HomeMy WebLinkAboutNPDES Permit ApplicationMUNICIPAL NPDES PERMIT
COMPLETENESS CHECKLIST &
SUBMITTAL FORM
MAIL TO:
Indiana Dep.artment of Environmental Management
Office of Water Quality
Permits Section
P. O. Box 6015
Indianapolis, Indiana 46206-6015
Facility Name
Mailing Address
Facility Location
Contact & Telephone
REQUIRED INFORMATION
REQUIRED WITH ALL APPLICATIONS TECHNICAL APPLICA~I'IONS
X $50.00 Permit Application Fee
X Affected Parties Identification Form
Request for Information Form
X
Semi-Public WVqTP Form
Minor Municipal - Short Form A
Major Municipal - Form A and EPA Form
The Permit Fee, Affected Parties andRequest for Information Forms are required with all applications.
Please check the information that is included, and insure that all forms are completely filled out with
date and signature.
(Account No. & Revenue Code: 2830411200-100600~
Franlc 0 'Bottttott
Lori F. Kaplan
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT.
We make Indiana a cleaner, healthier place to live
P.O. Box 6015
(317) 232-8603
18001451-60'27
TO:
All NPDES Permit Applicants
FROM:
NPDES Pem~it Sectton
Office of Water Quality
SUBJECT: Request for Information
We request that you fill in th9 blanks on this form and return 'it along with your NPDES PERMIT
application. The information provided will be helpful in our personal contact with officials of our
municipality, industry or other facil ty in assuring prompt delivery of con'espondenee, etc. Thank you for
your cooperation.
I. Currenl N PDES Permit No. I N 00'23302 {.New applicants will N: assigned a number later)
11.
111.
WASTEWATER TREATMENT PLANT FACILITY LOCATION ADDRESS (PHYSICAL
LOCATION OF FACII.I'I'Y)
Facility Name: JEFFERSONVILLE WASTEWATER TREATMENT PLANT
701 CHAMPION ROAD
Address: ,
City: JEFFERSONVILLE State:_ IN .zip: 47130
MAILING ADDRESS IF DIFFERENT FROM FACILITY LOCATION
IV.
Address:
City: State: .Zip:
OWNER OR LEGALLY RESPONSIBLE PARTY (TOWN BOARD/CODNCIL I~RESIDENT,
MAYOR. SUPERINTENDENT)
Name: THOMAS R. GALLIGAN Title: MAYOR
Address: 501 F~. COURT AVF.NIIR
City: JEFF-ERSONVILLE State:_ IN .Zip: 47130
Phone:(R12 ) 2Rq-JS~00
WASTEWATER TREATMENT PLANT CERTIFI~,D OPERATOR
Name: TIMOTHY L. CRAWFORD Certification#: 131 56
.Address: 701 CHAMPION .RQA__D___
City:. jEFFERSONVILEE State:__IN Zip:. 47130
Work Pho,'~c(J~.~lW,._) 285-645_1 Classification:L IV
I. Identification of Potentially Affected Persons
Please list here any and all persons whom you have reason to believe have a substantial or proprietary interest in this~-
maUcr, or could othmxvisc be considered to be potentially affected nndcr the law. Failure to notify any person who is Iai,
detenniued to be potentially affected could result in voiding our deosion on procedural grounds. To ensure conformance
with AOPA and to avoid reversal o£a decision, please list all such parties. The letter attached to this form will [urther
explain the rcqu.'cmcnts under the AOPA
Name: US CENSUS BUREAU
Street: 1201 E. 10TH STREET
City/Stateff'Z, ip: JEFFERSONVILLE, IN
47130
Name: PEH ENGINEERS
Street: WATERFRONT PLAZA, SUITE 71 0
City/State/zip: 325 W. MAIN/LOUISVILLE, KY
40202
Name: ORSANCO
Street: 5735 KELLOGG AVENUE
City/State/Zip: CINCINNATI, OH
45228
~ FALLS OF THE OHIO STATE
PARK
~tatef.,~i01W. RIVERSIDE DRIVE
P: OT.ARg~VTT.T,Rr TN 47131
Name: US ARMY CORPS. OF ENGINEERS
Street: P O BOX 59
City/StateZZip: LOUiSViLLEt KY 40201
Street:
City~tateTZip:
Name: CSX
Street: 1350 PENNSYLVANIA AVENUE
City/State/zip: JEFFERSONVILLE, IN 47130
Name: JACOBI, TOOMBS, LANZ, INC.
Street: 120 BELL AVENUE
City/State/Zip: CLARKSVILLE, IN 47131
Name: CLARK COUNTY COMMISSIONERS
Street: 501 E. COURT AVENUE
City/State/zip: JEFFERSONVILLE, IN 47130
Nams: ASHLAND PARK
2 00 HROAD AY STREET
~ty/~tat~p: CLARKSVILLE, IN 47131
Name: CHAMPION WOOD PRODUCTS
Strea: 1301 WATT STREET
City/StaterZiP: JEFFERSONVILLE, IN 47130
Name:
Street:
City/State/Zip:
IL Please complete this form by signing the following statement.
