quality impacts on the receiving water caused by
the CSO (e.g., permanent or intermittent beach closings,

permanent or intermittent shellfish bed closings, fish kills, fish
advisories, other recreational loss, or exceedance of any
applicable state water quality standard).
Section 6. Checklist and Certification Statement
Item 6.1. Review the checklist provided. In Column 1, mark the
sections of Form 2A that you have completed and are
submitting with your application. In Column 2, indicate for each
section whether you are submitting attachments.
Item 6.2. The Clean Water Act provides for severe penalties for
submitting false information on this application form. CWA
Section 309(c)(2) provides that “Any person who knowingly
makes any false statement, representation, or certification in
any application, …shall upon conviction, be punished by a fine
of no more than $10,000 or by imprisonment for not more than
six months, or both.”
FEDERAL REGULATIONS AT 40 CFR 122.22 REQUIRE THIS
APPLICATION TO BE SIGNED AS FOLLOWS:
A. For a corporation, by a responsible corporate officer. For
the purpose of this section, a responsible corporate officer
means: (1) a president, secretary, treasurer, or vicepresident of the corporation in charge of a principal
business function, or any other person who performs
similar policy- or decision-making functions for the
corporation, or (2) the manager of one or more
manufacturing, production, or operating facilities, provided
the manager is authorized to make management decisions
which govern the operation of the regulated facility
including having the explicit or implicit duty of making major
capital investment recommendations, and initiating and
directing other comprehensive measures to assure long
term environmental compliance with environmental laws
and regulations; the manager can ensure that the
necessary systems are established or actions taken to
gather complete and accurate information for permit
application requirements; and where authority to sign
documents has been assigned or delegated to the
manager in accordance with corporate procedures.
B. For a partnership or sole proprietorship, by a general
partner or the proprietor, respectively.
C. For a municipality, state, federal, or other public facility, by
either a principal executive officer or ranking elected
official. For purposes of this section, a principal executive
officer of a federal agency includes: (1) the chief executive
officer of the agency or (2) a senior executive officer having
responsibility for the overall operations of a principal
geographic unit of the agency (e.g., Regional
Administrators of EPA).
END
Submit your completed Form 2A and
all associated attachments
(and any other required NPDES application forms)
to your NPDES permitting authority.

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FORM 2A—INSTRUCTIONS (CONTINUED)
Exhibit 2A–2. Example Topographic Map

2A-10

FORM 2A—INSTRUCTIONS (CONTINUED)
Exhibit 2A–3. Example Flow Diagram

2A-11

FORM 2A—GLOSSARY
Note: This glossary includes terms used in the various NPDES application forms, including Form 2A. The definitions are from the NPDES
regulations at 40 CFR 122.2 unless otherwise specified. If you have any questions concerning the meaning of any of these terms, contact
your NPDES permitting authority.
ANIMAL FEEDING OPERATION (defined at § 122.23) means a lot or facility (other than an aquatic animal production facility) where the
following conditions are met;
•
•

Animals (other than aquatic animals) have been, are, or will be stabled or confined and fed or maintained for a total of 45 days or
more in any 12-month period; and
Crops, vegetation, forage growth, or post-harvest residues are not sustained in the normal growing season over any portion of the lot
or facility.

APPLICATION means the EPA standard national forms for applying for a permit, including any additions, revisions, or modifications to the
forms; or forms approved by EPA for use in approved states, including any approved modifications or revisions.
APPROVED PROGRAM or APPROVED STATE means a State or interstate program which has been approved or authorized by EPA
under part 123.
AQUACULTURE PROJECT (defined at § 122.25) means a defined managed water area which uses discharges of pollutants into that
designated area for the maintenance or production of harvestable freshwater, estuarine, or marine plants or animals. DESIGNATED
PROJECT AREA means the portions of the waters of the United States within which the permittee or permit applicant plans to confine the
cultivated species, using a method or plan or operation (including, but not limited to, physical confinement) which, on the basis of reliable
scientific evidence, is expected to ensure that specific individual organisms comprising an aquaculture crop will enjoy increased growth
attributable to the discharge of pollutants, and be harvested within a defined geographic area.
AVERAGE MONTHLY DISCHARGE LIMITATION means the highest allowable average of daily discharges over a calendar month,
calculated as the sum of all daily discharges measured during that month divided by the number of daily discharges measured during that
month.
AVERAGE WEEKLY DISCHARGE LIMITATION means the highest allowable average of daily discharges over a calendar week,
calculated as the sum of all daily discharges measured during a calendar week divided by the number of daily discharges measured during
that week.
BEST MANAGEMENT PRACTICES (BMPs) means schedules of activities, prohibitions of practices, maintenance procedures, and other
management practices to prevent or reduce the pollution of waters of the United States. BMPs include treatment requirements, operation
procedures, and practices to control plant site runoff, spillage or leaks, sludge or waste disposal, or drainage from raw material storage.
BIOSOLIDS (see sewage sludge).
BYPASS (defined at § 122.41(m)) means the intentional diversion of waste streams from any portion of a treatment facility.
COMBINED SEWER OVERFLOW (CSO) means a discharge from a combined sewer system (CSS) at a point prior to the Publicly Owned
Treatment Works (POTW) Treatment Plant (defined at § 403.3(r)).
COMBINED SEWER SYSTEM (CSS) means a wastewater collection system owned by a State or municipality (as defined by Section
502(4) of the CWA) which conveys sanitary wastewaters (domestic, commercial and industrial wastewaters) and storm water through a
single-pipe system to a Publicly Owned Treatment Works (POTW) Treatment Plant (as defined at § 403.3(r)).
CONCENTRATED ANIMAL FEEDING OPERATION (defined at § 122.23) means an animal feeding operation that is defined as a Large
CAFO or as a Medium CAFO by the terms of (A) or (B) below, or that is designated as a CAFO in accordance with 40 CFR 122.23(c). Two
or more AFOs under common ownership are considered to be a single AFO for the purposes of determining the number of animals at an
operation, if they adjoin each other or if they use a common area or system for the disposal of wastes.
A.

LARGE CONCENTRATED ANIMAL FEEDING OPERATION (LARGE CAFO) means an AFO that stables or confines as many as or
more than the numbers of animals specified in any of the following categories:
1. 700 mature dairy cows, whether milked or dry;
2. 1,000 veal calves;
3. 1,000 cattle other than mature dairy cows or veal calves. Cattle includes but is not limited to heifers, steers, bulls and cow/calf
pairs;
4. 2,500 swine each weighing 55 pounds or more;
5. 10,000 swine each weighing less than 55 pounds;
2A-12

FORM 2A—GLOSSARY (CONTINUED)
6.
7.
8.
9.
10.
11.
12.
13.
B.

500 horses;
10,000 sheep or lambs;
55,000 turkeys;
30,000 laying hens or broilers, if the AFO uses a liquid manure handling system;
125,000 chickens (other than laying hens), if the AFO uses other than a liquid manure handling system;
82,000 laying hens, if the AFO uses other than a liquid manure handling system;
30,000 ducks (if the AFO uses other than a liquid manure handling system); or
5,000 ducks (if the AFO uses a liquid manure handling system).

MEDIUM CONCENTRATED ANIMAL FEEDING OPERATION (MEDIUM CAFO) means any AFO with the type and number of
animals that fall within any of the ranges listed below and which has been defined or designated as a CAFO. An AFO is defined as a
Medium CAFO if:

The type and number of animals that it stables and confines falls within any of the following ranges:
a. 200 to 699 mature dairy cows, whether milked or dry;
b. 300 to 999 veal calves;
c. 300 to 999 cattle other than mature dairy cows or veal calves. Cattle includes but is not limited to heifers, steers, bulls and
cow/calf pairs;
d. 750 to 2,499 swine each weighing 55 pounds or more;
e. 3,000 to 9,999 swine each weighing less than 55 pounds;
f. 150 to 499 horses;
g. 3,000 to 9,999 sheep or lambs;
h. 16,500 to 54,999 turkeys;
i. 9,000 to 29,999 laying hens or broilers, if the AFO uses a liquid manure handling system;
j. 37,500 to 124,999 chickens (other than laying hens), if the AFO uses other than a liquid manure handling system;
k. 25,000 to 81,999 laying hens, if the AFO uses other than a liquid manure handling system;
l. 10,000 to 29,999 ducks (if the AFO uses other than a liquid manure handling system); or
m. 1,500 to 4,999 ducks (if the AFO uses a liquid manure handling system); and
2. Either one of the following conditions are met:
a. Pollutants are discharged into waters of the United States through a man-made ditch, flushing system, or other similar manmade device; or
b. Pollutants are discharged directly into waters of the United States which originate outside of and pass over, across, or
through the facility or otherwise come into direct contact with animals confined in the operation.
CONCENTRATED AQUATIC ANIMAL PRODUCTION FACILITY (defined at § 122.24) means a hatchery, fish farm, or other facility which
contains, grows, or holds aquatic animals in either of the following categories, or which the Director designates as such on a case-by-case
basis:
1.

A.

