Form 3510-1 NPDES Application Form 1

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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 1
General Information

NPDES Permitting Program

Note: All applicants to the National Pollutant Discharge Elimination System (NPDES) permits
program, with the exception of publicly owned treatment works and other treatment works treating
domestic sewage, must complete Form 1. Additionally, all applicants must complete one or more of the
following forms: 2B, 2C, 2D, 2E, or 2F. To determine the specific forms you must complete, consult the
“General Instructions” for this form.

Paperwork Reduction Act Notice
This collection of information is approved by OMB under the Paperwork Reduction Act, 44
U.S.C. 3501 et seq. (OMB Control No. 2040-0004). Responses to this collection of information
are mandatory (40 CFR 122.21). An agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it displays a currently valid OMB
control number. The public reporting and recordkeeping burden for this collection of information
is estimated to be 2.7 hours per response. Send comments on the Agency’s need for this
information, the accuracy of the provided burden estimates and any suggested methods for
minimizing respondent burden to the Regulatory Support Division Director, U.S. Environmental
Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the
OMB control number in any correspondence. Do not send the completed form to this address.

DESCRIPTION OF NPDES PERMIT APPLICATION FORMS

CONTENTS OF FORM 1 PACKAGE

The application forms for individual National Pollutant Discharge
Elimination System (NPDES) permits include the following:
Form 1—General Information (included in this package).

Form 1—General Instructions
Form 1—Line-by-Line Instructions
Form 1—Activities That Do Not Require Permits
Form 1—Glossary
Form 1—Application

Form 2—Forms Based on Facility or Activity Type (not included in
this package):
2A.
2B.
2C.
2D.
2E.
2F.
2S.

New and Existing Publicly Owned Treatment Works
Concentrated Animal Feeding Operations and Concentrated
Aquatic Animal Production Facilities
Existing Manufacturing, Commercial, Mining, and Silvicultural
Operations
New Manufacturing, Commercial, Mining, and Silvicultural
Operations That Have Not Yet Commenced Discharge of
Process Wastewater
Manufacturing, Commercial, Mining, and Silvicultural Facilities
Which Discharge Only Nonprocess Wastewater
Stormwater Discharges Associated with Industrial Activity
New and Existing Treatment Works Treating Domestic Sewage

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FORM 1—INSTRUCTIONS
with industrial activity—excluding discharges from
construction activity under 122.26(b)(14)(x) or (b)(15)—you
must also complete Form 2F. If the discharge is composed
of stormwater and non-stormwater, you must complete
Form 2F and you must also complete Forms 2C, 2D,
and/or 2E, as appropriate. See Form 2F’s instructions for
further details.

General Instructions
Who Must Apply for an NPDES Permit?
With the exceptions described in “Form 1—Activities That Do
Not Require Permits,” the federal Clean Water Act (33 U.S.C.
1251 et seq.) prohibits any person from discharging pollutants
into waters of the United States without first having been
issued a permit under the NPDES program.
Who Must Complete Form 1?
All applicants, other than publicly owned treatment works
(POTWs) and sludge-only facilities, must submit Form 1. If you
operate one of the following facilities, you must submit Form 1:
concentrated animal feeding operations and aquatic animal
production facilities; manufacturing, commercial, mining, and
silvicultural operations; or other industrial facilities.
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 1 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.
Exhibit 1–1 (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.
Upon your request, and based on information supplied by you,
EPA or the authorized NPDES state will determine whether you
are required to obtain a permit for a particular facility or activity.
Be sure to contact EPA or your state if you have a question.
Form 1 collects general information only. You must also
complete a more detailed application based on your proposed
discharge activity, as follows:
•

If your facility is a concentrated animal feeding
operation or a concentrated aquatic animal production
facility, you must also complete Form 2B.

•

If your facility is an existing manufacturing, commercial,
mining, or silvicultural facility that currently discharges
process wastewater, you must also complete Form 2C.

•

If your facility is a new manufacturing, commercial, mining,
or silvicultural facility that has yet to commence discharge
of process wastewater, you must also complete Form 2D.

