Download 04 Module 1 and Module 1 Instructions

3800-PM-BCW0008d
Module 1
11/2016
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF CLEAN WATER
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
APPLICATION FOR INDIVIDUAL PERMIT TO DISCHARGE
INDUSTRIAL WASTEWATER
MODULE 1 – STORMWATER
1.
Applicant/Operator Name:
2.
List all outfalls receiving stormwater in whole or in part and provide the requested information.
Outfall No.
Entirely
Stormwater?
Drainage
Area (ft2)
%
Impervious
Description of Materials/Activities in Drainage Area
Exposed to Precipitation
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No
Exposure?
3800-PM-BCW0008d
Module 1
3.
11/2016
Applicant Name:
List all outfalls receiving stormwater in the same order as question 2, above, and provide the requested information.
Outfall No.
Sampling
Completed?
Representative
Outfall No.
Treatment?
Description of BMPs in Drainage Area to Control
Pollutants in Stormwater
PCSM?
4.
All non-stormwater discharges from these outfall(s) are identified in the Discharge Information section of the application?
5.
If there have been leaks or spills on-site within the past five years that have reached stormwater outfall(s), identify the outfall(s)
receiving the leaks or spills, the substance(s) released, measures taken to remediate the incident(s) and preventative
measure(s) taken to reduce the possibility of future incidents. Attach additional sheets as necessary.
6.
Describe how often stormwater outfalls are inspected and routine maintenance performed, if not identified in question 3.
Yes
No
There are no non-stormwater discharges associated with these outfalls (If No, attach an explanation)
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3800-PM-BCW0008d
Module 1
11/2016
Applicant Name:
STORMWATER SAMPLING RESULTS
Complete the following tables for each stormwater outfall sampled for analysis.
OUTFALL NO.:
1.
You must provide the results of at least one analysis for every pollutant identified in the table below.
Average Concentration
Pollutant
Grab Sample
Flow-Weighted
Composite
Sample
Maximum Concentration
Grab Sample
Flow-Weighted
Composite
Sample
No. Storm
Events
Sampled
Quantitation
Limit
Oil and Grease (mg/L)
BOD5 (mg/L)
COD (mg/L)
TSS (mg/L)
Total Nitrogen (mg/L)
Total Phosphorus (mg/L)
pH (S.U.)
2.
Min:
Max:
Min:
Max:
XXX
List all pollutants contained within an Effluent Limitation Guideline (ELG) that is applicable to the facility’s production. Also list all
pollutants listed in the facility’s existing NPDES permit for the outfall identified above; process wastewater discharges; and any
other pollutants that are considered the cause of impairment to waters receiving stormwater discharges from the outfall. Provide
the results of at least one analysis for every pollutant listed. Specify the units with your results (e.g., mg/L).
Average Concentration
Pollutant
Grab Sample
Flow-Weighted
Composite
Sample
Maximum Concentration
Grab Sample
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Flow-Weighted
Composite
Sample
No. Storm
Events
Sampled
Quantitation
Limit
3800-PM-BCW0008d
Module 1
11/2016
Applicant Name:
OUTFALL NO.:
3.
List all pollutants contained in Pollutant Groups 1 through 7, as identified in the Analysis Results Tables of the industrial
wastewater application (3800-PM-BCW0008b), which are not identified in questions 1 or 2 of the Stormwater Sampling Results
section, but the applicant knows or has reason to believe are present in the stormwater discharge.
Average Concentration
Pollutant
4.
Grab Sample
Flow-Weighted
Composite
Sample
Maximum Concentration
Grab Sample
Flow-Weighted
Composite
Sample
No. Storm
Events
Sampled
Quantitation
Limit
Provide the information requested below for the storm event(s) that resulted in the maximum values reported in questions 1, 2
and 3 for the flow-weighted composite sample.
Storm Event Date
Duration of Storm
Event (Min)
Total Rainfall
During Storm Event
(In)
No. Hours Since
End of Previous
Measurable Storm
Event
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Maximum Flow
Rate During Storm
Event (GPM)
Volume of
Stormwater at
Outfall from Storm
Event
3800-PM-BCW0008d 11/2016
Module 1 Instructions
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF CLEAN WATER
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
APPLICATION FOR INDIVIDUAL PERMIT TO DISCHARGE
INDUSTRIAL WASTEWATER
INSTRUCTIONS FOR MODULE 1 – STORMWATER
New and existing industrial facilities with stormwater discharges must complete Module 1. Attach the completed
Module 1 form to the industrial wastewater permit application (3800-PM-BCW0008b) for all outfalls that receives any
stormwater, in whole or in part (combined with other wastewaters). Pages 1 and 2 of Module 1 are general to all
stormwater discharges on-site; the Stormwater Sampling Results section of Module 1 should be completed for each
outfall sampled. Attach additional sheets as necessary to provide all requested information. A site map with
stormwater outfalls and drainage areas must be attached to the application.
1. Identify the applicant or operator name, as reported on page 1 of the industrial wastewater permit application.
2. List all outfalls (in sequential order by Outfall No.) receiving stormwater in whole or in part and provide the
following information:

Entirely Stormwater? – Check the box if the outfall receives only stormwater. If the box is checked, the
permittee is certifying that there are no non-stormwater discharges to the outfall (or, for new facilities, there is
no intention to discharge non-stormwater).

