HomeMy WebLinkAbout2646 - Washington State - Agreement - NPDES-PSNGP Biosolids Delegation LetterI<
EPA Identification Number NPDES Permit Number
WA0022497 I
Facility Name
I
Form Approved 03/05/19
0MB No. 2040-0004
Form
2A
NPDES &EPA
City of Marysville WWTP
U.S. Environmental Protection Agency
Application for NPDES Permit to Discharge Wastewater
NEW AND EXISTING PUBLICLY OWNED TREATMENT WORKS
SECTION 1. BASIC APPLICATION INFORMATION FOR ALL APPLICANTS (40 CFR 122.210)(1) and (9))
1.1
1.2
1.3
1.4
1.5
1.6
Facility name
City of Marysville WWTP
Mailing address (street or P.O. box)
80 Columbia Ave
City or town State ZIP code
Marysville WA 98270
Contact name (first and last) I Title Phone number Email address
Jason Crain Water Resource Supervisor (360) 363-8127 jcrain@marysvillewa.gov
Location address (street, route number, or other specific identifier) D Same as mailing address
20 Columbia Avenue
City or town
Marysville
State
WA
Is this application for a facility that has yet to commence discharge?
D Yes-+ See instructions on data submission [Z] No
requirements for new dischargers.
Is applicant different from entity listed under Item 1.1 above?
ZIP code
98270
0 Yes @ No-+ SKIP to Item 1.4.
Applicant name
Applicant address (street or P.O. box)
City or town State ZIP code
Contact name (first and last) I Title Phone number Email address
Is the applicant the facility's owner, operator, or both? (Check only one response.)
D Owner D Operator 0 Both
To which entity should the NPDES permitting authority send correspondence? (Check only one response.)
D Facility □ Applicant Facility and applicant
(they are one and the same)
Indicate below any existing environmental permits. (Check all that apply and print or type the corresponding permit
number for each.)
Existing Environmental Permits . ,• ;.· .. · .. .. . ·. ", ,
0 NPDES (discharges to surface □ RCRA (hazardous waste) □ UIC (underground injection
water) control)
WA0022497
□ PSD (air emissions) □ Nonattainment program (CAA) □ NESHAPs (CAA)
□ Ocean dumping (MPRSA) □ Dredge or fill (CWA Section □ Other (specify)
404)
EPA Form 3510-2A (Revised 3-19) Page 1
ORIGINAL
EPA Identification Number NPDES Permit Number
WA0022497
Facility Name
1.7
1.8
1.9
City of Marysville WWTP
Provide the collection s stem information re uested below for the treatment works.
Municipality · . ·. Population 'Collection System Type ·
Serv~d • . . · Serve:cl<t~. , indicate ercent~. e . . " , ,
City of
Marysville
17,904
City of Arlington 548
Snohomish Co. 420
100 % separate sanitary sewer
% combined storm and sanitary sewer
□ Unknown
100 % separate sanitary sewer
% combined storm and sanitary sewer
□ Unknown
lQQ_ % separate sanitary sewer
% combined storm and sanitary sewer
□ Unknown
% separate sanitary sewer
% combined storm and sanitary sewer
□ Unknown
Total percentage of each type of
I. · ·1 100 % sewer me m m1 es
Is the treatment works located in Indian Country?
D Yes 0 No
Does the facility discharge to a receiving water that flows through Indian Country?
D Yes 0 No
1.10 Provide design and actual flow rates in the designated spaces.
·AnnualAvera·e Flow Rate!i Actual
JwoYears Ago Last Year ·
5.48
Two . .Yearil'J\go , .
16.21
1.11 Provide the total number of effluent dischar e
· Treated Effluent
2
EPA Form 3510-2A (Revised 3-19)
Form Approved 03/05/19
0MB No. 2040-0004
· .. _Ownenship Status
IZI Own
□ Own
□ Own
IZI Own
□ Own
□ Own
IZI Own
□ Own
□ Own
□ Own
□ Own
□ Own
~:,: f ~,' , ' '
□ Maintain
□ Maintain
□ Maintain
□ Maintain
□ Maintain
□ Maintain
□ Maintain
□ Maintain
□ Maintain
□ Maintain
□ Maintain
□ Maintain
%
' •, }Constructed ~
Emergency···
·;·.,Overflows'
Page2
EPA Identification Number NPDES Permit Number
WA0022497
·• ... ';:outfalls 0therthan,toV\faters·6fthe:UnifedStates
Facility Name
City of Marysville WWTP
Form Approved 03/05119
0MB No. 2040-0004
· ; ·' 1.12 Does the POTW discharge wastewater to basins, ponds, or other surface impoundments that do not have outlets for
discharge to waters of the United States?
□ Yes [Z] No-+ SKIP to Item 1.14.