•

If your facility is a new or existing facility (including
manufacturing, commercial, mining, and silvicultural
facilities) that discharges only nonprocess wastewater,
you must also complete Form 2E.

•

If your facility is a new or existing treatment works
treating domestic sewage, you must also complete Form
2S.
If your facility is a federally owned or privately owned
treatment works, contact your permitting authority to determine
the appropriate form(s) to submit (see 64 FR 42436).
•

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 1–1).

When to File Your Completed Form
Because of statutory and regulatory requirements, the deadlines
for filing applications vary according to your facility or activity
type and the type of permit you need. The various permit
application deadlines are listed in Exhibit 1–2 at the end of this
section.
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.
Public Availability of Submitted Information
EPA will make information from NPDES permit application forms
available to the public for inspection and copying upon request.
You may not claim any information on Form 1 (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 1. 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
Print or type in the specified areas only. If you do not have
enough space on the form to answer a question, you may

If your facility is a new or existing facility whose
discharge is composed entirely of stormwater associated
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FORM 1—INSTRUCTIONS (CONTINUED)
continue on additional sheets, as necessary, using a format
consistent with the form.

applicable” to show that you considered the item and
determined a response was not necessary for your facility.

The NPDES permitting authority could consider your application
incomplete if you do not provide an answer (or indicate "NA" for
"not applicable") for all questions on Form 1 and the applicable
Form 2.

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.

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

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FORM 1—INSTRUCTIONS (CONTINUED)
Exhibit 1–1. 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

Exhibit 1–2. Filing Dates for NPDES Permit Applications
Permit Application
2A
2B
2C
2D
2E
2F
2S

When to File
180 days before your present NPDES permit expires or, if you are a
new discharger, 180 days before the date on which the discharge is
to commence unless the NPDES permitting authority has granted
permission for a later date.
180 days before your present NPDES permit expires or 180 days
prior to startup if you are a new facility.
180 days before your present NPDES permit expires.
180 days prior to startup.
180 days before your present NPDES permit expires, or 180 days
prior to startup if you are a new facility.
Construction: 90 days prior to date construction is to commence.
Nonconstruction: 180 days before your present NPDES permit
expires or 180 days prior to startup if you are a new facility.
180 days before your present NPDES permit expires or 180 days
prior to startup if you are a new facility.

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FORM 1—LINE-BY-LINE INSTRUCTIONS
EPA Identification Number, NPDES Permit Number, and
Facility Name
Provide your EPA Identification Number from the Facility
Registry Service, NPDES permit number, and facility name at
the top of each page of Form 1 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 number. If you do not know your EPA Identification
Number, contact your NPDES permitting authority. See Exhibit
1–1 for contact information.

Item 2.5. Give the address or location of the facility identified
under Item 2.1. 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").
Also provide the county name, county code (if known), city or
town, state, and zip code.

Section 1. Activities Requiring an NPDES Permit
Item 1.1. Review the questions in Item 1.1 to determine if you
are required to submit Form 1. Be sure to check “Form 1—
Glossary” below for the legal definitions of any key terms.

Section 3. SIC and NAICS Codes
Items 3.1 and 3.2. List, in descending order of significance, up
to four 4-digit standard industrial classification (SIC) codes and
North American Industrial Classification System (NAICS) codes
that best describe your facility in terms of the principal products
or services it produces or provides. If the SIC or NAICS codes
do not adequately describe your facility’s products or services,
you have the option to provide additional descriptive information.

For concentrated aquatic animal production facilities, provide
the address or location of the production area (i.e., the location
where the animals are contained, grown, or held).

If the facility is a new or existing POTW or your permitting
authority has directed you to submit Form 2A, then you do not
need to complete Form 1, but you must submit Form 2A. If the
facility is also a treatment works treating domestic sewage, you
must also complete Form 2S.