Cold water fish species or other cold water aquatic animals including, but not limited to, the Salmonidae family of fish (e.g., trout and
salmon) in ponds, raceways, or other similar structures which discharge at least 30 days per year but does not include:
1. Facilities which produce less than 9,090 harvest weight kilograms (approximately 20,000 pounds) of aquatic animals per year;
and
2. Facilities which feed less than 2,272 kilograms (approximately 5,000 pounds) of food during the calendar month of maximum
feeding.

B.

Warm water fish species or other warm water aquatic animals including, but not limited to, the Ameiuridae, Cetrarchiclae, and
Cyprinidae families of fish (e.g., respectively, catfish, sunfish, and minnows) in ponds, raceways, or other similar structures which
discharge at least 30 days per year, but does not include;
1.

Closed ponds which discharge only during periods of excess runoff; or

2.

Facilities which produce less than 45,454 harvest weight kilograms (approximately 100,000 pounds) of aquatic animals per year.

2A-13

FORM 2A—GLOSSARY (CONTINUED)
CWA means the Clean Water Act (formerly referred to as the Federal Water Pollution Control Act or Federal Water Pollution Control Act
Amendments of 1972) Public Law 92–500, as amended by Public Law 95–217, Public Law 95–576, Public Law 96–483 and Public Law
97–117, 33 U.S.C. 1251 et seq.
CWA AND REGULATIONS means the Clean Water Act (CWA) and applicable regulations promulgated thereunder. In the case of an
approved State program, it includes State program requirements.
DAILY DISCHARGE means the “discharge of a pollutant” measured during a calendar day or any 24-hour period that reasonably
represents the calendar day for purposes of sampling. For pollutants with limitations expressed in units of mass, the “daily discharge” is
calculated as the total mass of the pollutant discharged over the day. For pollutants with limitations expressed in other units of
measurement, the “daily discharge” is calculated as the average measurement of the pollutant over the day.
DIRECT DISCHARGE means the “discharge of a pollutant.”
DIRECTOR means the Regional Administrator or the State Director, as the context requires, or an authorized representative. When there
is no “approved State program,” and there is an EPA administered program, “Director” means the Regional Administrator. When there is
an approved State program, “Director” normally means the State Director. In some circumstances, however, EPA retains the authority to
take certain actions even when there is an approved State program. (For example, when EPA has issued an NPDES permit prior to the
approval of a State program, EPA may retain jurisdiction over that permit after program approval, see § 123.1.) In such cases, the term
“Director” means the Regional Administrator and not the State Director.
DISCHARGE (OF A POLLUTANT) means:
•
•

Any addition of any pollutant or combination of pollutants to waters of the United States from any point source; or
Any addition of any pollutant or combination of pollutants to the waters of the contiguous zone or the ocean from any point source
other than a vessel or other floating craft which is being used as a means of transportation.

This definition includes discharges into waters of the United States from: surface runoff which is collected or channelled by man;
discharges through pipes, sewers, or other conveyances owned by a State, municipality, or other person which do not lead to a treatment
works; and discharges through pipes, sewers, or other conveyances, leading into privately owned treatment works. This term does not
include an addition of pollutants by any “indirect discharger.”
DISCHARGE MONITORING REPORT means the EPA uniform national form, including any subsequent additions, revisions, or
modifications for the reporting of self-monitoring results by permittees. DMRs must be used by “approved States” as well as by EPA. EPA
will supply DMRs to any approved State upon request. The EPA national forms may be modified to substitute the state agency name,
address, logo, and other similar information, as appropriate, in place of EPA's.
DRAFT PERMIT means a document prepared under § 124.6 indicating the Director's tentative decision to issue or deny, modify, revoke
and reissue, terminate, or reissue a “permit.” A notice of intent to terminate a permit, and a notice of intent to deny a permit, as discussed
in § 124.5, are types of “draft permits.” A denial of a request for modification, revocation and reissuance, or termination, as discussed in
§ 124.5, is not a “draft permit.” A “proposed permit” is not a “draft permit.”
EFFLUENT LIMITATION means any restriction imposed by the Director on quantities, discharge rates, and concentrations of “pollutants”
which are “discharged” from “point sources” into “waters of the United States,” the waters of the “contiguous zone,” or the ocean.
EFFLUENT LIMITATIONS GUIDELINES means a regulation published by the Administrator under Section 304(b) of the CWA to adopt or
revise “effluent limitations.”
ENVIRONMENTAL PROTECTION AGENCY (EPA) means the United States Environmental Protection Agency.
FACILITY or ACTIVITY means any NPDES “point source” or any other facility or activity (including land or appurtenances thereto) that is
subject to regulation under the NPDES program.
GENERAL PERMIT means an NPDES “permit” issued under § 122.28 authorizing a category of discharges under the CWA within a
geographical area.
HAZARDOUS SUBSTANCE means any substance designated under 40 CFR part 116 pursuant to Section 311 of the CWA.
INDIAN COUNTRY (or INDAN LANDS) means:
•
•
•

All land within the limits of any Indian reservation under the jurisdiction of the United States Government, notwithstanding the
issuance of any patent, and, including rights-of-way running through the reservation;
All dependent Indian communities with the borders of the United States whether within the originally or subsequently acquired territory
thereof, and whether within or without the limits of a state; and
All Indian allotments, the Indian titles to which have not been extinguished, including rights-of-way running through the same.
2A-14

FORM 2A—GLOSSARY (CONTINUED)
INDIAN TRIBE means any Indian Tribe, band, group, or community recognized by the Secretary of the Interior and exercising
governmental authority over a Federal Indian reservation.
INDIRECT DISCHARGE means a nondomestic discharger introducing “pollutants” to a “publicly owned treatment works.”
LARGE MUNICIPAL SEPARATE STORM SEWER SYSTEM (defined at § 122.26(b)(4)) means all municipal separate storm sewers that
are either:
(i) Located in an incorporated place with a population of 250,000 or more as determined by the 1990 Decennial Census by the Bureau of
the Census (Appendix F of 40 CFR 122); or
(ii) Located in the counties listed in appendix H of 40 CFR 122, except municipal separate storm sewers that are located in the
incorporated places, townships or towns within such counties; or
(iii) Owned or operated by a municipality other than those described in paragraphs (i) or (ii) and that are designated by the Director as part
of the large or medium municipal separate storm sewer system due to the interrelationship between the discharges of the designated
storm sewer and the discharges from municipal separate storm sewers described under paragraphs (i) or (ii). In making this determination
the Director may consider the following factors:
(A) Physical interconnections between the municipal separate storm sewers;
(B) The location of discharges from the designated municipal separate storm sewer relative to discharges from municipal separate storm
sewers described in paragraph (i);
(C) The quantity and nature of pollutants discharged to waters of the United States;
(D) The nature of the receiving waters; and
(E) Other relevant factors; or
(iv) The Director may, upon petition, designate as a large municipal separate storm sewer system, municipal separate storm sewers
located within the boundaries of a region defined by a storm water management regional authority based on a jurisdictional, watershed, or
other appropriate basis that includes one or more of the systems described in paragraphs (i), (ii), (iii).
LOG SORTING AND LOG STORAGE FACILITIES (defined at § 122.27) means facilities whose discharges result from the holding of
unprocessed wood, for example, logs or roundwood with bark or after removal of bark held in self-contained bodies of water (mill ponds or
log ponds) or stored on land where water is applied intentionally on the logs (wet decking). (See 40 CFR 429, subpart I, including the
effluent limitations guidelines.)
MAJOR FACILITY means any NPDES “facility or activity” classified as such by the Regional Administrator, or, in the case of “approved
State programs,” the Regional Administrator in conjunction with the State Director.
MAXIMUM DAILY DISCHARGE LIMITATION means the highest allowable “daily discharge.”
MEDIUM MUNICIPAL SEPARATE STORM SEWER SYSTEM (defined at § 122.26(b)(7)) means all municipal separate storm sewers that
are either:
(i) Located in an incorporated place with a population of 100,000 or more but less than 250,000, as determined by the 1990 Decennial
Census by the Bureau of the Census (appendix G of 40 CFR 122); or
(ii) Located in the counties listed in appendix I of 40 CFR 122, except municipal separate storm sewers that are located in the incorporated
places, townships or towns within such counties; or
(iii) Owned or operated by a municipality other than those described in paragraph (i) or (ii) and that are designated by the Director as part
of the large or medium municipal separate storm sewer system due to the interrelationship between the discharges of the designated
storm sewer and the discharges from municipal separate storm sewers described under paragraph (i) or (ii). In making this determination
the Director may consider the following factors:
(A) Physical interconnections between the municipal separate storm sewers;
(B) The location of discharges from the designated municipal separate storm sewer relative to discharges from municipal separate storm
sewers described in paragraph (i);
(C) The quantity and nature of pollutants discharged to waters of the United States;
(D) The nature of the receiving waters; or
(E) Other relevant factors; or
2A-15

FORM 2A—GLOSSARY (CONTINUED)
(iv) The Director may, upon petition, designate as a medium municipal separate storm sewer system, municipal separate storm sewers
located within the boundaries of a region defined by a storm water management regional authority based on a jurisdictional, watershed, or
other appropriate basis that includes one or more of the systems described in paragraphs (i), (ii), (iii) of this section.
MUNICIPALITY means a city, town, borough, county, parish, district, association, or other public body created by or under State law and
having jurisdiction over disposal of sewage, industrial wastes, or other wastes, or an Indian tribe or an authorized Indian tribal organization,
or a designated and approved management agency under Section 208 of the CWA.
MUNICIPAL SEPARATE STORM SEWER (defined at § 122.26(b)(8)) means a conveyance or system of conveyances (including roads
with drainage systems, municipal streets, catch basins, curbs, gutters, ditches, man-made channels, or storm drains):
•

Owned or operated by a State, city, town, borough, county, parish, district, association, or other public body (created by or pursuant to
State law) having jurisdiction over disposal of sewage, industrial wastes, stormwater, or other wastes, including special districts under
State law such as a sewer district, flood control district or drainage district, or similar entity, or an Indian tribe or an authorized Indian
tribal organization, or a designated and approved management agency under Section 208 of the CWA that discharges to waters of
the United States.

