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COMMONWEALTH OF PENNSYLVANIADEPARTMENT OF ENVIRONMENTAL PROTECTION

BUREAU OF WATER QUALITY PROTECTION

INSTRUCTIONS FOR COMPLETING AND SUBMITTINGAN INDIVIDUAL PERMIT APPLICATION FOR

AQUACULTURE PRODUCTION OPERATIONSNOTE: (Before completing this application, pleaseread carefully the Table I matrix to determine whichother module(s) of this application must becompleted and submitted with this application).

This is the Department’s One Permit Application for newfacilities and expanded existing operations requiredunder the Aquaculture Development Law. Thisapplication primarily is an individual NPDES permitapplication. Modules A through F of this applicationdeal with information needed to process other potentialrequired permits, authorizations and approvals from theDepartment to begin or continue Aquaculture Operationsin Pennsylvania.

This form is to be used by new AquacultureFacilities/operators subject to the individual NPDESpermitting requirements. This application may also beused for discharges from aquacultural operations inspecial protection waters.

Submission of only this NPDES Application (and GIF) isrequired if there are no other permits/authorizationsinvolved.

Permit Application Review and Approval Process

The one permit application contains all of the requiredinformation to process various permits. Prospectiveapplicants should carefully review the generalinstructions and Table I matrix to determine which otherpermits are or may be required for their proposedactivities or operations. A pre-application conferencewith the Department’s regional office, CountyConservation District and central office Dam SafetyProgram is recommended in making this determination.The applicant must submit five copies of the completedapplication package (application, GIF, plans,specifications, reports, etc.) to the Assistant RegionalDirector (ARD) of the Department Regional Office wherethe facility or the operation is or will be located.

Once complete application packages are received, theARD will distribute the copies to appropriate regionalprograms, County Conservation Districts or to theCentral Office for processing. Each reviewing programwill use the current permit review and coordinationprocedures. Each processing regional office, CountyConservation District or Central Office Dam SafetyProgram will coordinate any written communication withthe applicant through the ARD Office. The processingprograms may use some judgement in making directcontacts with the applicant to clarify minor issues ifnecessary. The ARD will be informed of these contacts.

This permit is covered under the money back guarantyprogram (MBG) and its review, approval and processingwill follow the current MBG time schedules. The actualtime schedule will vary from 60 to 120 days dependingupon how many permits are or will be required for agiven operation. The MBG time for any applicationprocessing will be the time for the longest permitprocessing time of the various permits involved for aspecific operation. It should be noted that if a DamPermit or an Environmental Assessment approval for anon-jurisdictional dam is required, the total MBGprocessing time could be up to 220 days.

All comments on various applications will becoordinated by the ARD and the applicant will beadvised using one comment letter for any deficiencies invarious applications. The Department will use onepublic notice each for a proposed and final action of thepermit action/decision, unless more public input isnecessary. The notice should identify each permitapproval.

The individual reviewing programs or Central Office willreview and process the permit applications using theDepartment’s normal operating policies, procedures andguidance and forward the final signed permit to the ARDwho will collect and transmit all permits, authorizationsand approvals together under one letter.

For new or expanding existing discharges/operations,the operator shall file an administratively complete andacceptable application as soon as possible (but not laterthan 180 days or 220 days if a Dam Permit or anEnvironmental Assessment approval for a non-jurisdictional dam is also required) prior to commencingany discharge.

The Table I Matrix is a checklist and a quick review ofall possible permits that may be and provides whichadditional sections must be completed and submitted tothe Department. The application is divided into variousmodules and each module represents a separate permitapplication and provides instructions for completing it.

General Information Form (GIF): (0130-PM-DPC0001). This is the Department’s GeneralInformation Form which is required with eachapplication to be submitted to the Department. Allapplicants must submit this form.

MODULE A: Individual Application for StormwaterNPDES Permit for Construction Activities. Thisapplication is required for all earth disturbances offive or more acres.

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MODULE B: Water Quality Management Part IIPermit Application for Industrial WastewaterFacilities. A WQM Part II permit application isrequired before constructing new or modifiedtreatment facilities.

MODULE C: Water Obstruction and EncroachmentPermit Application. A Water Obstruction andEncroachment Permit is required as specified inChapter 105 Dam Safety and WaterwayManagement. Activities listed as an Encroachmentor Water Obstruction that are located in regulatedwaters of the Commonwealth require a permit. AnEnvironmental Assessment Form is a component ofthe Water Obstruction and Encroachment PermitApplication.

MODULE D: Environmental Assessment Form andEnvironmental Assessment Information Sheet. Anenvironmental impact assessment statement isrequired as specified in Chapter 105 of theDepartment’s regulations.

MODULE E: Dam Permit Application. A dampermit is required (usually for dams with maximumdepth greater than 15 feet and/or drainage area inexcess of 100 acres) as specified in Chapter 105 ofthe Department.

I. GENERAL INSTRUCTIONS

A. Who Must Apply for a National PollutantDischarge Elimination System (NPDES) Permitfor Aquaculture Production Operation?

Any aquaculture projects identified in 40 CFR§§ 122.24 and 122.25, including PennsylvaniaFish and Boat Commission (PFBC) cooperativenurseries which operate facilities or activitieswhich discharge pollutants into surface waters ofthe Commonwealth (including intermittentlyflowing streams and dry drainage channels),including discharges to municipal separatestorm sewers or non-municipal separate stormsewers are required to have the dischargesauthorized by an NPDES permit.