You can find SIC code numbers and descriptions in the
1987 Standard Industrial Classification Manual, prepared by the
Executive Office of the President, Office of Management and
Budget. This document is available from the Government
Printing Office, Washington, D.C. An online version of the
manual is also available courtesy of the Occupational Safety
and Health Administration at
http://www.osha.gov/pls/imis/sic_manual.html.

If the facility is a sludge-only facility that is not otherwise
required to obtain an NPDES permit, then you do not need to
complete Form 1, but you must submit Form 2S.
Item 1.2. Respond to the questions in Items 1.2.1 to 1.2.6. If you
answer “Yes” to any question in Items 1.2.1 to 1.2.5, you must
complete Form 1 and the Form 2 application specified. If you
also answer “Yes” to Item 1.2.6, you must also submit Form 2S.
See Exhibit 1–2 for filing deadlines.

You can find NAICS code numbers and descriptions in the
North American Industrial Classification System Manual
prepared by the Executive Office of the President, Office of
Management and Budget. This document is available from the
National Technical Information Service (NTIS) in Alexandria,
Virginia. It is also available online at
http://www.census.gov/eos/www/naics/.

If you answer “No” to every question in Items 1.1 and 1.2, then
you do not need an NPDES permit, and you do not need to
complete and return any of the NPDES application forms.
Contact your NPDES permitting authority if you have questions
about the need to submit an NPDES permit application or the
applicable forms that you need to submit.

Use the latest edition of the manuals. If you have any questions
about the appropriate SIC or NAICS codes for your facility,
contact your NPDES permitting authority.

Section 2. Name, Mailing Address, and Location
Item 2.1. Enter the facility’s official or legal name. Do not use a
colloquial name.

Section 4. Operator Information
Item 4.1. Give the legal name of the person, firm, public
organization, or other entity that operates the facility described
in this application. This may or may not be the same as the
facility’s name. The operator of the facility is the legal entity that
controls the facility’s operation rather than the plant or site
manager. Do not use a colloquial name.

Item 2.2. Provide your EPA Identification Number from the
Facility Registry Service if you have an existing facility. If you do
not know your EPA Identification Number, contact your NPDES
permitting authority. If your facility is new (i.e., not yet
constructed), write or type “New Facility.”
Item 2.3. 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. The NPDES permitting authority will
contact the person listed if they have questions on the material
submitted.

Item 4.2. Indicate whether the entity listed in response to Item
4.1 also owns the facility by marking the appropriate box.
Item 4.3. Indicate the ownership status of the operator of the
facility by marking the appropriate box. If the facility is a federal
facility (i.e., owned by the U.S. government), check the box for
“Public—federal.” If the facility is owned by a state government,
check the box for “Public—state.” If the facility is owned by a
county government, municipal (e.g., city or town) government,
tribal government, school district, water district, or other local

Item 2.4. Give the complete mailing address of the office to
which the NPDES permitting authority should send
correspondence. This often is not the address used to designate
the location of the facility or activity.
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FORM 1—LINE-BY-LINE INSTRUCTIONS (CONTINUED)
government entity, check the box for “Other public” and specify
the type of government entity. If the facility is owned by a
corporation or other private entity, check the box for “Private.” If
the facility has mixed ownership (e.g., public/private) or is not
owned by an entity of the types previously listed, check the box
for “Other” and specify the type of entity.
Items 4.4 to 4.6. Enter the telephone number, address, and
email address of the operator identified in Item 4.1.

•

All hazardous waste management, storage, and disposal
facilities.

•

Each well where you inject fluids underground.

•

All wells, springs, surface water bodies, and drinking water
wells that are in the public record or otherwise known to
you and that are located in the map area.

If the facility has associated water intakes, discharge structures,
hazardous waste disposal sites, or injection wells and these
items are located more than one mile from the facility, include
them on the map if possible. If you cannot, attach additional
sheets describing the location of the structures, disposal site(s),
or well(s) and identify the U.S. Geological Survey (USGS) or
other map corresponding to the location(s).