•
•
•

Designed or used for collecting or conveying stormwater.
Which is not a combined sewer; and
Which is not part of a POTW as defined at 40 CFR 122.2.

MUNICIPAL SLUDGE (see sewage sludge)
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) means the national program for issuing, modifying, revoking
and reissuing, terminating, monitoring and enforcing permits, and imposing and enforcing pretreatment requirements, under Sections 307,
402, 318, and 405 of the CWA. The term includes an “approved program.”
NEW DISCHARGER means any building, structure, facility, or installation:
•
•
•
•

From which there is or may be a “discharge of pollutants;”
That did not commence the “discharge of pollutants” at a particular “site” prior to August 13, 1979;
Which is not a “new source;” and
Which has never received a finally effective NPDES permit for discharges at that “site.”

This definition includes an “indirect discharger” which commences discharging into “waters of the United States” after August 13, 1979. It
also means any existing mobile point source (other than an offshore or coastal oil and gas exploratory drilling rig or a coastal oil and gas
developmental drilling rig) such as a seafood processing rig, seafood processing vessel, or aggregate plant, that begins discharging at a
“site” for which it does not have a permit; and any offshore or coastal mobile oil and gas exploratory drilling rig or coastal mobile oil and gas
developmental drilling rig that commences the discharge of pollutants after August 13, 1979, at a “site” under EPA’s permitting jurisdiction
for which it is not covered by an individual or general permit and which is located in an area determined by the Regional Administrator in
the issuance of a final permit to be an area of biological concern. In determining whether an area is an area of biological concern, the
Regional Administrator shall consider the factors specified in 40 CFR 125.122(a)(1) through (10).
An offshore or coastal mobile exploratory drilling rig or coastal mobile developmental drilling rig will be considered a “new discharger” only
for the duration of its discharge in an area of biological concern.
NEW SOURCE means any building, structure, facility, or installation from which there is or may be a “discharge of pollutants,” the
construction of which commenced:
•
•

After promulgation of standards of performance under Section 306 of the CWA which are applicable to such source, or
After proposal of standards of performance in accordance with Section 306 of the CWA which are applicable to such source, but only
if the standards are promulgated in accordance with Section 306 within 120 days of their proposal.

OWNER OR OPERATOR means the owner or operator of any “facility or activity” subject to regulation under the NPDES program.
PERMIT means an authorization, license, or equivalent control document issued by EPA or an “approved State” to implement the
requirements of this part and parts 123 and 124. “Permit” includes an NPDES “general permit” (§ 122.28). Permit does not include any
permit which has not yet been the subject of final agency action, such as a “draft permit” or a “proposed permit.”
PESTICIDE DISCHARGES TO WATERS OF THE UNITED STATES FROM PESTICIDE APPLICATION means the application of
biological pesticides, and the application of chemical pesticides that leave a residue, from point sources to waters of the United States. In
the context of this definition of pesticide discharges to waters of the United States from pesticide application, this does not include
2A-16

FORM 2A—GLOSSARY (CONTINUED)
agricultural storm water discharges and return flows from irrigated agriculture, which are excluded by law (33 U.S.C. 1342(l); 33 U.S.C.
1362(14)).
PESTICIDE RESIDUE for the purpose of determining whether an NPDES permit is needed for discharges to waters of the United States
from pesticide application, means that portion of a pesticide application that is discharged from a point source to waters of the United
States and no longer provides pesticidal benefits. It also includes any degradates of the pesticide.
POINT SOURCE means any discernible, confined, and discrete conveyance, including but not limited to, any pipe, ditch, channel, tunnel,
conduit, well, discrete fissure, container, rolling stock, concentrated animal feeding operation, landfill leachate collection system, vessel or
other floating craft from which pollutants are or may be discharged. This term does not include return flows from irrigated agriculture or
agricultural stormwater runoff. (See § 122.3).
POLLUTANT means dredged spoil, solid waste, incinerator residue, filter backwash, sewage, garbage, sewage sludge, munitions,
chemical wastes, biological materials, radioactive materials (except those regulated under the Atomic Energy Act of 1954, as amended (42
U.S.C. 2011 et seq.)), heat, wrecked or discarded equipment, rock, sand, cellar dirt and industrial, municipal, and agricultural waste
discharged into water. It does not mean:
•
•

Sewage from vessels; or
Water, gas, or other material which is injected into a well to facilitate production of oil or gas, or water derived in association with oil
and gas production and disposed of in a well, if the well used either to facilitate production or for disposal purposes is approved by
authority of the State in which the well is located, and if the State determines that the injection or disposal will not result in the
degradation of ground or surface water resources. Note: Radioactive materials covered by the Atomic Energy Act are those
encompassed in its definition of source, byproduct, or special nuclear materials. Examples of materials not covered include radium
and accelerator-produced isotopes. See Train v. Colorado Public Interest Research Group, Inc., 426 U.S. 1 (1976).

PRIMARY INDUSTRY CATEGORY means any industry category listed in the NRDC settlement agreement (Natural Resources Defense
Council et al. v. Train, 8 E.R.C. 2120 (D.D.C. 1976), modified 12 E.R.C. 1833 (D.D.C. 1979)); also listed in appendix A of part 122.
PRIVATELY OWNED TREATMENT WORKS means any device or system which is (1) used to treat wastes from any facility whose
operator is not the operator of the treatment works and (2) not a “POTW.”
PROCESS WASTEWATER means any water which, during manufacturing or processing, comes into direct contact with or results from the
production or use of any raw material, intermediate product, finished product, byproduct, or waste product.
PROPOSED PERMIT means a state NPDES “permit” prepared after the close of the public comment period (and, when applicable, any
public hearing and administrative appeals) which is sent to EPA for review before final issuance by the State. A “proposed permit” is not a
“draft permit.”
PUBLICLY OWNED TREATMENT WORKS or POTW (defined at § 403.3) means a treatment works as defined by CWA Section 212,
which is owned by a state or municipality (as defined by CWA Section 502(4)). This definition includes any devices or systems used in the
storage, treatment, recycling, and reclamation) of municipal sewage or industrial wastes of a liquid nature. This definition also includes
sewers, pipes, and other conveyances only if they convey wastewater to a POTW. The term also means the municipality as defined in
CWA Section 502(4), which has jurisdiction over the indirect discharges to and the discharges from such a treatment works.
REGIONAL ADMINISTRATOR means the Regional Administrator of the appropriate Regional Office of the Environmental Protection
Agency or the authorized representative of the Regional Administrator.
ROCK CRUSHING AND GRAVEL WASHING FACILITIES (defined at § 122.27) means facilities which process crushed and broken
stone, gravel, and riprap (See 40 CFR 436, subpart B, including the effluent limitations guidelines).
SCHEDULE OF COMPLIANCE means a schedule of remedial measures included in a “permit”, including an enforceable sequence of
interim requirements (for example, actions, operations, or milestone events) leading to compliance with the CWA and regulations.
SECONDARY INDUSTRY CATEGORY means any industry category which is not a primary industry category.
SEWAGE FROM VESSELS means human body wastes and the wastes from toilets and other receptacles intended to receive or retain
body wastes that are discharged from vessels and regulated under Section 312 of the CWA, except that with respect to commercial
vessels on the Great Lakes this term includes graywater. For the purposes of this definition, “graywater” means galley, bath, and shower
water.
SEWAGE SLUDGE means any solid, semi-solid, or liquid residue removed during the treatment of municipal waste water or domestic
sewage. Sewage sludge includes, but is not limited to, solids removed during primary, secondary, or advanced waste water treatment,
scum, septage, portable toilet pumpings, type III marine sanitation device pumpings (33 CFR 159), and sewage sludge products. Sewage
sludge does not include grit or screenings, or ash generated during the incineration of sewage sludge.
2A-17