I certify to the ~ptyf my kn,9,},vl/eft,~ I,.4aa~ve listed all potentially affected parties, as defined by IC 4-21.5.
[Signatu~ ,/~/./.~//c.,., Printed name: THOMAS R. GALL IGA4 Date: /I/,~/Z9*
~_l ' · .% /~, ,rI -- --
Facility Name: JEFFERSONVI~LI/E WASTE WATER TREATMENT PLANT / / '
../
Facility Address:
701 CHAMPION ROAD, JEFFERSONVILLE, IN 47130
III. T3'pe of Action (check one)
~NPDES PERMIT - 327 IAC 5
[] PRETREATMENT PERMIT - 327 IAC 5
[] SEWER BAN WAIVER REQUILST- 327 IAC 4
[] CONSTRUCTION PERMIT- 327 lAC 3
Return To:
Indiana Deparunent of Environmental Managemcm
Office of Water quality
100 North Senate Avenue
ILO_ Box 6015
Indianapolis, Indiana, 46206-6015
Identification of Potentially Affected Parties
Sta(¢ Fofra 49456 (7-99)
Indiana Department of Env/ronmcntal Management
Office of Water Quality
The Administrative Orders and Procedures Act (AOPA) IC 4-21.5-3-5(b), requires that the Indiana
Department of Environmental Management (IDEM) give not,ce of its decision on your application to
thc following persons:
(a) each person to whom the decision is specifically directed;
Co)
(c)
(d)
(e)
(f)
each person to whom a law requires notice to be given;
each competitor who has applied to the IDEM for a mutually exclusive license, if issuance is the
subject of the decision and the competitor's application has not been denied in an order for .
which all fights to judicial review have been waived or_e. xhaus[ed _
earn person who has provided the IDEM with a written request for notification of the decision;
each person who has a substantial and direct proprietary.interest in the issuance of the
(per, t/variance);
each person whose absence as a.party in the proceeding concerning the (permit/variance)
decision would deny another party complete relief in the proceeding or who claims an interest
related to the issuance of the (permit/variance) and is so situated that the disposition of the
matter, in the person's absence may:
(1) as a practical matter impair or impede the person's ability to protect that interest, or
(2) leave any other person who is a party to a proceeding concerning the permit subject to a
substantial risk of ineurring multiple or otherwise inconsistent obligations by reason of the
person's claimed interest.
IC 4-21.5-3-5(f) provides that we may request your assistance in identifying these people. Our failure to
properly identify and notify these people of the decision could have the result of voiding any decision
which is made.
Additionally, IC 13-15-3-1 requires IDEM to send notice that the pemfit applicatiofi has been received
by the department to the following:
(a) the board of County commissioners of a county affected by the permit application and
(b) the mayor of a city that is affected by the permit application, or
(c) the president of a town council of a town affected by the permit application.
Please provide on the attached form the names of those persons affected by these statutes.
JEFFERSONVILLE
¢. EXISTING ENVIRONMENTAL PERMITS ~r__
"t
. I ,47? 3,0., .. YES_ '~ NO '
N/A . .
Attach to this application a topograp~iJc map of the area extending to at least one mile beyond propei'ty bou'nderies. The map must show
the outline of the facility, ~he Ioc~tion of each of it~ existing' and proposed intake and discharg~*$~',,~.-tures. each of its hazardous waste
treatment, storage, or disposal facilities, and ~a'ch' ~N where it iniect~ fluids underground. Include all sprin,.q~.,., rivers and othbr surface.
.~. ..... .~;~ ;~.,,J._~.,.' ~... ~ ,,~.
MUNICIPAL WA~TEWATER TREATMENT FACILITY WITH ~ CAPACITY OF
5.2 MGD
under penalty of law that I have personally examined and am £amil~a~ witl~ 't~ ~n~o~at~n ~bm~ed in th[; appl;ca¢/on and
· ?~'U,Na *OOReSS,.. ,} .,,.p. ezzersonvllle WWTP
~ .. N. ,x,, X. ";. ~ ~ 701 Ch~pion Road
INSTRUCTIONS: Com01e[e A through J to determine whether you need to submit any perm t application forms to th,~ ,E. PA. If you another "ye=" to any
qu=tions, you mun submit this form and the supp ementat form lined in the pa~nth~ follo~ng the qu~ion. Ma~ X in the box in ~e ~;~ column
the supplemental form is a~ached. If you an~ "no" to ~h qu~on.