1.13 Provide the location of each surface im oundment and associated dischar e information in the table below.
· /. :;•;'.Surface Im oundment Location and. Dischar e ,Data'.::;,'.· ·· .:
rt;:. 1.14 Is wastewater applied to land?
□ Continuous
gpd □ Intermittent
gpd □ Continuous
D Intermittent
gpd D Continuous
D Intermittent
' , :ii: □ . {:l .. ,·.· f--1-.1-5-+-----------------re_u_e-st_e_d-be-lo_w __ ------------------1
a. e and·Discha
[Z] No-+ SKIP to Item 1.16 .
:::}~t /·: ·•: Av,~r~ge Daily Yql~~ei:'' ,, · -·~. · , , ··;t~.' ,Applied . , . · ..
•~;<}lJ acres '
acres
acres
1.16 Is effluent transported to another facility for treatment prior to discharge?
□ Yes Ill No ➔ SKIP to Item 1.21.
1.17 Describe the means by which the effluent is transported (e.g., tank truck, pipe).
1.18 Is the effluent transported by a party other than the applicant?
0 Yes □ No-+ SKIP to Item 1.20.
1.19
D gpd D
gpd g
gpd g
. Continuous or. .
· :; .~:1r{t~rinittent :
' '. check one:,,
Continuous
Intermittent
Continuous
Intermittent
Continuous
Intermittent
Entity name Mailing address (street or P.O. box)
City or town State ZIP code
Contact name (first and last) Title
Phone number Email address
EPA Form 3510-2A (Revised 3-19) Page3
EPA Identification Number
I
NPDES Permit Number
WA0022497 I
Facility Name
I
Form Approved 03/05/19
0MB No. 2040--0004
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1.20
City of MarysvilleWWTP
In the table below, indicate the name, address, contactinformation, NPDES number, and average daily flow rate of the
receiving facility.
Facility name Mailing address (street or P.O. box)
City or town State I ZIP code
Contact name (first and last) Title
Phone number Email address
NPDES number of receiving facility (if any) □ None Average daily flow rate mgd
'111--, I----+------------------~--------------------; ,c:
'"•• · .... /'' ,0
Cl)
< e>
C';I . .c
1.21 Is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do not
have outlets to waters of the United States (e.g., underground percolation, underground injection)?
□ Yes [ZI No+ SKIP to Item 1.23.
·u, •t----+----------------------------------------; Ill c , ...
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1'·'',,,"0,,,
"C , C. l':I 1/~ :a:. ·a . )
1.22
1.23
1.24
1.25
Provide information ih the table below on these other disposal methods.
_ lnformation·on Other Disposal Methods ::' r' ·· , -
acres
acres
acres
□ Continuous
gpd □ Intermittent
□ Continuous
gpd □ Intermittent
□ Continuous
gpd □ Intermittent
Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21 (n)? (Check all that apply.
Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
□ Discharges into marine waters (CWA
Section 301(h))
0 Not applicable
□ Water quality related effluent limitation (CWA Section
302(b)(2))
Are any operational or maintenance aspects (related to wastewater treatment and effluent quality) of the treatment works
the responsibility of a contractor?
D Yes 0 No +SKIP to Section 2.
Provide location and contact information for each contractor in addition to a description of the contracto(s operational
and maintenance responsibilities.
Contractor name
(company name)
Mailing address
(street or P.O. box)
City, state, and ZIP
code
Contact name (first and
last)
Phone number
Email address
Operational and
maintenance
responsibilities of
contractor
, :cc;l]ltractor 3, --_
EPA Form 3510-2A (Revised 3-19) Page4
EPA Identification Number NPDES Permit Number Form Approved 03/05/19
0MB No. 2040-0004
2.1 Does the treatment works have a design flow greater than or equal to 0.1 mgd?
0 Yes D No ➔ SKIP to Section 3.
Provide the treatment works' current average daily volume of inflow
and infiltration.
Indicate the steps the facility is taking to minimize inflow and infiltration.
Average Daily Volume of lnflow;and Infiltration
1110000 gpd
Smoke testing, camera and surveying sewer mains, manhole inspections for joint cracks and sewer pipe rehabilitation.
Have you attached a topographic map to this application that contains all the required information? (See instructions for
specific requirements.)
0 Yes □ No
Have you attached a process flow diagram or schematic to this application that contains all the required information?
(See instructions for specific requirements.)
0 Yes D No
2.5 Are improvements to the facility scheduled?
0 Yes D No ➔ SKIP to Section 3.
Briefly list and describe the scheduled improvements.
1. A mechanical band screen is going to be installed pre sand filtration. A strainer will also be installed pre sand filtration
2.
3.
4.
2.6 Provide scheduled or actual dates of com letion for im rovements.
1. 001 04/03/2023 10/30/2023
2. 100 04/03/2023 10/30/2023
3.