FORM 2A—GLOSSARY (CONTINUED)
SlLVICULTURAL POINT SOURCE (defined at § 122.27) means any discernible, confined, and discrete conveyance related to rock
crushing, gravel washing, log sorting, or log storage facilities which are operated in connection with silvicultural activities and from which
pollutants are discharged into waters of the United States. This term does not include non-point source silvicultural activities such as
nursery operations, site preparation, reforestation and subsequent cultural treatment, thinning, prescribed burning, pest and fire control,
harvesting operations, surface drainage, or road construction and maintenance from which there is natural runoff. However, some of these
activities (such as stream crossing for roads) may involve point source discharges of dredged or fill material which may require a CWA
Section 404 permit (see 33 CFR 209.120 and part 233).
SITE means the land or water area where any “facility or activity” is physically located or conducted, including adjacent land used in
connection with the facility or activity.
SLUDGE-ONLY FACILITY means any “treatment works treating domestic sewage” whose methods of sewage sludge use or disposal are
subject to regulations promulgated pursuant to Section 405(d) of the CWA and is required to obtain a permit under § 122.1(b)(2).
STANDARDS FOR SEWAGE SLUDGE USE OR DISPOSAL means the regulations promulgated pursuant to Section 405(d) of the CWA
which govern minimum requirements for sludge quality, management practices, and monitoring and reporting applicable to sewage sludge
or the use or disposal of sewage sludge by any person.
STATE means any of the 50 States, the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Virgin Islands, American
Samoa, the Commonwealth of the Northern Mariana Islands, the Trust Territory of the Pacific Islands, or an Indian Tribe as defined in
these regulations which meets the requirements of § 123.31 of this chapter.
STATE DIRECTOR means the chief administrative officer of any State or interstate agency operating an “approved program,” or the
delegated representative of the State Director. If responsibility is divided among two or more State or interstate agencies, “State Director”
means the chief administrative officer of the State or interstate agency authorized to perform the particular procedure or function to which
reference is made.
STORMWATER (or STORM WATER) (defined at § 122.26(b)(13)) means stormwater runoff, snow melt runoff, and surface runoff and
drainage.
STORMWATER DISCHARGE ASSOCIATED WITH INDUSTRIAL ACTIVITY (defined at § 122.26(b)(14)) means the discharge from any
conveyance that is used for collecting and conveying stormwater and that is directly related to manufacturing, processing or raw materials
storage areas at an industrial plant. The term does not include discharges from facilities or activities excluded from the NPDES program
under this part 122. For the categories of industries identified in this section, the term includes, but is not limited to, stormwater discharges
from industrial plant yards; immediate access roads and rail lines used or traveled by carriers of raw materials, manufactured products,
waste material, or by-products used or created by the facility; material handling sites; refuse sites; sites used for the application or disposal
of process waste waters (as defined at 40 CFR 401); sites used for the storage and maintenance of material handling equipment; sites
used for residual treatment, storage, or disposal; shipping and receiving areas; manufacturing buildings; storage areas (including tank
farms) for raw materials, and intermediate and final products; and areas where industrial activity has taken place in the past and significant
materials remain and are exposed to stormwater. For the purposes of this paragraph, material handling activities include storage, loading
and unloading, transportation, or conveyance of any raw material, intermediate product, final product, by-product or waste product. The
term excludes areas located on plant lands separate from the plant's industrial activities, such as office buildings and accompanying
parking lots as long as the drainage from the excluded areas is not mixed with stormwater drained from the above described areas.
Industrial facilities (including industrial facilities that are federally, State, or municipally owned or operated that meet the description of the
facilities listed in paragraphs 1 through 14 below) include those facilities designated under the provisions of 40 CFR 122.26(a)(1)(v). The
following categories of facilities are considered to be engaging in “industrial activity” for purposes of 40 CFR 122.26(b)(14):
1.
2.

3.

Facilities subject to stormwater effluent limitations guidelines, new source performance standards, or toxic pollutant effluent standards
under 40 CFR Subchapter N (except facilities with toxic pollutant effluent standards which are exempted under paragraph 11 below);
Facilities classified as Standard Industrial Classification 24, Industry Group 241 that are rock crushing, gravel washing, log sorting, or
log storage facilities operated in connection with silvicultural activities defined in 40 CFR 122.27(b)(2)–(3) and Industry Groups 242
through 249; 26 (except 265 and 267), 28 (except 283), 29, 311, 32 (except 323), 33, 3441, 373; (not included are all other types of
silvicultural facilities);
Facilities classified as Standard Industrial Classifications 10 through 14 (mineral industry) including active or inactive mining
operations (except for areas of coal mining operations no longer meeting the definition of a reclamation area under 40 CFR 434.11(1)
because the performance bond issued to the facility by the appropriate SMCRA authority has been released, or except for areas of
non–coal mining operations which have been released from applicable State or Federal reclamation requirements after
December 17, 1990) and oil and gas exploration, production, processing, or treatment operations, or transmission facilities that
discharge stormwater contaminated by contact with or that has come into contact with, any overburden, raw material, intermediate
products, finished products, byproducts or waste products located on the site of such operations; (inactive mining operations are
mining sites that are not being actively mined, but which have an identifiable owner/operator; inactive mining sites do not include sites
2A-18

FORM 2A—GLOSSARY (CONTINUED)

4.

where mining claims are being maintained prior to disturbances associated with the extraction, beneficiation, or processing of mined
materials, nor sites where minimal activities are undertaken for the sole purpose of maintaining a mining claim);
Hazardous waste treatment, storage, or disposal facilities, including those that are operating under interim status or a permit under
subtitle C of RCRA;

Landfills, land application sites, and open dumps that receive or have received any industrial wastes (waste that is received from any
of the facilities described under this subsection) including those that are subject to regulation under subtitle D of RCRA;
6. Facilities involved in the recycling of materials, including metal scrapyards, battery reclaimers, salvage yards, and automobile
junkyards, including but limited to those classified as Standard Industrial Classification 5015 and 5093;
7. Steam electric power generating facilities, including coal handling sites;
8. Transportation facilities classified as Standard Industrial Classifications 40, 41, 42 (except 4221–25), 43, 44, 45, and 5171 which have
vehicle maintenance shops, equipment cleaning operations, or airport deicing operations. Only those portions of the facility that are
either involved in vehicle maintenance (including vehicle rehabilitation, mechanical repairs, painting, fueling, and lubrication),
equipment cleaning operations, airport deicing operations, or which are otherwise identified under paragraphs 1–7 or 9–11 are
associated with industrial activity;
9. Treatment works treating domestic sewage or any other sewage sludge or wastewater treatment device or system, used in the
storage treatment, recycling, and reclamation of municipal or domestic sewage, including land dedicated to the disposal of sewage
sludge that are located within the confines of the facility, with a design flow of 1.0 mgd or more, or required to have an approved
pretreatment program under 40 CFR 403. Not included are farm lands, domestic gardens or lands used for sludge management
where sludge is beneficially reused and which are not physically located in the confines of the facility, or areas that are in compliance
with Section 405 of the CWA;
10. Construction activity including clearing, grading and excavation, except operations that result in the disturbance of less than five acres
of total land area. Construction activity also includes the disturbance of less than five acres of total land area that is a part of a larger
common plan of development or sale if the larger common plan will ultimately disturb five acres or more;
11. Facilities under Standard Industrial Classifications 20, 21, 22, 23, 2434, 25, 265, 267, 27, 283, 285, 30, 31 (except 311), 323, 34
(except 3441), 35, 36, 37 (except 373), 38, 39, and 4221–25.
5.

TOXIC POLLUTANT means any pollutant listed as toxic under Section 307(a)(1) or, in the case of “sludge use or disposal practices,” any
pollutant identified in regulations implementing Section 405(d) of the CWA.
TREATMENT WORKS TREATING DOMESTIC SEWAGE (TWTDS) means a POTW or any other sewage sludge or waste water
treatment devices or systems, regardless of ownership (including federal facilities), used in the storage, treatment, recycling, and
reclamation of municipal or domestic sewage, including land dedicated for the disposal of sewage sludge. This definition does not include
septic tanks or similar devices. For purposes of this definition, “domestic sewage” includes waste and waste water from humans or
household operations that are discharged to or otherwise enter a treatment works. In States where there is no approved State sludge
management program under Section 405(f) of the CWA, the Regional Administrator may designate any person subject to the standards for
sewage sludge use and disposal in 40 CFR 503 as a “treatment works treating domestic sewage,” where he or she finds that there is a
potential for adverse effects on public health and the environment from poor sludge quality or poor sludge handling, use or disposal
practices, or where he or she finds that such designation is necessary to ensure that such person is in compliance with 40 CFR 503.
UPSET (defined at § 122.41(n)) means an exceptional incident in which there is unintentional and temporary noncompliance with
technology based permit effluent limitations because of factors beyond the reasonable control of the permittee. An upset does not include
noncompliance to the extent caused by operational error, improperly designed treatment facilities, inadequate treatment facilities, lack of
preventive maintenance, or careless or improper operation.
VARIANCE means any mechanism or provision under Section 301 or 316 of the CWA or under 40 CFR 125, or in the applicable “effluent
limitations guidelines” which allows modification to or waiver of the generally applicable effluent limitation requirements or time deadlines of
the CWA. This includes provisions which allow the establishment of alternative limitations based on fundamentally different factors or on
Sections 301(c), 301(g), 301(h), 301(i), or 316(a) of the CWA.
WATERS OF THE UNITED STATES as defined at § 122.2.
WHOLE EFFLUENT TOXICITY (WET) means the aggregate toxic effect of an effluent measured directly by a toxicity test.