excluded from permit requirement; ~e Section C of the i~mction[ S~ aim. S~ion O of ~e im~iom for definitlo~ of hot-rod ~[
you n~d not ~bmit any of th~ form~ You may an~r 'no" if your act~hy
(FORM 2Al
A or 8 above? ~FO_RM 2CI
d'm:~ to water~ of the* U.S.? (FORM 281 X ]
w~ter~of ~e U.S.? (FORM_2D! · d~:haa~e to X I
I
I. FACILITY I
CRAWFORD,
· FACILITY ~_AILING ADOR
CLARK
A Form 3S10~1 (8-90)
COntINUE ON
NATIONAL POLLUTANT DISCHARGE EUMINATION sYSTEM
APPLICATION FOR PERMIT TO DISCHARGE WASTEWATER
STANDARD FORM A - MUNICIPAL
Please print o~r Type
CITY OF JEFFERSONVILLE
JEFFERSONVILLE
cay
INDIANA
30
(S~e. ~uc~or~) ' THOMAS R. GALLIGAN
MAYOR
JEFFERSONVILLE
C~
iNDIANA
Te~e 812
Em~na~S~temhasbee. me4e, 99 06 01 (PREVIOUS EFFECTIVE DATE)
MAYOR
YR MO DAY
Date ,NAo,r~a:t ion Skied
18 U.S.C. SecEon 1001 provides
Whoever, ~n any ~er ~ ~e ~ of ~ ~t or ag~ of ~ Unit~ ~t~ ~ ~ ~7~ f~, ~ls
~ ~ up ~ ~y ~ ~e, ~ d~ a ~te~ ~ or ~ ~y ~1~, ~ ~ ~t ~t~ent ~ r~ or
~k~ ~ ~ ~ ~ ~ ~ ~m~t
~t ~re ~ $10,~ ~ ~
fac~y where (:f~:flarge(s)
occur(s) o~ wi. occur.
Public P~vate
Yes No
JEFFERSONVILLE
CLARK
Rece~i~ Discharge
Number and Street
.~p Co4e
Average Deay Ftow to Fac~ity
(mgd) Give your average daily
Yes
N/A
N/A
I-2
t07ct 107c2
107dl 107d2
107el 107e2
5.336
N/A
14
N/A
189
Miles
CITY OF JEFFERSONVILLE
TOWN OF UTICA
Actual pop~t~on
Se,'ved
27362
591
27953 __
EPA Form 7559-.22 {7-7
eS~Tat ed average da~/was~
(a)
IDEM _
Agency Use License
(b) (c}
NPDES
(d) (e)
IN0023 )2
Date Issued
(t)
13, Maps and Drawings
Date Denim Ex~rat~3a
Date
YR/MO/DA YR/MO/DA
(g) (h)
Item Number
2
3
4
EPA Form 7550-22 (7-73)
Information
SCHMEATIC OF WASTEWATER FLOW
SCHEMATIC OF SYSTEM CONVEYANCE
JEFFERSONVILLE LOCATION MAP
U.S. GOVERNMEI~'F PRINTING OFFICE: 1975~28-068/448 3-
STANDARD FORM A - MUNICIPAL
SECTION I[ BASIC DISCHARGE DESCRIPTION
BEFORE FILl. lNG OCff THESE REMS.
(See instructions)
001
001
OHIO RIVER VIA CANE RUN CREEK
EST
t~A OTH
/m ~°~1 3 8 DEG
II-2
16
44
48
~narge. {See
Give reaso~s ~y bypass ocoJrs
Overt'low ~rge (~ee hsinJ<~m~)
a. Ore.low Occurrence
~ANE RUN TO OHIO RIVER
~/A
Feel
N/A
Feel
Yes N/A No
Y"~ __ N/A No
N/A
N/A
N/A
yp,; N/A
-N/A
Yes
~/A
10¸
Oays
Oct N/A NOV ,
EPA Form 7550~22 ~7.73~
14.