4.
2.7 Have appropriate permits/clearances concerning other federal/state requirements been obtained? Briefly explain your
response.
0 Yes D No D None required or applicable
Explanation:
Ecology has reviewed and a SEPA was done.
EPA Form 3510-2A (Revised 3-19) Page5
EPA Identification Number NPDES Permit Number Form Approved 03/05/19
0MB No. 2040-0004
Provide the following information for each outfall. (Attach additional sheets if you have.more than three outfalls.)
Washington Washington
County Snohomish Snohomish
City or town Marysville Everett
Distance from shore 55 ft. 1300 ft. ft.
Depth below surface 18-21 ft. 350 f!i._ ft.
Average daily flow rate 5.09 mgd 5.60 mgd pgd
Latitude 48° 2' 8,CIJ' N 4/ 58' 9.~' N
Longitude 122° 10' 19jf w 122° 141 . 471' w
3.2 Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
IZ] Yes □ No~ SKIP to Item 3.4.
3.3 If so, provide the following information for each applicable outfall.
3.4
3.5
Number of times per year
dischar e occurs
Average duration of each
dischar e s eci units
Average flow of each
dischar e
Months in which discharge
occurs
r;ti Outfall. Num .. b_~r .. _:.:.:.:0 .. ,0.1. · . · . : : · :(G>,.~~-tf~.ll'N.uJibe}.1:1.'og · '. :-i ' O~tfall' Num6ei: . , f,:si
• '' ' • • < '\,·,,,y-·, <>,'. -• -.-, -~tf\'
High River Season appx 243 days Low River Season appx 122 Da\
24 Hours 24 Hours
5.09 mgd 5.60 mgd mgd
Seasonal November -June Seasonal July -October
Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
IZl Yes D No ~ SKIP to Item 3.6.
licable outfall.
24"HDPE pipe with 13 diffuser 63" HDPE pipe. The diffuser
Tees 6 inches in diameter. has 80 vertical risers with 90
degree elbows and these
terminate with 5 inch round
ports on each diffuser. The
Does the treatment works discharge or plan to discharge wastewater to waters of the United States from one or more
discharge points?
IZl Yes D No ~SKIP to Section 6.
EPA Form 3510-2A (Revised 3-19) Page6
I
EPA Identification Number
I
NPDES Permit Number
I
Facility Name
I
3.7
WA0022497 City of Marysville WWTP
Provide the receivina water and related information (if known for each outfall.
Receiving water name
Name of watershed, river,
or stream system
U.S. Soil Conservation
Service 14-digit watershed
code
Name of state
managemenUriver basin
U.S. Geological Survey
8-digit hydrologic
cataloging unit code
Critical low flow (acute)
Critical low flow (chronic)
Total hardness at critical
lowflow
",, )•' ,_, . ,,
. Outfall Num_ber ~
Steamboat Slough
WRIA07
17110011000288
Snohomish
17110011
cfs
cfs
mg/L of
CaC03
Outfall·Number 100 ..
'' s. ~ -.-.-•. '
Port Gardner Bay
WRIA07
Puget Sound
17110019
cfs
cfs
mg/L of
CaC03
Form Approved 03/05/19
0MB No. 2040-0004
..
Outfall Number __
cfs
cfs
mg/Lot
CaCOJ
3.8 Provide the following information describing the treatment provided for discharges from each outfall. l ... :xr . . i• . . . ,• .. it'/: · :· · :j/J '· ·· ·_)f>utfallNu~ber·~ Qu~~II Num.ber~::· Outfall:~.umber_:_-_ /i
Highest Level of □ Primary □ Primary □ Primary
Treatment (check all that □ Equivalent to □ Equivalent to □ Equivalent to
apply per outfall) secondary secondary secondary
0 Secondary 0 Secondary □ Secondary
□ Advanced □ Advanced □ Advanced
□ Other (specify) □ Other (specify) □ Other (specify)
Design Removal Rates by 85 85 Outfall
BODs or CBODs 85 % 85 % %
TSS 85 % 85 % %
'21 Not applicable '21 Not applicable □ Not applicable
Phosphorus % % %
'21 Not applicable liZl Not applicable □ Not applicable
Nitrogen % % %
Other (specify) □ Not applicable □ Not applicable □ Not applicable
% % %
EPA Form 3510-2A (Revised 3-19) Page7
EPA Identification Number
I
NPDES Permit Number
WA0022497 I
Facility Name
I
Form Approved 03/05/19
0MB No. 2040--0004
3.9
3.10
3.11
City of Marysville WWTP
Describe the type of disinfection used for the effluent from each outfall in the table below. If disinfection varies by
season, describe below.