2A-19

EPA Identification Number

NPDES Permit Number

OMB No. 2040-0004
Expires MM/DD/YYYY

Facility Name

U.S. Environmental Protection Agency
Application for NPDES Permit to Discharge Wastewater

Form
2A
NPDES

NEW AND EXISTING PUBLICLY OWNED TREATMENT WORKS
SECTION 1. BASIC APPLICATION INFORMATION FOR ALL APPLICANTS (40 CFR 122.21(J)(1) AND (9))
1.1
Facility name
Mailing address (street or P.O. box)

Facility Information

City or town
Contact name (first and last)

Title

State

ZIP code

Phone number

Email address

 Same as mailing address

Location address (street, route number, or other specific identifier)
City or town

State

1.2

Is this application for a facility that has yet to commence discharge?
 Yes  See instructions on data submission
 No
requirements for new dischargers.

1.3

Is applicant different from entity listed under Item 1.1 above?





Yes

ZIP code

No  SKIP to Item 1.4.

Applicant Information

Applicant name
Applicant address (street or P.O. box)
City or town
Contact name (first and last)
1.4

Existing Environmental Permits

1.6

Owner

Phone number

Email address



Operator



Both

To which entity should the NPDES permitting authority send correspondence? (Check only one response.)
and applicant
 Facility
 Applicant
 Facility
(they are one and the same)
Indicate below any existing environmental permits. (Check all that apply and print or type the corresponding permit
number for each.)



NPDES (discharges to surface
water)
________________________
PSD (air emissions)



________________________
Ocean dumping (MPRSA)



________________________

EPA Form 3510-2A

ZIP code

Is the applicant the facility’s owner, operator, or both? (Check only one response.)


1.5

Title

State

Existing Environmental Permits



RCRA (hazardous waste)





________________________
Nonattainment program (CAA)



________________________



Dredge or fill (CWA Section
404)
________________________

UIC (underground injection
control)
______________________
NESHAPs (CAA)
______________________



Other (specify)
______________________

Page 1

EPA Identification Number

Collection System and Population Served

1.7

NPDES Permit Number

OMB No. 2040-0004
Expires MM/DD/YYYY

Facility Name

Provide the collection system information requested below for the treatment works.
Municipality
Population
Collection System Type
Served
Served
(indicate percentage)
_____ % separate sanitary sewer
_____ % combined storm and sanitary sewer

Unknown
_____ % separate sanitary sewer
_____ % combined storm and sanitary sewer

Unknown
_____ % separate sanitary sewer
_____ % combined storm and sanitary sewer

Unknown
_____ % separate sanitary sewer
_____ % combined storm and sanitary sewer
Unknown

Total
Population
Served

Ownership Status













Indian Country

Separate Sanitary Sewer System

1.8
1.9

Design and Actual
Flow Rates

1.10

Total percentage of each type of
sewer line (in miles)
Is the treatment works located in Indian Country?



Yes



Yes



No



No

Combined Storm and
Sanitary Sewer
%

Design Flow Rate

Provide design and actual flow rates in the designated spaces.

mgd

Annual Average Flow Rates (Actual)
Last Year

This Year

mgd
Maximum Daily Flow Rates (Actual)
Last Year

Two Years Ago
mgd

Discharge Points
by Type

Maintain
Maintain
Maintain
Maintain
Maintain
Maintain
Maintain
Maintain
Maintain
Maintain
Maintain
Maintain

%

mgd

EPA Form 3510-2A














Does the facility discharge to a receiving water that flows through Indian Country?

Two Years Ago

1.11

Own
Own
Own
Own
Own
Own
Own
Own
Own
Own
Own
Own

This Year

mgd

Provide the total number of effluent discharge points to waters of the United States by type.
Total Number of Effluent Discharge Points by Type
Treated Effluent

Untreated Effluent

mgd

Combined Sewer
Overflows

Bypasses

mgd

Constructed
Emergency
Overflows

Page 2

Outfalls and Other Discharge or Disposal Methods

EPA Identification Number

NPDES Permit Number

OMB No. 2040-0004
Expires MM/DD/YYYY

Facility Name

Outfalls Other Than to Waters of the United States
1.12 Does the POTW discharge wastewater to basins, ponds, or other surface impoundments that do not have outlets for
discharge to waters of the United States?
 Yes
 No  SKIP to Item 1.14.
1.13 Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Impoundment Location and Discharge Data
Average Daily Volume
Continuous or Intermittent
Location
Discharged to Surface
(check one)
Impoundment
 Continuous
gpd
 Intermittent
 Continuous
gpd
 Intermittent
 Continuous
gpd
 Intermittent
1.14 Is wastewater applied to land?
 Yes
 No  SKIP to Item 1.16.
1.15 Provide the land application site and discharge data requested below.
Land Application Site and Discharge Data
Continuous or
Average Daily Volume
Location
Size
Intermittent
Applied
(check one)
 Continuous
acres
gpd
 Intermittent
 Continuous
acres
gpd
 Intermittent
 Continuous
acres
gpd
 Intermittent
1.16 Is effluent transported to another facility for treatment prior to discharge?
No  SKIP to Item 1.21.
 Yes

1.17 Describe the means by which the effluent is transported (e.g., tank truck, pipe).

1.18
1.19

EPA Form 3510-2A

Is the effluent transported by a party other than the applicant?
 Yes
 No  SKIP to Item 1.20.
Provide information on the transporter below.
Transporter Data
Entity name
Mailing address (street or P.O. box)
City or town

State

Contact name (first and last)

Title

Phone number

Email address

ZIP code

Page 3

EPA Identification Number

Outfalls and Other Discharge or Disposal Methods Continued

1.20

NPDES Permit Number

In the table below, indicate the name, address, contact information, NPDES number, and average daily flow rate of the
receiving facility.
Receiving Facility Data
Facility name
Mailing address (street or P.O. box)
City or town

State

Contact name (first and last)

Title

Phone number

Email address

NPDES number of receiving facility (if any)
1.21

 None

Average daily flow rate

Yes



Provide information in the table below on these other disposal methods.
Information on Other Disposal Methods
Disposal
Annual Average
Location of
Size of
Method
Daily Discharge
Disposal Site
Disposal Site
Description
Volume

Variance
Requests
Contractor Information

1.25

Continuous or Intermittent
(check one)

 Continuous
 Intermittent
 Continuous
acres
gpd
 Intermittent
 Continuous
acres
gpd
 Intermittent
Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)? (Check all that apply.
Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
Discharges into marine waters (CWA
 Section 301(h))
 Water quality related effluent limitation (CWA Section 302(b)(2))


1.24

mgd

No  SKIP to Item 1.23.

acres

1.23

ZIP code

Is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do not have
outlets to waters of the United States (e.g., underground percolation, underground injection)?


1.22

OMB No. 2040-0004
Expires MM/DD/YYYY

Facility Name

gpd

Not applicable

Are any operational or maintenance aspects (related to wastewater treatment and effluent quality) of the treatment works
the responsibility of a contractor?
 Yes
 No SKIP to Section 2.

Provide location and contact information for each contractor in addition to a description of the contractor's operational and
maintenance responsibilities.
Contractor Information
Contractor 1
Contractor 2
Contractor 3
Contractor name
(company name)
Mailing address
(street or P.O. box)
City, state, and ZIP code
Contact name (first and
last)
Phone number
Email address
Operational and
maintenance
responsibilities of
contractor

EPA Form 3510-2A

Page 4

EPA Identification Number

NPDES Permit Number

OMB No. 2040-0004
Expires MM/DD/YYYY

Facility Name

Flow
Topographic
Inflow and Infiltration Design Flow
Diagram
Map

SECTION 2. ADDITIONAL INFORMATION (40 CFR 122.21(J)(1) AND (2))
Outfalls to Waters of the United States
2.1
Does the treatment works have a design flow greater than or equal to 0.1 mgd?


2.2

No  SKIP to Section 3.

Provide the treatment works’ current average daily volume of inflow
and infiltration.

Average Daily Volume of Inflow and Infiltration

gpd

Indicate the steps the facility is taking to minimize inflow and infiltration.

2.3

Have you attached a topographic map to this application that contains all the required information? (See instructions for
specific requirements.)


2.4

Yes

Have you attached a process flow diagram or schematic to this application that contains all the required information? (See
instructions for specific requirements.)


2.5

Yes

Are improvements to the facility scheduled?


Scheduled Improvements and Schedules of Implementation



Yes



Yes

No  SKIP to Section 3.