DISCHARGE SERIAL NUMBER
001
Description of Influent and Effluent (See Instructions)
Parameter and Code
214
0050
Influent
Annual
Value Average Value
5.445
5,336
Average Value
4.505
NIA N/A N/A
)0 mi
if available)
Fecal Coliform Bacteria
if available)
Coliform Bacteria
Prowae if available)
~OD 5-day
hemical Oxygen
204
5.2
OR
Carbon
00680
Provid6 if availabte)
NIA
N/A
S0060
-Total
0.01
0.01
Form Approved OMB No. 156-R0100
Effluent
Frequency of Number el Sample
~,verage Value Analysis Analyses Type
7.103 ] CONT. 365 N/A
8 7/7 365 G
NA NIA NIA · N/A
87~ NOV-MAR 7/7 120 G
N/A NIA N/A N/A
6.5 7/7 365 24
N/A N/A N/A N/A
0.01 7/7 365
EPA Form 7550-22 (7-73)
DISCHARGE SERIAL NUMSER
001
Description of Influen~ and Effluent (See Instructions) (Continue(J)
fflfluent
Effiuen[
ParameTer and Cooe Annual LOWeSt Montdiy
Value Average Value Average Value Average Valu~
214
¥otat Solids
Total Dissolved Solids
g,~
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Frequency of
AnaJysis
N/A
N/A
mg/~ 217 6.7
00530 5.1
e Ma~ter
N/A
N/A
N/A
9.0
N/A
7/7
N/A
Kieldahl Nitrogen
Nitrat? (as NI
iProvide if ava able:
Nitrate (as N)
3hosphorus Total (as P)
3issolved Oxygen 'DO
00300
12,9
N/A
N/A
N/A
N/A
0.166
N/A
N/A
N/A
N/A
8.0
0.078
N/A
N/A
N/A
7.0
0.394
N/A
N/A
N/A
N/A
8.9
7/7
N/A
N/A
N/A
N/A
7/7
EPA Form 7550-22
003
(215) (215) (215)
Cc~alt Thatlium
0O940 X
C<~pe~' Tin
×'
00951 X
Mo~oden~m
'~-n ,~.~-~L~ 1, m~..~ a~d ro~enticldes must be re~o~ted in temls o! the acceptable ~,qo~ r, ames epec~ied in Acceptable
Jun~.. !p~..es..~r~re~ ~ <~.. e<~on ~ e~..7~) of u~e Re~,da~n~ ~' ~ ~nfo,"ce~t o~ U~e Feue,~l I~e~,de. ~u~,~,de. a~ ro~err~
I!-8.
OlSCH,~RGE SERIAL ta~MI~ER
-"~JZO ~ ......... "
II-9
FormADoroved OME No. ~58-R0100
STANDARD FORM A - MUNICIPAL
SECTION Ill SCHEDULED IMPROVEMENTS AND SCHEDULES OF IMPLEMENTATION
DIFFERENT IMPLEMENTATION SCHEDULES EITHER BECAUSE OF DIFFERENT LEVELS OF AUTHORITY IMPOSING DIFFERENT
SCHEOULES ¢~TEM lb AND/OR STAGED CONSTRUCTION OF SEPARATE OPERATIONAL UNITS TEM 'lc' SUBMIT A SEPARATE SECTION
FOR EACH ONE
a Discharge Seriat Numbers FOR AGENCY USE
D. Authorit~ imposing Requirement
Locafly developed alan X LOC
Area'wide Plan ARE
Basn Plan BAS
State court order CRT
c. improvement Descrict[on. Specif~ the 3 character code for the
constructin schedule state the stage of construction being MASTER PLANNING UNDERWAY
described here with the appropriate general action code. SEVERAL OPTIONS BEING EXPLORED.
3-character generaI action ~301c NEW-INT
I
3-character soecific action ' 301d SEC
mc ementationSteos 2. Schedule YdMo/Day) 3.ActuaIComDlet~on yr/Mo/Day)
N/A 1302a
NIA 302P
N/A 302C
N/A 302d
N/A 302e
N/A 302f
N/A 302g
N/A 302h
N/A
N/A
N/A
N/A
N/A
N/A
EPA Form 7550-2217-73)
-his Section contains 1 page
STANDARD FORM A - MUNICIPAL
SECTION IV - INDUSTRIAL WASTE CONTRIBUTION TO MUNICIPAL SYSTEM
INDIANA AMER CAN WATER COMPANY
2433 MIDDLE ROAD
JEFFER$ONVILLE
POTABLE DRINKING WATER
WELL NATER
0 O09
STANDARD FORM A - MUNICIPAL
SECTION V- INDUSTRIAL WASTE CONTRIBUTION TO MUNICIPAL SYSTEM
~aw Material
CARGO CLEAN
62t3 GHEENS MILL ROAD
JEFFERSONVILLE
CLAR~<
4713C
7699
Yes
EPA Form 7550~22
STANDARD FORM A - MUNICIPAL
SECTION IV - INDUSTRIAL WASTE CONTRIBUTION TO MUNICIPAL SYSTEM
Number & Street
BRINLEY HARDY
3230INDUSTRIAL BLVD
JEFFER$ONVILLE
CLARK
tN~ ANA
47130
3524
Parame[er rOTAL SUSPENDEE I
~me BOD SOLIDS {TSS) AMMONIA
STANDARD FORM A- MUNICIPAL
SECTION IV - INDUSTRIAL WASTE CONTRIBUTION TO MUNICIPAL SYSTEM
Submit a description of each major industrial facility discharging to tile Rluntclpa{ system, usm~ a separate Section IV loc each facility
Number & S~met
City
47130
Product
HCL, NAOn
X Yes
Parame[er TOTAL SUSpENOEC
Name ~OD SOLIDS (TSS) AMMONIA
STANDARD FORM A - MUNICIPAL
SECTION IV - INDUSTRIAL WASTE CONTRIBUTION TO MUNICIPAL SYSTEM
X Yes mNO
IV-2
STANDARD FORM A - MUNICIPAL