Outfall 001-Disinfection is achieved by Ultraviolet light. Sodium Hypochlorite is in place as a back up to the ultraviolet
light. Outfall 100 -Disinfection is achieved by Ultraviolet light. Sodium Hypochlorite in conjunction with UV is used to
minimize the biological growth in the discharge force main.
Disinfection type
Seasons used
Dechlorination used?
Ultraviolet Light
Daily when discharging to
outfall
IZI Not applicable
D Yes
□ No
n
Ultraviolet Light
Daily when discharging to
outfall
□ Not applicable □ Not applicable
□ Yes □ Yes
IZI No □ No
Have you completed monitoring for all Table A parameters and attached the results to the application package?
1Z1 fu □ ~
Have you conducted any WET tests during the 4.5 years prior to the date of the application on any of the facility's
discharges or on any receiving water near the discharge points?
1ZJ Yes □ No ➔ SKIP to Item 3.13.
3.12 Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
discharaes by outfall number or of the receiving water near the discharge points.
Number of tests of discharge
water
Number of tests of receiving
water
9
NA
2
NA
Chronic'· ,,·, ''
NA NA
1
.,..e 3.13 Does the treatment works have a design flow greater than or equal to 0.1 mgd?
L !:! IZJ Yes □ No ➔ SKIP to Item 3.16.
-~. 3.14 Does the POTW use chlorine for disinfection, use chlorine elsewhere in the treatment process, or otherwise have
I, .g, reasonable potential to discharge chlorine in its effluent?
; i· IZI Yes ➔ Complete Table B, including chlorine. D No ➔ Complete Table B, omitting chlorine. {:!.·1-----+----------------------------------------i · ... · 3.15 Have you completed monitoring for all applicable Table B pollutants and attached the results to this application :::,j:r:,:,,,i'. ::, . package?
Ii.· ffi . f-----1-IZl-✓ __ Y_es _______________ D __ N_o ____________ --i
' 3.16 Does one or more of the following conditions apply?
}
;; ,'<,
3.17
'<,,'•
' "
; ,.,.
(: 3.18
: "
''
• The facility has a design flow greater than or equal to 1 mgd.
• The POTW has an approved pretreatment program or is required to develop such a program.
• The NPDES permitting authority has informed the POTW that it must sample for the parameters in Table C, must
sample other additional parameters (Table D), or submit the results of WET tests for acute or chronic toxicity for
each of its discharge outfalls (Table E).
Yes ➔ Complete Tables C, D, and E as
applicable. D No ➔ SKIP to Section 4.
Have you completed monitoring for all applicable Table C pollutants and attached the results to this application
package?
IZI Yes D No
Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
attached the results to this application package?
□ Yes IZI No additional sampling required by NPDES
permitting authority.
EPA Form 3510-2A (Revised 3-19) Page8
EPA Identification Number NPDES Permit Number
WA0022497
Facility Name Form Approved 03/05/19
0MB No. 2040-0004
3.19
3.20
3.21
3.22
3.23
City of Marysville WWTP
Has the POTW conducted either (1) minimum of four quarterly WET tests for one year preceding this permit application
or (2) at least four annual WET tests in the past 4.5 years?
IZ] Yes □ No+ Complete tests and Table E and SKIP to
Item 3.26.
Have you previously submitted the results of the above tests to your NPDES permitting authority?
0 Yes D No + Provide results in Table E and SKIP to
Item 3.26.
Indicate the dates the data were submitted to
DateJ!!) Sub"'!itted ·: ; :·
~M/DD/YYYY I I.
Please see attachments to 3.21 WET testing.
Regardless of how you provided your WET testing data to the NPDES permitting authority, did any of the tests result in
toxicity?
□ Yes IZ] No ➔ SKIP to Item 3.26.
Describe the cause(s) of the toxicity:
3.24 Has the treatment works conducted a toxicity reduction evaluation?
□ Yes IZ] No + SKIP to Item 3.26.
3.25 Provide details of any toxicity reduction evaluations conducted.
3.26 Have you completed Table E for all applicable outfalls and attached the results to the application package?
IZ] Not applicable because previously submitted
information to the NPDES ermittin authori .
SECTION 4. INDUSTRIAL DISCHARGES AND HAZARDOUS WASTES (40 CFR 122.21ij)(6) and (7))
:I ·--~ {:ii:
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-4.2
4.3
4.4
4.5
Does the POTW receive discharges from SI Us or NSCIUs?
IZ] Yes □ No ➔ SKIP to Item 4.7.
Indicate the number of SIUs and NSCIUs that dischar e to the POTW.
3
Does the POTW have an approved pretreatment program?
IZ] Yes D No
Have you submitted either of the following to the NPDES permitting authority that contains information substantially
identical to that required in Table F: (1) a pretreatment program annual report submitted within one year of the
application or (2) a pretreatment program?