Drainage Area (ft2) – Report the total drainage area, in square feet, in which stormwater runoff may flow to
the outfall.

% Impervious – Indicate the percentage of the drainage area is impervious. For the purpose of this Module,
impervious surfaces are those where stormwater runs off at rates significantly higher than background rates
and include paved areas, building roofs, parking lots, and roadways.

Description of Materials/Activities in Drainage Area Exposed to Precipitation – Identify all materials in
the drainage area that may be exposed to precipitation. Identify materials used for production, tanks or
containers and their contents, vehicular maintenance activities, product storage, etc. The applicant should
report sufficient information to allow DEP to understand why the applicant considers two or more outfalls to
be similar in nature, if applicable.

No Exposure? – Check the box if the applicant certifies there are are no industrial sources of pollutants in
the drainage area of the outfall and the applicant believes there is no potential for pollution. This may assist
DEP in determining whether or not stormwater monitoring requirements in the permit are necessary.
NOTE – if the applicant selects this box and then conditions change following issuance of the permit, the
applicant is responsible for notifying DEP of the changed conditions.
3. List all outfalls in the same order as question 2 and provide the following information:

Sampling Completed? – Check the box if sampling was completed for the application and the Stormwater
Sampling Results section of Module 1 is attached for the outfall. NOTE – stormwater must be sampled for all
stormwater outfalls identified in question 2, above, where the applicant checked the box for No Exposure?, in
order to verify that pollutant concentrations are commensurate with such conditions.

Representative Outfall No. – If the Sampling Completed? box is not checked, report the Outfall No(s) that
the applicant has sampled as representative of the reported outfall.

Treatment? – Check the box if the applicant has or is proposing any structural (e.g., oil water separator) or
non-structural (e.g., wetlands) treatment technology designed to reduce pollutants in stormwater discharged
to the outfall.
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3800-PM-BCW0008d 11/2016
Module 1 Instructions

Description of BMPs in Drainage Area to Control Pollutants in Stormwater – Describe any treatment
proposed or in place for stormwater and any other proposed (for new facilities) or existing (for existing
facilities) best management practices (BMPs) intended to control pollutants in stormwater runoff. Examples
of BMPs including routine inspection and cleanup activities, ponds, swales or other features intended to
promote infiltration, etc.

PCSM? – Check the box if there are post-construction stormwater management facilities within the drainage
area to the outfall that were installed to comply with DEP’s Chapter 102 Erosion and Sedimentation Control
regulations.
4. Check the appropriate box to certify whether all non-stormwater discharges from the listed outfall(s) are identified
in the Discharge Information section of the industrial waste application. If No is selected, attach an explanation
for why the non-stormwater discharge is not included in the industrial waste application.
5. If there have been leaks or spills on-site within the past five years that have reached stormwater outfall(s) (i.e.,
have been discharged to the receiving waters), identify the outfall(s) receiving the leaks or spills, the
substance(s) released, measures taken to remediate the incident(s) and preventative measure(s) taken to
reduce the possibility of future incidents. Attach additional sheets as necessary.
6. Describe how often stormwater outfalls are inspected and routine maintenance is performed, if not identified in
question 3.
Stormwater Sampling Results
For existing discharges only, attach a completed Stormwater Sampling Results section to the application for each
stormwater outfall that was sampled.
NOTE – stormwater must be sampled for all stormwater outfalls identified in question 2, above, where the applicant
checked the box for No Exposure?, in order to verify that pollutant concentrations are commensurate with No
Exposure conditions.
In general, DEP considers the following benchmark values to be indicative of No Exposure conditions; these values
may also be used by DEP to evaluate non-degrading stormwater discharges for anti-degradation purposes (see
Module 4).