SECTION IV - INDUSTRIAL WASTE CONTRIBUTION TO MUNICIPAL SYSTEM
2819
ZEOLITES
SODA ASH, NAOH, ALU MINA TRI-
HYDRATE
Qu~mnt[by Jnlt$ (see
Table
STANDARD FORM A - MUNICIPAL
SECTION IV - INDUSTRIAL WASTE CONTRIBUTION TO MUNICIPAL SYSTEM
Number & Street
ALTEC, iNC
242AMERICA pLACE
JEFFERSONVILLE
CLARK
47130
3354
MANUFACTURE AND PAINT I.~03c [
ALUMINUM EXTRUCION$
ALUMINUM BILLETS. H2SO4, NAOH 403d
PAINTS
STANDARD FORM A - MUNICIPAL
SECTION IV - INDUSTRIAL WASTE CONTRIBUTION TO MUNICIPAL SYSTEM
DALLAS 31~OUP
1402 FABRICON BLVD
JEFFERSONVILLE
47130
2819
MANUFACTUREMAGNES[UM
$1UCATE
~ODiUM SILiCATE, MAGNESIUM
HYDROXIDE
EpA Form 7550-22 (7-73}
STANDARD =ORM A - MUNICIPAL
SECTION IV - INDUSTRIAL WASTE CONTRIBUTION TO MUNICIPAL SYSTEM
WYANDOT
155 pEACELY STREET
JEFFER$ONVLLE
CLARK
47130
2099
MANUFACTUREPOTATOE&CORN
CHIPS
pOTATOES AND CORN
STANDARD FORM A - MUNICIPAL
SECTION ['V - INDUSTRIAL WASTE CONTRIBUTION TO MUNICIPAL SYSTEM
Submit a desCnpflon of each major industrial facility discharging to the municipaf system, using a separate Section IV for each facilit~
oescdotion, ndicate the 4 ¢hg~t StanDarD moustda Classification (SIC) Code for the ~nciustry, the major product
GEORGEPFAU&SONS
829WALL STREET
JEFFERSONVILLE
47130
2O77
pROCESSAN[MALFATSAND OILS
AN~MALFAT. H2SO4, NAOH ·
TOTAL SUSPENDED I
Parameter
Name BOD SOLIDS/TS$/ AMMONIA
L L 738 361L 177=
STANDARD FORM A - MUNICIPAL
SECTION I[ SASIC DISHCARGE DESCRIPTION
Complete th~s section for each present or propose6 discnare indicatee in Section 1 items 7 aha. tna[ is to surface waters. This includes
discharges to other municopal sewerage systems n winch the waste water does not go thourgh a treatment works prior to being
dischargesa to surface waters. Discharges to wells must Be eescribed where there are also discharges to surface waters from this facility.
Separate descriptions of each d,scharge are requirea even if several discharges originate in the same facility. A~I value." for an existing
discharges hould be reqpresen~3tive of the twelve previous months of operation. If this is a proposed disharge, values snou[c reflect best
engineering estimates
003
SPRING STREET L :T STAT[N OVERFLOW
State
County
38
DEG
DEG'
M]N
IV-2
DISCHARGE SERIAL NUMBER
0O3
6. Discharge Receiving Water name /
Name of the wale~vay a~ the oolnt of /2 206
Discharge Receiving Water name
If the discharge i$ t~rougrl an out fal mai extenas 206b
7 Offshore Discharge
DQ/weether
__ MILL CREEK
IV-3
OCt
Feb _
II-4
11-5
STANDARD FORM A- MUNICIPAL
SECTION ti BASIC DISNCARGE DESCRiPTiON
Complete this section for each present or proposea discnare indicated in Section 1, items 7 and, that is to surface waters. This incluaes
discharges to other munico.Dal sewerage systems in which the waste water does no[ go thourgh a treatment works prior to being
dischargesd to surface waters. Discharges [o weus must he oescdbed where mere are a~so. discharges to..surfaceA~l valuesWaterSfo~fr°man [hiSexistingfacUity.
Separate descriptions of each discharge are reqmred even if several discharges oflgmate m the same facdfly.
discharges nould be reqpresentabve of the twelve previous months of operation if this is a proposed dlsharge values shoul~ reflect best
engineering estimates
N/A
N/A
N/A
N/A
85
OEG'
eEC
- SEC-
EpA Farm7550-22~-73)
IV-2
DISCHARGE SERIAL NUMBER
0O4
Bypass Frequency
Bypass Volume
MJLL CREEK
For A~enc¥ use
N/A Feet
N/A Feet
NQ
IV-3
Days
11-4
II-5
STANDARD FORM A- MUNICIPAL
SECTION II BASIC DISHCARGE DESCRIPTION
Complete this section for each present or 0ropceed C schare indicated n Section I. items 7 and, that is to surface wa[ers. This inciuaes
discharges to other municooal sewerage systems in which the waste water does not go thourgn a treatment WORKS Prior to being
dischargesd to surface waters. Discharges to wells must De described where there are atso discharges to surface wa[ers from this facility.