IZ] Yes □ No ➔ SKIP to Item 4.6.
Identify the title and date of the annual report or pretreatment program referenced in Item 4.4. SKIP to Item 4.7.
Industrial User Survey per section S6.E of NPDES Permit. 01/13/2022
.E !-----+---------------------------------------, 4.6 Have you completed and attached Table F to this application package?
IZ] ~ □ ~
EPA Form 3510-2A (Revised 3-19) Page9
EPA Identification Number
I
NPDES Permit Number
WA0022497 I
Facility Name
I
Form Approved 03/05/19
0MB No. 2040-0004 City of Marysville WWTP
4.7 Does the POTW receive, or has it been notified that it will receive, by truck, rail, or dedicated pipe, any wastes that are
regulated as RCRA hazardous wastes pursuant to 40 CFR 261?
0 Yes @ No-+ SKIP to Item 4.9.
4.8 If yes, provide the following information:
'Hazardous Waste
Number
1:-/ ', ,, '
□
□
□
□
□
□
' >, ' ;,, , • -'"\£''., Waste Transport Met~od
(check ali that apply), ·
'' ', ' ; ' ' ',',;,:'
Truck
Dedicated pipe
Truck
Dedicated pipe
Truck
Dedicated pipe
□
□
□
□
□
□
Rail
Other (specify)
Rail
Other (specify)
Rail
Other (specify)
Annual
Amouijtof
Waste
. ·Received·.
Units
Does the POTW receive, or has it been notified that it will receive, wastewaters that originate from remedial activities,
including those undertaken pursuant to CERCLA and Sections 3004(7) or 3008(h) of RCRA?
D Yes 0 No-+ SKIP to Section 5.
Does the POTW receive (or expect to receive) less than 15 kilograms per month of non-acute hazardous wastes as
specified in 40 CFR 261.30(d) and 261.33(e)?
D Yes-+ SKIP to Section 5. D No
4.11 Have you reported the following information in an attachment to this application: identification and description of the
site(s} or facility(ies) at which the wastewater originates; the identities of the wastewater's hazardous constituents; and
the extent of treatment, if any, the wastewater receives or will receive before entering the POTW?
D Yes D No
SECTION 5. COMBINED SEWER OVERFLOWS (40 CFR 122.21(j)(8))
E C'CI .... ,C)
C'CI ,i5
"C C,
C'CI
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0 en ',o
51
5.2
5.3
Does the treatmen works have a combined sewer system?
D Yes 0 No -+SKIP to Section 6.
Have you attached a CSO system map to this application? (See instructions for map requirements.)
D Yes D No
Have you attached a CSO system diagram to this application? (See instructions for diagram requirements.)
D Yes D No
EPA Form 3510-2A (Revised 3-19) Page 10
·=
EPA Identification Number
I
NPDES Permit Number I Facility Name
I
Form Approved 03/05/19
OM B No. 2040-0004 WA0022497 City of Marysville WWTP
·i 5.4 For each CSO outfall, provide the followino information. (Attach additional sheets as necessarv.)
.. , ·:> .. : •; . . ... ·• '.' ' ' '" ,· . . •.
. CSO Outfall·Numbet_·_ CSO O4tfall Number ·. CSO Outfall Number __ . ~-·',:.i!· -· -;/ ·" .. J, ~
City or town
State and ZIP code
County
Latitude 0 , ,, 0 , ,, 0 , ,,
Longitude 0 , ,, 0 , ,, 0 , ,,
Distance from shore ft. ft. ft.
Depth below surface ft. ft. ft.
5.5 Did the POTW monitor any of the following items in the past year for its CSO outfalls?
5.6
;
CSO Qutfall N~111ber ~· CSO Outfall Number __ · ..,~• "''• . ·,• > '' ~/s:, r: '. ,., ' ,; . . ·:". '. .-. ' . CSOiQutfall·Numbe~~
Rainfall D Yes □No □ Yes D No □Yes □No
CSO flow volume D Yes □No □ Yes D No D Yes □No
CSO pollutant D Yes □No concentrations D Yes D No D Yes □No
Receiving water quality □Yes □No □ Yes D No D Yes □No
CSO frequency D Yes □No □ Yes D No D Yes □No
Number of storm events D Yes □No D Yes O No D Yes D No
Provide the following information for each of your CSO outfalls.
Number of CSO events in
the past year
Average duration per
event
Average volume per event
Minimum rainfall causing
a CSO event in last year
events
hours
□ Actual or □ Estimated
million gallons
□ Actual or □ Estimated
inches of rainfall
□ Actual or □ Estimated
events
hours
□ Actual or □ Estimated
million gallons
□ Actual or □ Estimated
inches of rainfall
□ Actual or □ Estimated
,•,.