Pollutants with water quality criteria in 25 Pa. Code Chapter 93: ≤ most stringent water quality standard
Oil and Grease (mg/L): ≤ 5.0
BOD5 (mg/L): ≤ 10
COD (mg/L): ≤ 30
TSS (mg/L) ≤ 30
Total Nitrogen (mg/L): ≤ 2.0
Total Phosphorus (mg/L): ≤ 1.0
pH (S.U.): 6.0 to 9.0
Stormwater Sampling Guidance
The collection of the samples for the reported analyses should be supervised by a person experienced in performing
sampling of industrial wastewater or stormwater discharges. Any specific requirements contained in the applicable
analytical methods should be followed for sample containers, sample preservation, holding times, the collection of
duplicate samples, etc. Where applicable, samples should be collected from the center of the flow channel, where
turbulence is at a maximum, at a site specified in your present permit, or at any site adequate for the collection of a
representative sample.
If stormwater sampling is being conducted at an outfall that receives other wastewaters, the applicant must
ensure that only stormwater is sampled. This may require the applicant to sample stormwater at a location that is
different than the normal compliance monitoring location, or otherwise at times when only stormwater discharges are
occurring.
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3800-PM-BCW0008d 11/2016
Module 1 Instructions
For all pollutants the applicant must, at a minimum, analyze grab samples taken during the first 30 minutes (or as
soon thereafter as practicable) of the discharge. For pollutants other than pH, Temperature, Cyanide, Total Phenols,
Total Residual Chlorine, Oil and Grease, and Fecal Coliform it is preferred the applicant analyze both a grab sample
collected during the first 30 minutes (or as soon thereafter as practicable) of the discharge and a flow-weighted
composite sample.
All samples must be collected from the discharge resulting from a storm event that is greater than 0.1 inch and at
least 72 hours from the previously measurable (greater than 0.1 inch rainfall) storm event. Where feasible, the
variance in the duration of the event and the total rainfall of the event should not exceed 50 percent from the average
or median rainfall event in that area. Grab samples must be taken during the first thirty minutes of the
discharge (or as soon thereafter as practicable), and flow-weighted composite samples shall be taken for the
entire event or for the first three hours of the event.
For the purpose of these instructions, grab and composite samples are defined as follows:
Grab sample: An individual sample of at least 100 milliliters collected during the first thirty minutes (or as soon
thereafter as practicable) of the discharge. This sample is to be analyzed separately from the composite sample.
Flow-weighted composite sample: A flow-weighted composite sample may be taken with a continuous sampler
that proportions the amount of sample collected with the flow rate or as a combination of a minimum of three sample
aliquots taken in each hour of discharge for the entire event or for the first three hours of the event, with each aliquot
being at least 100 milliliters and collected with a minimum period of fifteen minutes between aliquot collections. The
composite must be flow proportional; either the time interval between each aliquot or the volume of each aliquot must
be proportional to either the stream flow at the time of sampling or the total stream flow since the collection of the
previous aliquot. Aliquots may be collected manually or automatically.
Data from samples taken in the past may be used, provided that all data requirements are met, sampling was done
no more than three years before submission, and all data are representative of the present discharge.
Completing the Stormwater Sampling Results Table
1. You must report at least one analysis for each pollutant listed. As noted above, flow-weighted composite sample
results are optional. Report the average and maximum concentrations of grab and flow-weighted composite
samples for each listed pollutant, as applicable, in the units provided (e.g., mg/L, S.U., etc.). Follow the
instructions contained in the industrial wastewater application for calculating statistical results. If only one
sample result for each pollutant is available, report the result in both the average and maximum columns under
the appropriate sample type. Identify the number of storm events where samples were collected to determine
the results. Identify the laboratory’s quantitation limit (QL) for the pollutants; the Target QLs in the industrial
wastewater application (Attachment C) should be achieved.
2. In the table provided, list all pollutants contained within an Effluent Limitation Guideline (ELG) that is applicable to
the facility’s production, not identified in question 1. Also list all pollutants listed in the facility’s existing NPDES
permit for the stormwater outfall; process wastewater discharges; and any other pollutants that are considered
the cause of impairment to waters receiving stormwater discharges from the outfall. See the industrial
wastewater application instructions for methods that may be used to determine pollutants causing impairments.
Provide the results of at least one analysis for every pollutant listed. Specify the units with your results
(e.g., mg/L).
3. In the table provided, list all pollutants contained in Pollutant Groups 1 through 7, as identified in the Analysis
Results Tables of the industrial wastewater application (3800-PM-BCW0008b), which are not identified in
questions 1 or 2 of the Stormwater Sampling Results section but the applicant knows or has reason to believe
are present in the stormwater discharge. Provide at least one result for each pollutant known or believed to be
present. Base your determination that a pollutant is present in or absent from your discharge on your knowledge
of your raw materials, material management practices, maintenance chemicals, history of spills and releases,
intermediate and final products and byproducts, and any previous analyses known to you of your effluent or
similar effluent.
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3800-PM-BCW0008d 11/2016
Module 1 Instructions
4. Provide the information requested below for the storm event(s) that resulted in the maximum values reported in
questions 1, 2 and 3 for the flow-weighted composite sample (or grab sample if flow-weighted composite
sampling was not completed). If multiple storm events resulted in maximum values, report each event
separately.






Identify the storm event date.
Record the duration of the storm event in minutes.
Report the total rainfall amount, in inches, for the storm event in which sample(s) were collected.
Identify the number of hours from the end of the previous measurable storm event of 0.1 inch to the
beginning of the storm event in which sample(s) were collected.
Optionally, specify the flow rate, in gallons per minute (GPM), measured at the outfall during the storm event.
Optionally, report the calculated volume of stormwater discharged from the outfall(s) during the storm event.
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