Seoarate descriptions of each discharge are reauired even if several discharges originate in the same facil ~/, Ali values for an existing
discharges hould be reqpresentative of the tweNe Drewous months of oceratlon if this is a proposed disharge ValUeS should reflect best
engineering estimates.
Discharge Sene NO and Name I 005
Estuary
EPA Form 7550-22 ~7-73
MISSOURI AVENUE OVERFLOW
Clark 203e
Jeffersonmlle 203f
SEC
O5
SE(;
O0
IV-2
Form Approved OMB No 158-R0100
DISCHARGE SERIAL NUMBER
O05
7 Offshore Discharge
a Discharge distance from shore
6. Discharge Receiving Water name
206b
207a
207b
I
-~'ry wealner
c Bypass Duration
EPA Form 7550-22 '7-73/
OHIO RIVER
For ac~ency Use For Agency Use
UNKNOWN Feel
UNKNOWN Feet
Yes No
Yes X No
IY-2
N/A
ONE
Oays
DISCHARGESER~LNUMBE~
005
Form Ad.dYed OMB No 158-RO100
STANDARD FORM A- MUNICIPAL
SECTION Il BASIC DISHCARGE DESCRIPTION
Com~: e[e this section for each present or proposed dlschare indicated in Section 1 items 7 and that is [o surface waters, This inClUdes
discharges to other municooal sewerage systems in which the waste water does not go thourgh a treatment works prior to being
dischargesd to surface waters. Discharges to wells must De oescnuee where there are also discharges to surfacs waters from this facility.
Separate descriptions of each discharge are reouired even if several discharges ong hate in the same facility, All values for an existing
discharges hould be reqpresentaflve of the twelve previous months of ooeraflon. [f this is a proposed disharge, values should reflect best
engineering estimates.
RIVERPOINT e ERFLOW
Clark 203e
Jeffersonvtlla 203f
DEG
36
DEG
85
MiN SEC
15 O0
MiN SEC
45
DISCHARGE SERIAL NUMBER 006
OHIO RIVER
IV~2
ONE
II-4
1I-5
STANDARD FORM A- MUNiCipAL
SECTION ti BASIC DISHCARGE DESCRIPTION
Complete mis section for each present or propose¢ discnare indicated in Section 1 items 7 and, mat is te surface waters This includes
discharges to other municopa~ sewerage systems in WhiCh t~e waste water does not go thourg~ a treatment works prior to being
dischargesd to surface waters. Discharges [e welts must De eescdbed where there are also discharges m surface waters from this facility.
Ser)arate descriptions of each discharge are required even [; several discharges originate in me same facility. Ail values for an existing
discharges hould be reqpresentative of the twelve previous months of operation, if this is a 3roposeo disharge values should reflect best
eng[neenng estimates,
See inst~u~ons)
0O7
FREET OVERFLOW
203d l
203e
203f
STR
EST
LKE
aCE
WEL
OTH
MIR
OEG 16 05
SEC
SEC
DISCHARGE SERrAL NUMBER OO7
OHIO RIVER
JNKNOWN Feet
UNKNOWN Feel
X Yes NO
Yes X NO
DISCHARGESERIALNUMB~R
007
N/A
N/^
Days
11-4
II-5
STANDARD FORM a - MUNICIPAL
SECTION [I BASIC DISHCARGE DESCRIPTION
Complete this section for each present or proposed dischare indicated in Section I items 7 and. that is to surface waters. This includes
discharges to other municopal sewerage systems in which the was[e water does not go mourgn a treatment works Drior to being
dischargesd to suri=aca waters Discharges to wells rnust be described where there are also discharges to sur[ace waters from this facility.
Separate oeacnptions of each discharge are required even if several discharges originate in the same facility. All values for an existing
discharges hould be reqpresentative of the twelve orevious months of operation, f this ia a proposed disharge, values should reflect best
engineering estimates.
Discharge Sedal NO. and Name 008
a Discharge eedal NO.
(See instructions'
EPA Form 7550-22
SPRING STREET OVERFLOW
Clark 203e
Jeffersonvli[e 203
STR
DEG MIN SEC
38 16 10
DSG MIN SEC
85 20
DISCHARGE SERIAL NUMBER OO8
206a
207a
207b
OHIO RIVER
UNKNOWN Feet
UNKNOWN Feet
For Agenc~ Use
13 Times per year
NIA T~mes per year
IV-3
DISCHARGE SERIAL NUMBER
O08
Days
EpA FO~1755~22
1I-4
II-5
STANDARD FORM A- MUNICIPAL
SECTION II BASIC DISHCARGE DESCRIPTION
Complete mis section for each present or proposed dischare indicated in Section 1 items 7 and, that is to surface waters. Thi-~ includes
discharges [o other mumcopal sewerage systems in which the waste water does not go tnourgn a treatment works prior to being
dischargesa to surfacg waters. Discharges to wells must be aescribea where that6 ere also discharges to surface wa[ers from this facility.