CSO Outfall.Number -,-;r' I '::',,',,,
events
hours
□ Actual or □ Estimated
million gallons
□ Actual or □ Estimated
inches of rainfall
□ Actual or □ Estimated
EPA Form 3510-2A (Revised 3-19) Page 11
EPA Identification Number
I
NPDES Permit Number
WA0022497 I
Facility Name
I
Form Approved 03/05/19
0MB No. 2040--0004
I!! ~ :!:
Cl C "> -~ u CII a::
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City of Marysville WWTP
5.7 Provide the information in the table below for each of your CSO outfalls.
Receiving water name
Name of watershed/
stream system
U.S. Soil Conservation
Service 14-digit
watershed code
(if known)
Name of state
manaqement/river basin
U.S. Geological Survey
8-Digit Hydrologic Unit
Code (if known)
Description of known
water quality impacts on
receiving stream by CSO
(see instructions for
•
CSO Outfall Number _ CSO Outfall Number_
□ Unknown □ Unknown
□ Unknown □ Unknown
CSO Outfall Number _
□ Unknown
□ Unknown
SECTION 6. CHECKLIST AND CERTIFICATION STATEMENT (40 CFR 122.22(a) and (d))
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6.1
6.2
In Column 1 below, mark the sections of Form 2A that you have completed and are submitting with your application. For
each section, specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note that not
all applicants are required to provide attachments.
Column 1 Column 2
0 Section 1: Basic Application □ w/ variance request(s) □ w/ additional attachments Information for All APPiicants
0 Section 2: Additional 0 w/ topographic map 0 w/ process flow diagram
Information □ w/ additional attachments
0 w/ Table A □ w/ Table D
0 Section 3: Information on 0 w/Table B 0 w/Table E Effluent Discharges
0 w/Table C □ w/ additional attachments
Section 4: Industrial □ w/ SIU and NSCIU attachments □ w/ Table F 0 Discharges and Hazardous □ w/ additional attachments Wastes
□ Section 5: Combined Sewer □ w/ CSO map □ w/ additional attachments
Overflows □ w/ CSO system diagram
0 Section 6: Checklist and □ w/ attachments Certification Statement
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 infonnation 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 infonnation, including the possibility of fine
and imorisonment for knowinq violations.
Name (print or type first and last name)
) 0 V\ N , ii, ,.,-, :_ ;,
Signature J ~f~~
Official title
Date signed
,;-I>, I"?.,,
EPA Form 3510-2A (Revised 3-19) Page 12
EPA Identification Number
Biochemical oxygen demand
□ BODs or @ CBODs
re art one
Design flow rate
Temperature (winter)
Temperature (summer)
Total suspended solids (TSS)
25
13
7.2
6.9
7.6
12
25
38
NPDES Permit Number
WA0022497
mg/L
CFU/l00ml
MGD
.Standard Units
·standard Units
Degrees Centigrade
Degrees Centigrade
mg/L
Facility Name
··~;Value,,
--~-'',",, .,
11.9
2.9
22.6
18.5
Outfall Number
001
mg/L 3/WEEK
CFU/l00ml . 3/WEEK
Degrees Centigrade 5/WEEK
Degrees Centigrade 5/WEEK
mg/L 3/WEEK
SM 5210 8-2011
SM 9222 D (mFC)-j
Form Approved 03/05/19
0MB No. 2040-0004
□ML
□MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter Nor 0. See instructions and 40 CFR 122.21 (e)(3).
EPA Form 3510-2A (Revised 3-19) Page 13
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EPA Identification Number NPDES Permit Number Facility Name
:value.
32.43
5.08 mg/L 7.40
1.07 mg/L 7.67
36.7 mg/L 49.8
Oil and grease <5 mg/L <5
1.08 mg/L 2.20
Total dissolved solids 220 mg/L 220
Outfall Number
mg/L
mg/L 5/Week Hach 10360 Rev.2
mg/L 1/Month EPA353.2
mg/L 1/Month SM 4500-NorgD
mg/L Annually EPA 1664
mg/L 1/Month EPA365.1
mg/L Annually SM 2540 C
Form Approved 03/05/19
0MB No. 2040-0004
:ML or MDL
(incluc!~ units}:.,
' e,, • . ;~\ •"
□ML
□MDL
□ML
□MDL
□ML
□MDL
□ML
□MDL
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1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter Nor 0. See instructions and 40 CFR 122.21(e)(3).
2 Facilities that do not use chlorine for disinfection, do not use chlorine elsewhere in the treatment process, and have no reasonable potential to discharge chlorine in their effluent are not
required to report data for chlorine.