Briefly list and describe the scheduled improvements.
1.
2.
3.
4.
2.6

Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
Affected
Scheduled
Begin
End
Begin
Outfalls
Improvement
Construction
Construction
Discharge
(list outfall
(from above)
(MM/DD/YYYY)
(MM/DD/YYYY)
(MM/DD/YYYY)
number)

Attainment of
Operational
Level
(MM/DD/YYYY)

1.
2.
3.
4.
2.7

Have appropriate permits/clearances concerning other federal/state requirements been obtained? Briefly explain your
response.



Yes



No



None required or applicable

Explanation:

EPA Form 3510-2A

Page 5

EPA Identification Number

NPDES Permit Number

OMB No. 2040-0004
Expires MM/DD/YYYY

Facility Name

SECTION 3. INFORMATION ON EFFLUENT DISCHARGES (40 CFR 122.21(J)(3) TO (5))
3.1
Provide the following information for each outfall. (Attach additional sheets if you have more than three outfalls.)
Outfall Number ______

Outfall Number _____

Outfall Number ______

State
Description of Outfalls

County
City or town
Distance from shore

ft.

ft.

ft.

Depth below surface

ft.

ft.

ft.

mgd

mgd

mgd

Average daily flow rate
Latitude

Seasonal or Periodic Discharge Data

Longitude
3.2

Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?


3.3

Diffuser Type

Outfall Number _____

Number of times per year
discharge occurs
Average duration of each
discharge (specify units)
Average flow of each
mgd
discharge
Months in which discharge
occurs
Are any of the outfalls listed under Item 3.1 equipped with a diffuser?


3.5

EPA Form 3510-2A

Outfall Number _____

mgd



Yes

mgd

No  SKIP to Item 3.6.

Briefly describe the diffuser type at each applicable outfall.
Outfall Number _____

3.6

No  SKIP to Item 3.4.

If so, provide the following information for each applicable outfall.
Outfall Number _____

3.4

Waters of
the U.S.



Yes

Outfall Number _____

Outfall Number _____

Does the treatment works discharge or plan to discharge wastewater to waters of the United States from one or more
discharge points?


Yes



No  SKIP to Section 6.

Page 6

EPA Identification Number

3.7

NPDES Permit Number

OMB No. 2040-0004
Expires MM/DD/YYYY

Facility Name

Provide the receiving water and related information (if known) for each outfall.
Outfall Number _____

Outfall Number _____

Outfall Number _____

Receiving water name

Receiving Water Description

Name of watershed, river,
or stream system
Natural Resources
Conservation Service 14digit watershed code
Name of state
management/river basin
U.S. Geological Survey
8-digit hydrologic
cataloging unit code
Critical low flow (acute)

cfs

cfs

cfs

Critical low flow (chronic)

cfs

cfs

cfs

mg/L of
CaCO3

mg/L of
CaCO3

mg/L of
CaCO3

Total hardness at critical
low flow
3.8

Provide the following information describing the treatment provided for discharges from each outfall.

Treatment Description

Highest Level of
Treatment (check all that
apply per outfall)

Design Removal Rates by
Outfall

Outfall Number _____

Outfall Number _____

 Primary
 Equivalent to
secondary
 Secondary
 Advanced
 Other (specify)
__________________

 Primary
 Equivalent to
secondary
 Secondary
 Advanced
 Other (specify)
___________________

 Primary
 Equivalent to
secondary
 Secondary
 Advanced
 Other (specify)
_________________

BOD5 or CBOD5

%

%

%

TSS

%

%

%

Phosphorus
Nitrogen
Other (specify)
______________________

EPA Form 3510-2A

Outfall Number _____

 Not applicable

 Not applicable
%

 Not applicable

 Not applicable
%

 Not applicable
%

 Not applicable

 Not applicable
%

 Not applicable
%

%
%
 Not applicable

%

%

Page 7

Treatment Description Continued

EPA Identification Number

3.9

NPDES Permit Number

Describe the type of disinfection used for the effluent from each outfall in the table below. If disinfection varies by season,
describe in the table below.
Outfall Number _____

Outfall Number _____

Outfall Number _____

Disinfection type
Seasons used
Dechlorination used?

3.10
3.11

3.12





Not applicable
Yes

3.13
3.14

3.15
3.16

3.18

EPA Form 3510-2A

Not applicable
Yes





Not applicable
Yes

Chronic

Acute

Chronic

Acute

Chronic

Number of tests of discharge
water
Number of tests of receiving
water
Does the treatment works have a design flow greater than or equal to 0.1 mgd?
 Yes
 No  SKIP to Item 3.16.
Does the POTW use chlorine for disinfection, use chlorine elsewhere in the treatment process, or otherwise have
reasonable potential to discharge chlorine in its effluent?
 Yes  Complete Table B, including chlorine.
 No  Complete Table B, omitting chlorine.
Have you completed monitoring for all applicable Table B pollutants and attached the results to this application package?



Yes
Does one or more of the following conditions apply?
• The facility has a design flow greater than or equal to 1 mgd.
• The POTW has an approved pretreatment program or is required to develop such a program.
• The NPDES permitting authority has informed the POTW that it must sample for the parameters in Table C, must
sample other additional parameters (Table D), or submit the results of WET tests for acute or chronic toxicity for each
of its discharge outfalls (Table E).


3.17





No
No
No
Have you completed monitoring for all Table A parameters and attached the results to the application package?
 Yes
Have you conducted any WET tests during the 4.5 years prior to the date of the application on any of the facility’s
discharges or on any receiving water near the discharge points?
 Yes
 No  SKIP to Item 3.13.
Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility’s discharges
by outfall number or of the receiving water near the discharge points.
Outfall Number _____
Outfall Number ______
Outfall Number _____
Acute

Effluent Testing Data

OMB No. 2040-0004
Expires MM/DD/YYYY

Facility Name

Yes  Complete Tables C, D, and E as applicable.



No  SKIP to Section 4.

Have you completed monitoring for all Table C pollutants and attached the results to this application package?
Yes

Have you completed monitoring for all Table D pollutants required by your NPDES permitting authority and attached the
results to this application package?
No additional sampling required by NPDES
Yes

 permitting authority.

Page 8

EPA Identification Number

3.19

3.20
3.21

NPDES Permit Number

Facility Name

OMB No. 2040-0004
Expires MM/DD/YYYY

Has the POTW conducted either (1) minimum of four quarterly WET tests for one year preceding this permit application or
(2) at least four annual WET tests in the past 4.5 years?
No  Complete tests and Table E and SKIP to
 Yes

Item 3.26.
Have you previously submitted the results of the above tests to your NPDES permitting authority?
Provide results in Table E and SKIP to
 Yes
 No  Item
3.26.
Indicate the dates the data were submitted to your NPDES permitting authority and provide a summary of the results.
Date(s) Submitted
Summary of Results

Effluent Testing Data Continued

(MM/DD/YYYY)

3.22

3.23

3.24
3.25

Regardless of how you provided your WET testing data to the NPDES permitting authority, did any of the tests result in
toxicity?
 Yes
 No  SKIP to Item 3.26.
Describe the cause(s) of the toxicity:

Has the treatment works conducted a toxicity reduction evaluation?
 Yes

Provide details of any toxicity reduction evaluations conducted.

No  SKIP to Item 3.26.

Have you completed Table E for all applicable outfalls and attached the results to the application package?
applicable because previously submitted
 Yes
 Not
information to the NPDES permitting authority.
SECTION 4. INDUSTRIAL DISCHARGES AND HAZARDOUS WASTES (40 CFR 122.21(J)(6) AND (7))
4.1
Does the POTW receive discharges from SIUs or NSCIUs? (See instructions for definitions of SIUs and NSCIUs.)
 Yes
 No  SKIP to Item 4.7.
4.2
Indicate the number of SIUs and NSCIUs that discharge to the POTW.
Number of SIUs
Number of NSCIUs
Industrial Discharges and Hazardous Wastes

3.26

4.3

Does the POTW have an approved pretreatment program?


4.4

Yes



No

Have you submitted either of the following to the NPDES permitting authority that contains information substantially
identical to that required in Table F: (1) a pretreatment program annual report submitted within one year of the application
or (2) a pretreatment program?



Yes



No  SKIP to Item 4.6.

4.5

Identify the title and date of the annual report or pretreatment program referenced in Item 4.4. SKIP to Item 4.7.

4.6

Have you completed and attached Table F to this application package?



EPA Form 3510-2A

Yes

Page 9

EPA Identification Number

4.7



Yes

Industrial Discharges and Hazardous Wastes Continued




Truck
Dedicated pipe




Rail
Other (specify)
________________
________________




Truck
Dedicated pipe




Rail
Other (specify)
________________
________________




Truck
Dedicated pipe




Yes

Yes  SKIP to Section 5.

CSO Map and Diagram





No

Yes



No  SKIP to Section 6.

Have you attached a CSO system map to this application? (See instructions for map requirements.)



EPA Form 3510-2A

No  SKIP to Section 5.