Separate descriptions of each discharge are reoulred even if several discharges originate in the same facility. ,All values for an existing
discharges hould be reqpresentad~e of the twelve previous months of operation. [f this is a proposed disharge values shoula reflect best
engineering estimates
Discharge Serial NO. and Name
Discharge Senal NO
Give name of disCharge, if any
Aqen~ use
N/A
STR
EST
LKE
aCE
WEL
OTH
38
MIN
SEC
SEC
DISCHARGE SERIAL NUMBER 009
Discharge Receiving Water name
Name of the waterway at the point of
Discharge Receiving Water name
OHIO RIVER
Offshore 2ischarge
a Discharge ¢llstance from shore UNKNOWN :eet
o Discharge oepm oemw water UNKNOWN Feet
Timesperyear
Timespecyear
Yes No
Yes --. X NC
EPA Fom~ 7550-22 ~7-73
IV~2
Days
Form Approved OMB NO 158-R010~
I1-5
STANDARD FORM A * MUNICIPAL
SECTION II BASIC DISHCARGE DESCRIPTION
Comolete th~s section for each present or proposee dischare indicated in Section 1, items 7 and, thai s to surface waters. This includes
discharges to other municopal sewerage systems in which the waste water aces not go tnourgn a treatment works prior to being
dischargesd to surface waters. Discharges to wells must be describeC where there are also discharges to surface waters from this facility.
Separate descnpaons of each discharge are required even if several discharges originate in the same facility. All values for an existing
discharges hould be reqpresentatlve of the twelve prewous months of operation. ~f this is a 9roeosed d[sharge, values ShOUld reflect best
engineering estimates.
Discharge Senal NO and Name 010
State
County
5 DisCharge Point - LaC-cng
State the precise location of thepoint of
EPA Form 7550-22
WALNUT STREET OVERFLOW
Clark 203e
Jeffersonv[lle 203f
N/A
38
85
DEG
MIN
MtN
SEC
SEU'
05
DISCHARGE SERIAL NUMBER 0'~0
2O6a
207a
207b
OHIO RIVER
For Agency Use For A~enc~ Use
UNKNOWN Feet
UNKNOWN Feet
Bypass Frequency
Ye." NO
Yes No
TJmesperyear
Proceed to Item
Wet weathel
10.
Days
N/A
N/A
MaK
Jun
Sep ,
II-4
STANDARD FORM A - MUNICIPAL
SECTION ti BASIC DISHCARGE DESCRIPTION
Complete this section for each present or proposed dischare indicated in Section 1, items 7 and, that is to surface waters. This includes
discharges to other municopal sewerage systems in which the waste water does not go thourgh a treatment works prior to being
dischargeso to surface waters. Discharges to wells must be described where there are also discharges to surface waters from this facility,
Separate descriptions of each discharge are requ~rea even if several discharges originate in the same facility, Al! values for an existing
discharges nould he reqpresentative of the twelve previous months of operation. If this is a proposed disharge, values should reflect best
engineering estimates.
OCE
MIN SEC
DEG 16 ~0
38 DE~' a3 55
85
IV-2
DISCHARG,:: SERIAL NUMBER
011
OHIO RIVER
For A~enc¥ use For Agency Use
Feet
NKNOWN Feet
IV-2
DISCHARGE SERtAL NUMBER
01'
Days
EPA For~ 755~22 (7-73)
II-4
II-5
STANDARD FORM A- MUNICIPAL
SECTION [I BASIC DISHCARGE DESCRIPTION
Complete this section for each present or proposed dischare indicated in Section 1. items 7 and that is to surface waters. This includes
discharges to other municopa[ sewerage systems in which the waste water does Rot go thourgh a b'eatment works prior to being
dischargesd to surface waters. Discharges to wells must be described where there are also discharges to surface waters from this facility.
Seoarate descriotions of each discharge are required even if several discharges originate in the same facility. All values for an existing
discharges hould be reqpresentative of the twelve orevious months of operation, f this is a proposed disharge, values should reflect best
engineering estimates.
c Previous Discharge Sedal No.
PENN STREET OVERFLOW
N/A
x STR
N/A EST
DISCHARGE SERIAL NUMBER 012
7 Offshore Discharge
c, Bypass Duration
Give reasons why bypass occurs
Proceea to item 11
206b
207a
207b
OHIO RIVER
For A~enc)~ USe For A~enc}~ Use
UNKNOWN Feet
UNKNOWN Fee~
X Yes NO
Yes × NO
APPROX 20 Times per year
0 Timesperyear
Discharge Treatment
DISCHARGE SERIAl. NUMBER
012
Feb
11-4
DISCHARGE SERIAL NUMBER
012
EPA Fotna 7550-22 (7.731
II-5
STANDARD FORM A * MUNICIPAL
SECTION Il BASIC DISHCARGE DESCRIPTION
Complete this section for each present or proposed dischare indicated in Section 1. items 7 and. that is to surface waters. This includes
discharges to other municopal sewerage systems in which the waste water does not go thourgh a treatment works prior to being
dischargeso to surface waters. DiScharges to wells must be described where mere are also discharges to surface waters from this facil ~y,
Separate descriptions of each discharge are re~4u~red even if several discharges originate in the same facility. All values for an existing
discharges hould be reqpresentative of the twelve previous months of operation. If this is a proposed disharge, values should reflect best
engineering estimates.