Section 5. Indian Land
Item 5.1. Indicate whether the facility is located on Indian Land.
Section 6. Existing Environmental Permits
Item 6.1. Check the appropriate boxes and provide the permit
numbers for all relevant federal, state, and local environmental
permits or construction approvals received or applied for under
any of the programs listed below. If you have more than one
currently effective permit under a particular permit program for
your facility, list the additional permit numbers on the
application form or on a separate sheet of paper.
•

Hazardous waste management program under the
Resource Conservation and Recovery Act (RCRA).

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., USGS).

•

Underground Injection Control (UIC) program under the
Safe Drinking Water Act (SDWA).

•

NPDES program under the Clean Water Act (CWA).

On all maps of rivers, show the direction of the current. In tidal
waters, show the directions of ebb and flow tides.

•

Prevention of Significant Deterioration (PSD) program
under the Clean Air Act (CAA).

•

Nonattainment program under the CAA.

•

National Emission Standards for Hazardous Pollutants
(NESHAPs) preconstruction approval under the CAA.

•

Ocean dumping permits under the Marine Protection
Research and Sanctuaries Act (MPRSA).

•

Dredge or fill permits under Section 404 of the CWA.

•

Other federal, state, or local environmental permits.

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 1–3 at the end of these
instructions. Note: Exhibit 1–3 is provided for illustration only; it
does not show an actual facility.
If the facility is a concentrated animal feeding operation, you are
not required to provide the topographic map required by this
section of Form 1. Instead, you are required to provide a
topographic map as specified in Section 4 of Form 2B.

Section 7. Map
Unless the facility is a concentrated animal feeding operation,
provide a topographic map(s) of the area extending at least
one mile beyond the property boundaries of the facility that
clearly shows the following:
•

The legal boundaries of the facility.

•

The location and serial number of each of your existing and
proposed intake and discharge structures.

Item 7.1. Note that you have completed your topographic map
and attached it to the application.
Section 8. Nature of Business
Briefly describe the nature of your business (e.g., products
produced or services provided). See Examples 1 and 2.

Example 1
Facilities Subject to 40 CFR 426, Subparts F and G
Industry A is an auto tempered and auto laminated glass manufacturing facility subject to effluent limitation guidelines (ELGs) for the
“Automotive Glass Tempering” and “Automotive Glass Laminating” subcategories of the “Glass Manufacturing” point source category at
40 CFR 426, subparts F and G. At the facility, glass is cut and then passed through a series of processes that grind and polish the
edges, bend the glass, and then temper the glass to produce side and back windows for automobiles. Tempering involves heating the
glass near the melting point, then rapidly cooling it to increase its mechanical and thermal endurance. The facility also produces
automobile windshields and undertakes processes that laminate a plastic sheet between two layers of glass and that prepare the glass
for lamination (e.g., cutting, bending, and washing).
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FORM 1—LINE-BY-LINE INSTRUCTIONS (CONTINUED)
Example 2
Facility Not Subject to ELGs
Industry B undertakes batch-type resin manufacturing operations. It has aboveground storage tanks for raw materials and finished
goods, resin loading operations, and warehouses for 55-gallon drums of finished product. Industry B manufactures alkyd, saturated and
unsaturated polyester resins in batches using reactor vessels and mix tanks. Most of the feedstock liquids are pumped from storage
tanks to the kettles and mixers via a closed piping system. Additional feedstocks are added manually as solids from bags and sacks via
manways, which are located on top of the kettles. The resin is then chemically reacted in the kettles. After the reaction step finishes, the
resin is transferred from the kettles to the mix tanks, where solvents are added to thin it. The primary byproduct of the reaction is water
vapor containing condensed soluble organics. The byproduct flows to an isolation tank where the vapors are directed to an onsite
thermal oxidizer. The finished resin is then pumped through one of three types of filtration systems into finished goods storage tanks,
55-gallon drums, 350-gallon intermediate bulk container totes, or directly into tanker trucks. A typical batch takes about 30 hours to
complete.
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.”