EPA Form 3510-2A (Revised 3-19) Page 15
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EPA Identification Number
. ' .. •
Hardness (as CaC03)
Antimony, total recoverable
Arsenic, total recoverable
Beryllium, total recoverable
Cadmium, total recoverable
Chromium, total recoverable
Copper, total recoverable
Lead, total recoverable
Mercury, total recoverable
Nickel, total recoverable
Selenium, total recoverable
Silver, total recoverable
Thallium, total recoverable
Zinc, total recoverable
Total phenolic compounds
l_e Organic Compounds .·
EPA Form 3510-2A (Revised 3-19)
NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
0MB No. 2040-0004
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Page 17
EPA Identification Number
Chlorobenzene
Chlorodibromomethane
Chloroethane
2-chloroethylvinyl ether
Dichlorobromomethane
1, 1-dichloroethane
1,2-dichloroethane
trans-1, 2-dichloroethylene
1, 1-dichloroethylene
1,2-dichloropropane
1,3-dichloropropylene
Methylene chloride
1, 1,2,2-tetrachloroethane
Tetrachloroethylene
1, 1, 1-trichloroethane
1, 1,2-trichloroethane
EPA Form 3510-2A (Revised 3-19)
Outfall Number Form Approved 03/05/19
0MB No. 2040-0004
MLorMDL .
. . · {include units)
"<·;,;-:' -<, '
□ML
□MDL
□ML
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Page 18
EPA Identification Number
,,
· · ., : Pollutant
' '~ ,, :, ·, ~-,
: .. ~' ·:'f~i .;-,
V '},'.;;:(f+.ft-:,• -',
Trichloroethylene
Vinyl chloride
2-chlorophenol
2,4-dichlorophenol
2,4-dimethylphenol
4,6-dinitro-o-cresol
2,4-dinitrophenol
4-nitrophenol
Pentachlorophenol
2,4,6-trichlorophenol
Acenaphthene
Acenaphthylene
Benzo(a)anthracene
Benzo(a)pyrene
3,4-benzofluoranthene
EPA Form 3510-2A (Revised 3-19)
NPDES Permit Number Facility Name Outfall Number
Analyti~al. · .
,-,--,
, Vah.ie-,:,"::,;\--c."
'1Vlethod1 · ·
•:i;\}~~ ~ti~:;:-~!i::::
Form Approved 03/05/19
0MB No. 2040-0004
·!VIL or MDL
(include unit~)
□ML
□MDL
□ML
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Page 19
EPA Identification Number
Benzo(k)fluoranthene
Bis (2-chloroethoxy) methane
Bis (2-chloroethyl) ether
Bis (2-chloroisopropyl) ether
Bis (2-ethylhexyl) phthalate
4-bromophenyl phenyl ether
Butyl benzyl phthalate
2-chloronaphthalene
4-chlorophenyl phenyl ether
di-n-butyl phthalate
di-n-octyl phthalate
Dibenzo(a,h)anthracene
1,2-dichlorobenzene
1,3-dichlorobenzene
1,4-dichlorobenzene
3,3-dichlorobenzidine
Diethyl phthalate
Dimethyl phthalate
2,4-dinitrotoluene
2,6-dinitrotoluene
EPA Form 3510-2A (Revised 3-19)
NPDES Permit Number Outfall Number Form Approved 03/05/19
0MB No. 2040-0004
· ML or NIDL.
•· \(include units).
□ML
□MDL
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Page20
EPA Identification Number
Fluoranthene
Hexachlorobenzene
Hexachlorobutadiene
Hexachlorocyclo-pentadiene
Hexachloroethane
lndeno{1,2,3-cd)pyrene
N-nitrosodi-n-propylamine
N-nitrosodimethylamine
N-nitrosodiphenylamine
Phenanthrene
NPDES Permit Number Outfall Number Form Approved 03/05/19
0MB No. 2040-0004
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1,2,4-trichlorobenzene g ~6L
1 Sampling shall be conducted according to sufficiently sensitive test procedures {i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR Chapter I, Subchapter N or 0. See instructions and 40 CFR 122.21 {e){3).
EPA Form 3510-2A (Revised 3-19) Page 21
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EPA Identification Number NPDES Permit Number Outfall Number
Value· Val.ue
D No additional sampling is required by NPDES permitting authority.
Form Approved 03/05/19
0MB No. 2040-0004
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1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or required
under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21 (e)(3).
EPA Form 3510-2A (Revised 3-19) Page 23
This page intentionally left blank.
EPA Identification Number
Test species
Age at initiation of test
Outfall number
Date sample collected
Date test started
Duration
Toxici · Test Methods
Test method number
Manual title
Edition number and year of publication
Page number(s}
. Sam le Location .
Check one:
.Point in Treatment Process
Describe the point in the treatment process
at which the sample was collected for each
test.
Indicate for each test whether the test was
performed to asses acute or chronic toxicity,
or both. (Check one response.)