Discharge Serial NO. and Name 013
Discharge SefiaT No.
c. Previous Discharge Sedal No
GRAHAM STREET OVERFLOW
Aqency use
N/A LKE
N/A OCS
DEG
DEG
MIN
MIN
SEC
35
SEC
35
This Se~on contains 8 pages
DISCHARGE SERIAL NUMBER 013
Offshore Discharge
OHIO RIVER
For Agency Use For Agenc}, Use
UNKNOWN Feet
UNKNOWN :eot
D B~ass Frequencz
Wet weather Times per year
Proceed to Item 11
Wet weather x Yes No
IV-3
This Section contains 8 pages
Timesperyeat
Oct
Days
EPA For~ 7550-22 ~7-75}
11-4
II-5
STANDARD FORM A - MUNICIPAL
SECTION II BASIC DISHCARGE DESCRIPTION
Comolete th~s section for each present or proposed dischare indicated in Section 1. items 7 end, that is to surface wa[ers. This includes
discharges to other municopal sewerage systems in which the waste water does not go thourgh a treatment works prior to being
dischargesd to surface waters. Discharges [o wells must De aescribed where there are also discharges to surface waters from this facility.
Separate descriptions of each discharge are required even if several discharges originate in the same faci[ibJ. All values for an existing
discharges hould be reaoresemadve of the twelve previous months of operation. If this is a proposed disharge, values should reflect best
engineering estimates.
3~scharge Sene NO. and Name
a Discharge Serial NO
014
BLANCHELTERRACEOVERFLOW
203e
38
85
MLN
55
M]N
42
SEC
SEC
EPA Form 7550,22 (7-73
DISCHARGE SERIAL NUMBER 014
Wei~eather
OHIO RIVER
UNKNOWN Feet
UNKNOWN Feet
Timesperyeal
Times peryear
NO
NO
1I-4
STANDARD FORM A- MUNICIPAL
SECTION Ii BASIC DISHCARGE DESCRIPTION
~mp~etethissecti~nf~reach~reSent~rpr~p~seddiScnare[ndicatedinSecti~n1~items7and tha~ is to surface waters Thisinc[udes
discharges to other municopa[ sewerage systems in which the waste water does not go mourgh a treatment works srior to being
dischargesa to surface waters. Discharges to wells must be described where there are also discharges to surface waters from this facility.
Separate descriptions of each discharge are required even if several d~sc~arges originate in the same facility. Ali values for an existing
discharges hou[d be reqpresentat[ve of the tweNe previous months of operation, if this is a 3ro~osed disharge, values should reflect best
engineering estimates.
DisCharge Sedal No and Name 015
DisCharge Sedat NO
EPA Form 7550-22 (7-73)
ATCTIC SPRINGS LIFT STATION OVERFLOW
203dt
203e
203f
38
85
DEG
DEG
MIN
SEC
00
SEC
40
This Section contains 8 pages
DISCHARGE SERIAL NUMBER 015
6 Discharge Receiving Water name
206a
206b
207a
207b
UN-NAMED DITCH TO OHIO RIVER
For A~ency Use
For A~ency Use
303e
Check when bypass occurs
IV-3
10.
Days
1I-4
EPA Form 7550-22
II-5
Folm Aooroved OMB NC 155-R0100
STANDARD FORM A - MUNICIPAL
SECTION ti BASIC DISHCARGE DESCRIPTION
Complete this section for each present or proposed discnare indicatec in Section 1 items 7 and mat is to surface waters. This includes
discharges to ether municopal sewerage systems n which the waste water does not go tnourgh a treatment works prior to being
discharges(3 to surface waters Discharges to welts must De oescribed where there are also a~scnarges to surface waters from this facility
Separate aescnpt~ons of each discharge are requirer~ even if several discharges originate in the same facility Ail values for an existing
discharges nould be reqpresentative of the twelve prewous months of operauon. If this is a proposed disnarge, values shoutd reflect best
engineering estimates.
Give name of discharge, if any
TENTH STREET L :T STATION OVERFLOW
ctar~ 203e
Jeffersonvl~le 203f
38
DEG
85
EpA Form 7550-22 (7-73)
IV-2
Form Approved OMB No 158.R0100
DISCHARGE SERrAL NUMBER
018
II-5