Section 9. Cooling Water Intake Structures
Item 9.1. Indicate whether the facility uses cooling water. If
yes, continue to Item 9.2. If no, skip to Item 10.1.

FEDERAL REGULATIONS AT 40 CFR 122.22 REQUIRE THIS
APPLICATION TO BE SIGNED AS FOLLOWS:

Item 9.2. Identify the source of the cooling water. For example,
indicate whether the cooling water is from a surface water,
groundwater well, public water system, or treated effluent that
would otherwise be discharged to a water of the U.S.

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).

If the facility uses a cooling water intake structure as described
in 40 CFR 125, Subparts I and J, the facility may have additional
application requirements under 40 CFR 122.21(r). Note that the
information required by 40 CFR 122.21(r) is not requested as
part of Form 1. Contact your NPDES permitting authority to
determine the specifics of what you should provide and when.
Section 10. Variance Requests
An applicant (other than a POTW) may request a variance from
otherwise applicable effluent limitations under certain
conditions described at 40 CFR 122.21(m).
Item 10.1. 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.
Section 11. Checklist and Certification
Item 11.1. Review the checklist provided. In Column 1, mark
the sections of Form 1 that you have completed and are
submitting with your application. In Column 2, indicate for each
section whether you are submitting attachments.
Item 11.2. 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

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FORM 1—LINE-BY-LINE INSTRUCTIONS (CONTINUED)
Exhibit 1–3. Example Topographic Map

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FORM 1— ACTIVITIES THAT DO NOT REQUIRE PERMITS
You are not required to obtain an NPDES permit if your discharge is in one of the following categories, as provided by the CWA and
NPDES regulations at 40 CFR 122 to 125. (However, under CWA Sections 510 and 312, some discharges exempted from the federal
NPDES requirements may still be regulated by a state permitting authority.)
•

Any discharge of sewage from vessels and any effluent from properly functioning marine engines, laundry, shower, and galley sink
wastes, or any other discharge incidental to the normal operation of a vessel, including vessels of the Armed Forces within the
meaning of Section 312 of the CWA and recreational vessels within the meaning of Section 502(25) of the CWA. None of these
exclusions apply to rubbish, trash, garbage, or other such materials discharged overboard; nor to other discharges when the vessel is
operating in a capacity other than as a means of transportation such as when used as an energy or mining facility, a storage facility or
a seafood processing facility, or when secured to a storage facility or a seafood processing facility, or when secured to the bed of the
ocean, contiguous zone or waters of the United States for the purpose of mineral or oil exploration or development.

•

Discharges of dredged or fill material into waters of the United States that are regulated under CWA Section 404.

•

The introduction of sewage, industrial wastes, or other pollutants into publicly owned treatment works by indirect dischargers. Plans or
agreements to switch to this method of disposal in the future do not relieve dischargers of the obligation to have and comply with
permits until all discharges of pollutants to waters of the United States are eliminated. (See also 40 CFR 122.47(b).) This exclusion
does not apply to the introduction of pollutants to privately owned treatment works or to other discharges through pipes, sewers, or
other conveyances owned by a state, municipality, or other party not leading to treatment works.

•

Any discharge in compliance with the instructions of an On-Scene Coordinator pursuant to 40 CFR 300 (The National Oil and
Hazardous Substances Pollution Contingency Plan) or 33 CFR 153.10(e) (Pollution by Oil and Hazardous Substances).

•

Any introduction of pollutants from nonpoint source agricultural and silvicultural activities, including stormwater runoff from orchards,
cultivated crops, pastures, range lands, and forest lands, but not discharges from concentrated animal feeding operations as defined
in 40 CFR 122.23, discharges from concentrated aquatic animal production facilities as defined in 40 CFR 122.23, discharges from
concentrated aquatic animal production facilities as defined in 40 CFR 122.24, discharges to aquaculture projects as defined in 40
CFR 122.25, and discharges from silvicultural point sources as defined in 40 CFR 122.27. Note: Per 40 CFR 122.26(b)(14)(ii),
facilities classified within SIC 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, and 373 (not included are all other types of silviculture
facilities) are considered stormwater discharges associated with industrial activity, and are required to obtain an NPDES permit.