Yes

SECTION 5. COMBINED SEWER OVERFLOWS (40 CFR 122.21(J)(8))
5.1
Does the treatment works have a combined sewer system?

5.3



Have you reported the following information in an attachment to this application: identification and description of the site(s)
or facility(ies) at which the wastewater originates; the identities of the wastewater’s hazardous constituents; and the extent
of treatment, if any, the wastewater receives or will receive before entering the POTW?



5.2

Units

Does the POTW receive (or expect to receive) less than 15 kilograms per month of non-acute hazardous wastes as
specified in 40 CFR 261.30(d) and 261.33(e)?


4.11

Annual
Amount of
Waste
Received

Waste Transport Method
(check all that apply)

Rail
Other (specify)
________________
________________
Does the POTW receive, or has it been notified that it will receive, wastewaters that originate from remedial activities,
including those undertaken pursuant to CERCLA and Sections 3004(7) or 3008(h) of RCRA?


4.10

No  SKIP to Item 4.9.

If yes, provide the following information:
Hazardous Waste
Number

4.9

OMB No. 2040-0004
Expires MM/DD/YYYY

Facility Name

Does the POTW receive, or has it been notified that it will receive, by truck, rail, or dedicated pipe, any wastes that are
regulated as RCRA hazardous wastes pursuant to 40 CFR 261?


4.8

NPDES Permit Number

Yes

Have you attached a CSO system diagram to this application? (See instructions for diagram requirements.)



Yes

Page 10

EPA Identification Number

5.4

NPDES Permit Number

OMB No. 2040-0004
Expires MM/DD/YYYY

Facility Name

For each CSO outfall, provide the following information. (Attach additional sheets as necessary.)
CSO Outfall Number ____

CSO Outfall Number _____

CSO Outfall Number _____

Distance from shore

ft.

ft.

ft.

Depth below surface

ft.

ft.

ft.

CSO Outfall Number ____

CSO Outfall Number _____

CSO Outfall Number _____

Rainfall

 Yes  No

 Yes  No

 Yes  No

CSO flow volume

 Yes  No

 Yes  No

 Yes  No

CSO pollutant
concentrations

 Yes  No

 Yes  No

 Yes  No

Receiving water quality

 Yes  No

 Yes  No

 Yes  No

CSO frequency

 Yes  No

 Yes  No

 Yes  No

Number of storm events

 Yes  No

 Yes  No

 Yes  No

CSO Outfall Number ____

CSO Outfall Number ____

CSO Outfall Description

City or town
State and ZIP code
County
Latitude
Longitude

CSO Monitoring

5.5

5.6

Did the POTW monitor any of the following items in the past year for its CSO outfalls?

Provide the following information for each of your CSO outfalls.

CSO Events in Past Year

CSO Outfall Number ____
Number of CSO events in
the past year
Average duration per
event
Average volume per event
Minimum rainfall causing a
CSO event in last year

EPA Form 3510-2A

events

events

events

hours

hours

hours

 Actual or  Estimated
million gallons
 Actual or  Estimated
inches of rainfall
 Actual or  Estimated

 Actual or  Estimated
million gallons
 Actual or  Estimated
inches of rainfall
 Actual or  Estimated

 Actual or  Estimated
million gallons
 Actual or  Estimated
inches of rainfall
 Actual or  Estimated

Page 11

EPA Identification Number

5.7

NPDES Permit Number

OMB No. 2040-0004
Expires MM/DD/YYYY

Facility Name

Provide the information in the table below for each of your CSO outfalls.
CSO Outfall Number ____

CSO Outfall Number ____

CSO Outfall Number ____

Receiving water name

Checklist and Certification Statement

CSO Receiving Waters

Name of watershed/
stream system
Natural Resources
 Unknown
 Unknown
 Unknown
Conservation Service 14digit watershed code
(if known)
Name of state
management/river basin
U.S. Geological Survey
 Unknown
 Unknown
 Unknown
8-Digit Hydrologic Unit
Code (if known)
Description of known
water quality impacts on
receiving stream by CSO
(see instructions for
examples)
SECTION 6. CHECKLIST AND CERTIFICATION STATEMENT (40 CFR 122.22(A) AND (D))
6.1
In Column 1 below, mark the sections of Form 2A that you have completed and are submitting with your application. For
each section, specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note that not all
applicants are required to provide attachments.
Column 1
Column 2
Section 1: Basic Application
 Information for All Applicants  w/ variance request(s)
 w/ additional attachments
 w/ topographic map
 w/ process flow diagram
Section 2: Additional
 Information
 w/ additional attachments



6.2

Section 3: Information on
Effluent Discharges



Section 4: Industrial
Discharges and Hazardous
Wastes



Section 5: Combined Sewer
Overflows










w/ Table A
w/ Table B
w/ Table C
w/ SIU and NSCIU attachments






w/ Table D



w/ additional attachments

w/ Table E
w/ additional attachments
w/ Table F

w/ additional attachments
w/ CSO map

w/ CSO system diagram
Section 6: Checklist and
w/ attachments
 Certification Statement
Provide the following certification. (See instructions to determine the appropriate person to sign the application.)
Certification Statement
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 persons directly responsible for
gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
I am aware that there are significant penalties for submitting false information, including the possibility of fine and
imprisonment for knowing violations.
Name (print or type first and last name)
Official title
Signature

EPA Form 3510-2A

Date signed

Page 12

EPA Identification Number

NPDES Permit Number

TABLE A. EFFLUENT PARAMETERS FOR ALL POTWS
Maximum Daily Discharge
Pollutant
Value
Units
Biochemical oxygen demand
 BOD5 or  CBOD5
(report one)

Facility Name

Outfall Number

Average Daily Discharge
Value

Units

Number of
Samples

OMB No. 2040-0004
Expires MM/DD/YYYY

Analytical
Method1

ML or MDL
(include units)
 ML
 MDL

Fecal coliform

 ML
 MDL

Design flow rate

 ML
 MDL

pH (minimum)

 ML
 MDL

pH (maximum)

 ML
 MDL

Temperature (winter)

 ML
 MDL

Temperature (summer)

 ML
 MDL

Total suspended solids (TSS)

 ML
 MDL

Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR Chapter I, Subchapter N or O. See instructions and 40 CFR 122.21(e)(3).
1

EPA Form 3510-2A

Page 13

This page intentionally left blank.

EPA Identification Number

NPDES Permit Number

Facility Name

TABLE B. EFFLUENT PARAMETERS FOR ALL POTWS WITH A FLOW EQUAL TO OR GREATER THAN 0.1 MGD
Maximum Daily Discharge
Average Daily Discharge
Pollutant
Number of
Value
Units
Value
Units
Samples
Ammonia (as N)
Chlorine
(total residual, TRC)2

OMB No. 2040-0004
Expires MM/DD/YYYY

Outfall Number

Analytical
Method1

ML or MDL
(include units)
 ML
 MDL
 ML
 MDL

Dissolved oxygen

 ML
 MDL

Nitrate/nitrite

 ML
 MDL

Kjeldahl nitrogen

 ML
 MDL

Oil and grease

 ML
 MDL

Phosphorus

 ML
 MDL

Total dissolved solids

 ML
 MDL

1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR Chapter I, Subchapter N or O. See instructions and 40 CFR 122.21(e)(3).
2 Facilities that do not use chlorine for disinfection, do not use chlorine elsewhere in the treatment process, and have no reasonable potential to discharge chlorine in their effluent are not
required to report data for chlorine.

EPA Form 3510-2A

Page 15

This page intentionally left blank.

EPA Identification Number

NPDES Permit Number

Facility Name

Outfall Number

OMB No. 2040-0004
Expires MM/DD/YYYY

TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Pollutant

Maximum Daily Discharge
Value

Units

Average Daily Discharge
Value

Units

Number of
Samples

Analytical
Method1

ML or MDL
(include units)

Metals, Cyanide, and Total Phenols
Hardness (as CaCO3)
Antimony, total recoverable
Arsenic, total recoverable
Beryllium, total recoverable
Cadmium, total recoverable
Chromium, total recoverable
Copper, total recoverable
Lead, total recoverable
Mercury, total recoverable
Nickel, total recoverable
Selenium, total recoverable
Silver, total recoverable
Thallium, total recoverable
Zinc, total recoverable
Cyanide
Total phenolic compounds

 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL

Volatile Organic Compounds
Acrolein
Acrylonitrile
Benzene
Bromoform
EPA Form 3510-2A

 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
Page 17

EPA Identification Number

NPDES Permit Number

Facility Name

Outfall Number

OMB No. 2040-0004
Expires MM/DD/YYYY

TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Pollutant
Carbon tetrachloride
Chlorobenzene
Chlorodibromomethane
Chloroethane
2-chloroethylvinyl ether
Chloroform
Dichlorobromomethane
1,1-dichloroethane
1,2-dichloroethane
trans-1,2-dichloroethylene
1,1-dichloroethylene
1,2-dichloropropane
1,3-dichloropropylene
Ethylbenzene
Methyl bromide
Methyl chloride
Methylene chloride
1,1,2,2-tetrachloroethane
Tetrachloroethylene
Toluene
1,1,1-trichloroethane
1,1,2-trichloroethane
EPA Form 3510-2A