EPA Form 3510-2A (Revised 3-19)
NPDES Permit Number
SEE ATTACHMENT FOR TABLE E
D 24-hour composite
-,:v,,
D Before Disinfection
D After Disinfection
D After Dechlorination
D Acute
D Chronic
□ Both
D 24-hour composite
D Before Disinfection
D After Disinfection
D After Dechlorination
D Acute
D Chronic
0 Both
Outfall Number
D 24-hour composite
D Before disinfection
D After disinfection
D After dechlorination
D Acute
D Chronic
0 Both
Form Approved 03/05/19
0MB No. 2040-0004
Page 25
EPA Identification Number NPDES Permit Number
Indicate the type of test performed. (Check one
response.)
'$ouri:ebf Dilution Water:
Indicate the source of dilution water. (Check
one response.)
If laboratory water, specify type.
If receiving water, specify source.
T e.of Dilution.Water .
Indicate the type of dilution water. If salt
water, specify "natural'' or type of artificial
sea salts or brine used .
. :Percenta e Effluent Usei:f
Specify the percentage effluent used for all
concentrations in the test series.
· Parameters Tested
Check the parameters tested.
. Acute Test.Results
Percent survival in 100% effluent
LCso
95% confidence interval
Control percent survival
EPA Form 3510-2A (Revised 3-19)
D Static
D Static-renewal
D Flow-through
D Laboratory water
D Receiving water
D Fresh water
D Salt water (specify)
D pH D Ammonia
D Salinity D Dissolved oxygen
D Temperature
%
%
%
Outfall Number
TestN~mber
D Static
D Static-renewal
D Flow-through
D Laboratory water
D Receiving water
D Fresh water
D Salt water (specify)
□pH
D Salinity
D Temperature
D Static
D Static-renewal
D Flow-through
D Laboratory water
D Receiving water
D Fresh water
D Salt water (specify)
D Ammonia D pH
D Dissolved oxygen D Salinity
D Temperature
%
%
%
Form Approved 03/05/19
0MB No. 2040-0004
D Ammonia
D Dissolved oxygen
%
%
%
Page 26
EPA Identification Number
"Acute-Jest Res"i.llts~Coritinued'.
Other (describe)
:chro·nicTest Results::
NOEC
IC2s
Control percent survival
Other (describe)
:· Quali Control/Quali . Assurance ~:> ,
Is reference toxicant data available?
Was reference toxicant test within
acce table bounds?
What date was reference toxicant test run
MM/DOM ?
Other (describe)
EPA Form 3510-2A (Revised 3-19)
NPDES Permit Number
D Yes
D Yes
Facility Name Outfall Number
%
%
%
□ No D Yes □ No
□ No D Yes □ No
%
%
%
D Yes
D Yes
Form Approved 03/05/19
0MB No. 2040-0004
%
%
%
□ No
□ No
Page 27
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EPA Identification Number
Mailing address (street or P.O. box)
City, state, and ZIP code
Description of all industrial processes that affect
or contribute to the discharge.
List the principal products and raw materials that
affect or contribute to the SIU's discharge.
Indicate the average daily volume of wastewater
discharged by the SIU.
How much of the average daily volume is
attributable to process flow?
How much of the average daily volume is
attributable to non-process flow?
Is the SIU subject to local limits?
Is the SIU subject to categorical standards?
EPA Form 3510-2A (Revised 3-19)
NPDES Permit Number
Seacast
6130 31st Avenue NE
Marysville, WA 98271
None
Principal Products -Casted Metals.
Raw Materials -Metals, Sand and Wax.
5500 gpd
5400 gpd
500 gpd
IZl Yes □ No
IZl Yes □ No
Artisan Finishing
14219 Smokey Point Blvd
Marysville, WA 98271
None
Principal Products -Aluminum Chromate
and powder coating.
Raw Materials -Metals and chemicals.
5000 gpd
4700 gpd
300 gpd
IZl Yes □ No
IZl Yes □ No
Form Approved 03/05/19
0MB No. 2040-0004
National Foods Corporation
16900 51st Avenue NE
Arlington, WA 98223
None
Principal Products -Egg Products
Raw Materials -Egg and egg wash
cleaners
50000
49000
1000
IZl Yes □ No
D Yes IZl No
gpd
gpd
gpd
Page 29
EPA Identification Number
Under what categories and subcategories is the
SIU subject?
Has the POTW experienced problems (e.g.,
upsets, pass-through interferences) in the past 4.5
ears that are attributable to the SIU?
If yes, describe.
EPA Form 3510-2A (Revised 3-19)
NPDES Permit Number
SIC Code 3324
·□ Yes 0 No
SIC Code 3471 Loe a I Lim its
□Yes 0 No D Yes
Form Approved 03/05/19
0MB No. 2040-0004
0 No
Page 30