•

Return flows from irrigated agriculture.

•

Discharges into a privately owned treatment works, except as the NPDES permitting authority may otherwise require under 40 CFR
122.44(m).

•

Discharges from a water transfer. “Water transfer” means an activity that conveys or connects waters of the United States without
subjecting the transferred water to intervening industrial, municipal, or commercial use. This exclusion does not apply to pollutants
introduced by the water transfer activity itself to the water being transferred.

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FORM 1—GLOSSARY
Note: This glossary includes terms used in the various NPDES application forms, including Form 1. 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.
2.
3.
4.
5.

700 mature dairy cows, whether milked or dry;
1,000 veal calves;
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;
2,500 swine each weighing 55 pounds or more;
10,000 swine each weighing less than 55 pounds;
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FORM 1—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:
1.

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:
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.

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FORM 1—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.
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FORM 1—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
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FORM 1—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
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FORM 1—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.
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FORM 1—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 where mining claims
1-18

FORM 1—GLOSSARY (CONTINUED)

4.

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;

5.

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.
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.

1-19

EPA Identification Number

NPDES Permit Number

Facility Name

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

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

Form
1
NPDES

GENERAL INFORMATION

Activities Requiring an NPDES Permit

SECTION 1. ACTIVITIES REQUIRING AN NPDES PERMIT (40 CFR 122.21(F) AND (F)(1))
1.1 Applicants Not Required to Submit Form 1
1.1.1 Is the facility a new or existing publicly owned
1.1.2 Is the facility a sludge-only facility (i.e., a facility
treatment works or has your permitting authority
that does not discharge wastewater to surface
directed you to submit Form 2A?
waters)?
If yes, STOP. Do NOT complete
 No
Form 1. Complete Form 2A. If the
facility is also a treatment works
treating domestic sewage, you
must also complete Form 2S.
1.2 Applicants Required to Submit Form 1
1.2.1 Is the facility a concentrated animal feeding
operation or a concentrated aquatic animal
production facility?
 Yes  Complete Form 1 and  No
Form 2B.
1.2.3 Is the facility a new manufacturing, commercial,
mining, or silvicultural facility that has not yet
commenced to discharge?
 Yes  Complete Form 1 and  No
Form 2D.
1.2.5 Is the facility a new or existing facility whose
discharge is composed entirely of stormwater
associated with industrial activity or whose
discharge is composed of both stormwater and nonstormwater?
 Yes  Complete Form 1 and  No
Form 2F unless
exempted by 40 CFR
122.26(b)(14)(x) or
(b)(15).

If yes, STOP. Do NOT complete
Form 1. Complete Form 2S.

1.2.2

1.2.4

1.2.6

Name, Mailing Address, and Location

SECTION 2. NAME, MAILING ADDRESS, AND LOCATION (40 CFR 122.21(F)(2))
2.1 Facility Name
2.2

EPA Identification Number

2.3

Facility Contact
Name (first and last)

EPA Form 3510-1

Title



No

Is the facility an existing manufacturing,
commercial, mining, or silvicultural facility that is
currently discharging process wastewater?
No
 Yes  Complete Form 
1 and Form 2C.
Is the facility a new or existing manufacturing,
commercial, mining, or silvicultural facility that
discharges only nonprocess wastewater?
 Yes  Complete Form 1  No
and Form 2E.
Is the facility a new or existing treatment works
treating domestic sewage that discharges
wastewater to surface waters?



Yes  Complete Form 1,
Form 2S, and
any other
applicable forms,
as directed by
your permitting
authority.