Maximum Daily Discharge
Value

Units

Average Daily Discharge
Value

Units

Number of
Samples

Analytical
Method1

ML or MDL
(include units)
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
Page 18

EPA Identification Number

NPDES Permit Number

Facility Name

Outfall Number

OMB No. 2040-0004
Expires MM/DD/YYYY

TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Pollutant
Trichloroethylene
Vinyl chloride
Acid-Extractable Compounds
p-chloro-m-cresol
2-chlorophenol
2,4-dichlorophenol
2,4-dimethylphenol
4,6-dinitro-o-cresol
2,4-dinitrophenol
2-nitrophenol
4-nitrophenol
Pentachlorophenol
Phenol
2,4,6-trichlorophenol

Maximum Daily Discharge
Value

Units

Average Daily Discharge
Value

Units

Number of
Samples

Analytical
Method1

ML or MDL
(include units)
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL

Base-Neutral Compounds
Acenaphthene
Acenaphthylene
Anthracene
Benzidine
Benzo(a)anthracene
Benzo(a)pyrene
3,4-benzofluoranthene
EPA Form 3510-2A

 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL

Page 19

EPA Identification Number

NPDES Permit Number

Facility Name

Outfall Number

OMB No. 2040-0004
Expires MM/DD/YYYY

TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Pollutant
Benzo(ghi)perylene
Benzo(k)fluoranthene
Bis (2-chloroethoxy) methane
Bis (2-chloroethyl) ether
Bis (2-chloroisopropyl) ether
Bis (2-ethylhexyl) phthalate
4-bromophenyl phenyl ether
Butyl benzyl phthalate
2-chloronaphthalene
4-chlorophenyl phenyl ether
Chrysene
di-n-butyl phthalate
di-n-octyl phthalate
Dibenzo(a,h)anthracene
1,2-dichlorobenzene
1,3-dichlorobenzene
1,4-dichlorobenzene
3,3-dichlorobenzidine
Diethyl phthalate
Dimethyl phthalate
2,4-dinitrotoluene
2,6-dinitrotoluene
EPA Form 3510-2A

Maximum Daily Discharge
Value

Units

Average Daily Discharge
Value

Units

Number of
Samples

Analytical
Method1

ML or MDL
(include units)
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
Page 20

EPA Identification Number

NPDES Permit Number

Facility Name

Outfall Number

OMB No. 2040-0004
Expires MM/DD/YYYY

TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Pollutant

Maximum Daily Discharge
Value

Units

Average Daily Discharge
Value

Units

Number of
Samples

Analytical
Method1

ML or MDL
(include units)

1,2-diphenylhydrazine
Fluoranthene
Fluorene
Hexachlorobenzene
Hexachlorobutadiene
Hexachlorocyclo-pentadiene
Hexachloroethane
Indeno(1,2,3-cd)pyrene
Isophorone
Naphthalene
Nitrobenzene
N-nitrosodi-n-propylamine
N-nitrosodimethylamine
N-nitrosodiphenylamine
Phenanthrene
Pyrene
1,2,4-trichlorobenzene
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR Chapter I, Subchapter N or O. See instructions and 40 CFR 122.21(e)(3).

EPA Form 3510-2A

 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL

Page 21

This page intentionally left blank.

EPA Identification Number

NPDES Permit Number

Facility Name

Outfall Number

TABLE D. ADDITIONAL POLLUTANTS AS REQUIRED BY NPDES PERMITTING AUTHORITY
Maximum Daily Discharge
Average Daily Discharge
Pollutant
Number of
(list)
Value
Units
Value
Units
Samples

OMB No. 2040-0004
Expires MM/DD/YYYY

Analytical
Method1

ML or MDL
(include units)

 No additional sampling is required by NPDES permitting authority.
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
 ML
 MDL
1 Sampling

shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or required
under 40 CFR Chapter I, Subchapter N or O. See instructions and 40 CFR 122.21(e)(3).

EPA Form 3510-2A

Page 23

This page intentionally left blank.

EPA Identification Number

NPDES Permit Number

Facility Name

Outfall Number

OMB No. 2040-0004
Expires MM/DD/YYYY

TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Test Information
Test Number _____
Test species
Age at initiation of test
Outfall number
Date sample collected
Date test started
Duration
Toxicity Test Methods
Test method number
Manual title
Edition number and year of publication
Page number(s)
Sample Type
Check one:
Sample Location
Check one:

Point in Treatment Process
Describe the point in the treatment process
at which the sample was collected for each
test.

Toxicity Type
Indicate for each test whether the test was
performed to assess acute or chronic
toxicity, or both. (Check one response.)

EPA Form 3510-2A

Test Number _____

Test Number _____

 Grab
 24-hour composite

 Grab
 24-hour composite

 Grab
 24-hour composite

 Before disinfection
 After disinfection
 After dechlorination

 Before disinfection
 After disinfection
 After dechlorination

 Before disinfection
 After disinfection
 After dechlorination

 Acute
 Chronic
 Both

 Acute
 Chronic
 Both

 Acute
 Chronic
 Both
Page 25

EPA Identification Number

NPDES Permit Number

Facility Name

Outfall Number

OMB No. 2040-0004
Expires MM/DD/YYYY

TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Test Number _____
Test Type
Indicate the type of test performed. (Check
one response.)

Source of Dilution Water
Indicate the source of dilution water. (Check

one response.)

If laboratory water, specify type.

Test Number _____

Test Number _____

 Static
 Static-renewal
 Flow-through

 Static
 Static-renewal
 Flow-through

 Static
 Static-renewal
 Flow-through

 Laboratory water
 Receiving water

 Laboratory water
 Receiving water

 Laboratory water
 Receiving water

 Fresh water
 Salt water (specify)

 Fresh water
 Salt water (specify)

 Fresh water
 Salt water (specify)

If receiving water, specify source.
Type of Dilution Water
Indicate the type of dilution water. If salt
water, specify “natural” or type of artificial
sea salts or brine used.

Percentage Effluent Used
Specify the percentage effluent used for all
concentrations in the test series.

Parameters Tested
Check the parameters tested.

Acute Test Results
Percent survival in 100% effluent
LC50
95% confidence interval
Control percent survival
EPA Form 3510-2A

 pH
 Salinity
 Temperature

 Ammonia
 pH
 Dissolved oxygen  Salinity
 Temperature

 Ammonia
 pH
 Ammonia
 Dissolved oxygen  Salinity
 Dissolved oxygen
 Temperature

%

%

%

%
%

%
%

%
%
Page 26

EPA Identification Number

NPDES Permit Number

Facility Name

Outfall Number

OMB No. 2040-0004
Expires MM/DD/YYYY

TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Test Number _____

Test Number _____

Test Number _____

Acute Test Results Continued
Other (describe)

Chronic Test Results
NOEC
IC25
Control percent survival
Other (describe)

Quality Control/Quality Assurance
Is reference toxicant data available?
Was reference toxicant test within
acceptable bounds?
What date was reference toxicant test run
(MM/DD/YYYY)?
Other (describe)

EPA Form 3510-2A

%
%
%

 Yes
 Yes

 No
 No

%
%
%

 Yes
 Yes

 No
 No

%
%
%

 Yes
 Yes

 No
 No

Page 27

This page intentionally left blank.

EPA Identification Number

NPDES Permit Number

Facility Name

OMB No. 2040-0004
Expires MM/DD/YYYY

TABLE F. INDUSTRIAL DISCHARGE INFORMATION
Response space is provided for three SIUs. Copy the table to report information for additional SIUs.
SIU ____

SIU ____

SIU ____

Name of SIU
Mailing address (street or P.O. box)
City, state, and ZIP code
Describe all industrial processes that affect or
contribute to the discharge.

List the principal products and raw materials that
affect or contribute to the SIU’s discharge.

Indicate the average daily volume of wastewater
discharged by the SIU.

gpd

gpd

gpd

How much of the average daily volume is
attributable to process flow?

gpd

gpd

gpd

How much of the average daily volume is
attributable to non-process flow?

gpd

gpd

gpd

Is the SIU subject to local limits?
Is the SIU subject to categorical standards?

EPA Form 3510-2A

 Yes

 No

 Yes

 No

 Yes

 No

 Yes

 No

 Yes

 No

 Yes

 No

Page 29

EPA Identification Number

NPDES Permit Number

Facility Name

OMB No. 2040-0004
Expires MM/DD/YYYY

TABLE F. INDUSTRIAL DISCHARGE INFORMATION
Response space is provided for three SIUs. Copy the table to report information for additional SIUs.
SIU ____

SIU ____

SIU ____

Under what categories and subcategories is the
SIU subject?

Has the POTW experienced problems (e.g.,
upsets, pass-through interferences) in the past
4.5 years that are attributable to the SIU?
If yes, describe.

EPA Form 3510-2A

 Yes

 No

 Yes

 No

 Yes

 No

Click to go back to the beginning of Form

Page 30