No

Phone number

Email address

Page 1

EPA Identification Number

2.4

NPDES Permit Number

Facility Name

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

Facility Mailing Address
Street or P.O. box

Name, Mailing Address,
and Location Continued

City or town
2.5

State

ZIP code

Facility Location
Street, route number, or other specific identifier
County name

County code (if known)

City or town

State

ZIP code

SIC and NAICS Codes

SECTION 3. SIC AND NAICS CODES (40 CFR 122.21(F)(3))
3.1
SIC Code(s)
Description (optional)

3.2

NAICS Code(s)

Description (optional)

Operator Information

SECTION 4. OPERATOR INFORMATION (40 CFR 122.21(F)(4))
4.1 Name of Operator

4.2

Is the name you listed in Item 4.1 also the owner?

 Yes  No
4.3

Operator Status

4.4

Phone Number of Operator

EPA Form 3510-1

 Public—federal
 Private

 Public—state
 Other public (specify)_______________
 Other (specify) _______________

Page 2

EPA Identification Number

Operator Information
Continued

4.5

NPDES Permit Number

Facility Name

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

Operator Address
Street or P.O. Box
City or town

State

ZIP code

Email address of operator

Indian
Land

SECTION 5. INDIAN LAND (40 CFR 122.21(F)(5))
5.1 Is the facility located on Indian Land?

 Yes  No

Existing Environmental
Permits

SECTION 6. EXISTING ENVIRONMENTAL PERMITS (40 CFR 122.21(F)(6))
6.1 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)

________________________

 RCRA (hazardous wastes)
____________________________

 Nonattainment program (CAA)

fluids)
________________________

 NESHAPs (CAA)

_______________________

 Dredge or fill (CWA Section 404)
 Other (specify)
________________________
____________________________
_________________________
SECTION 7. MAP (40 CFR 122.21(F)(7))
7.1 Have you attached a topographic map containing all required information to this application? (See instructions for
specific requirements.)
Map

 Ocean dumping (MPRSA)

___________________________

 UIC (underground injection of

 Yes  CAFO—Not Applicable (See requirements in Form 2B.)

Nature of Business

SECTION 8. NATURE OF BUSINESS (40 CFR 122.21(F)(8))
8.1 Describe the nature of your business.

Cooling Water
Intake Structures

SECTION 9. COOLING WATER INTAKE STRUCTURES (40 CFR 122.21(F)(9))
9.1 Does your facility use cooling water?
9.2

EPA Form 3510-1

 Yes  No  SKIP to Item 10.1.

Identify the source of cooling water. (Note that facilities that use a cooling water intake structure as described at
40 CFR 125, Subparts I and J may have additional application requirements at 40 CFR 122.21(r). Consult with your
NPDES permitting authority to determine what specific information needs to be submitted and when.)

Page 3

EPA Identification Number

NPDES Permit Number

Facility Name

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

Variance Requests

SECTION 10. VARIANCE REQUESTS (40 CFR 122.21(F)(10))
10.1 Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(m)? (Check all that
apply. Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
Fundamentally different factors (CWA

 Water quality related effluent limitations (CWA Section
302(b)(2))
Section 301(n))



Non-conventional pollutants (CWA
Section 301(c) and (g))



Not applicable



Thermal discharges (CWA Section 316(a))

Checklist and Certification Statement

SECTION 11. CHECKLIST AND CERTIFICATION STATEMENT (40 CFR 122.22(A) AND (D))
11.1 In Column 1 below, mark the sections of Form 1 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: Activities Requiring an NPDES

 w/ attachments
Permit
Section 2: Name, Mailing Address, and

 w/ attachments
Location



Section 3: SIC Codes



w/ attachments



Section 4: Operator Information



w/ attachments



Section 5: Indian Land



w/ attachments



Section 6: Existing Environmental Permits



w/ attachments



Section 7: Map



w/ topographic map



Section 8: Nature of Business



w/ attachments



Section 9: Cooling Water Intake Structures



w/ attachments



Section 10.: Variance Requests



w/ attachments

 w/ additional
attachments

Section 11: Checklist and Certification
 w/ attachments
Statement
Provide the following certification. (See instructions to determine the appropriate person to sign the application.)


11.2

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

Date signed

Click to go back to the beginning of Form
EPA Form 3510-1

Page 4