NPDES permits are required for facilitiescovered under §122.24 (as described in thissection). A permit application shall not berequired from a concentrated aquatic animalproduction facility that does not meet theSection 122.24(a) requirements until theDepartment has conducted on-site inspection ofthe facility and has determined that the facilityshould be regulated under the NPDES permitprogram pursuant to §122.24(c)(2).

The Department may designate any aquaticanimal production facility as a concentratedaquatic animal production facility upondetermining that it is a significant contributor ofpollution to waters of the Commonwealth. In

making this designation, the Department shallconsider the following factors:

(i) The location and quality of the receivingwaters of the Commonwealth;

(ii) The holding, feeding and productioncapacities of the facility;

(iii) The quantity and nature of the pollutantsreaching waters of the Commonwealth;and

(iv) Other relevant factors.

Discharges into aquaculture projects, as definedin §122.25 also are subject to the NPDESPermit Program.

An aquaculture project means a definedmanaged water area which uses discharges ofpollutants into that designated area for themaintenance or production of harvestablefreshwater, estuarine or marine plants oranimals.

Designated project area means the portions ofthe waters of the Commonwealth within whichthe permittee or permit applicant plans toconfine the cultivated species, using a methodor plan or operation (including, but not limitedto, physical confinement) which, on the basis ofreliable scientific evidence, is expected toensure that specific individual organismscomprising an aquaculture crop will enjoyincreased growth attributable to the discharge ofpollutants, and be harvested within a definedgeographic area.

A hatchery, fish farm or other facility is aconcentrated aquatic animal production facilityfor purposes of §122.24 if it contains, grows orholds aquatic animals in either of the followingcategories:

(a) Cold water fish species or other cold wateraquatic animals in ponds, raceways orother similar structures which discharge atleast 30 days per year but does notinclude:

(1) Facilities which produce less than9,090 harvest weight kilograms(approximately 20,000 pounds) ofaquatic animals per year; and

(2) Facilities which feed less than 2,272kilograms (approximately 5,000pounds) of food during the calendarmonth of maximum feeding.

(b) Warm water fish species or other warmwater aquatic animals in ponds, racewaysor other similar structures which discharge

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at least 30 days per year, but does notinclude:

(1) Closed ponds which discharge onlyduring periods of excess runoff; or

(2) Facilities which produce less than45,454 harvest weight kilograms(approximately 100,000 pounds) ofaquatic animals per year.

“Cold water aquatic animals” include, butare not limited to, the Salmonidae familyof fish; e.g., trout and salmon.

“Warm water aquatic animals” include, butare not limited to, the Ameiuride,Centrarchidae and Cyprinidae families offish; e.g., respectively, catfish, sunfishand minnows.

B. Where to File the Application

Applications are to be submitted to theappropriate Department Regional Office (seeTable 2) on this Department application form (orphotocopy thereof).

C. Municipal Notification

Act 14, which amended the Commonwealth’sAdministrative Code (effective April 17, 1984)(71 P.S. Section 510-5) requires every applicantfor a new, amended or revised NPDES permit togive written notice to each municipality(Borough, Township) and county government inwhich the discharge is located. The writtennotice must be received by the municipality andcounty government at least thirty (30) daysbefore the Department may issue or denyapproval of coverage.

In order to demonstrate compliance with Act 14,submit with the Application:

1. A copy of correspondence notifying themunicipality and county government of yourintention to discharge under a permit; and

2. Evidence that the municipality and countygovernment has received your notification.Acceptable forms of this evidence include,certified mail receipt or writtenacknowledgment of the notification from themunicipality.

Failure to provide a copy of the notificationcorrespondence and evidence of municipalreceipt of your notification with the applicationwill delay processing of this application. Failureto comply with Act 14 may result in disapprovalof the permit application.

D. Application Fee

The amount of the check must be equal to thefinal total of the various application fees forrequired sections on Table 1. The check shouldbe made payable to the “Commonwealth ofPennsylvania”. It is to be dated within 10 daysof the application submittal date.

E. Number of Copies

The applicant is required to submit five (5)copies of the completed application package(GIF, application, plans, specifications, designengineer’s report, etc.)

II. COMPLETION OF NPDES PERMITAPPLICATION FORM

A. Facility Owner’s Name - Please provide theassociation, corporation, partnership, individual,or other business entity’s name as applicable.

Mailing Address - Please provide the address atwhich the responsible officer of the association,corporation, partnership, individual, or otherbusiness entity can receive mail related to thepermit.

Telephone and Fax Numbers - Please includethe association, corporation, partnership,individual or other business entity’s telephoneand Fax numbers.

Please provide Operator’s name, mailingaddress and telephone and fax numbers ifdifferent from owner.

Location - Please indicate municipality, county,latitude, longitude and name of the watershedfor the aquaculture production operation.

B. Description of Operations - Indicate if theapplication is for the new, existing or expansionof existing operation. Provide other informationfor the operation:

1. List aquatic species and correspondingweight.

2. Indicate if the facility is located in a highquality or exceptional value watershed.

3. Indicate the number of days the dischargeis expected to occur.

4. Indicate the quantity of food fed during thecalendar month of maximum production.

C. Other Applicable Requirements - Respond tothe questions.

D. Quantitative Data - Please submit any availablequantitative data on existing storm and wastewater discharges from the facility. Pleaseprovide names of the pollutants that wereanalyzed, the concentrations present in the

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stormwater or wastewater where the sampleswere taken from, the sample type, the date(s)and number of samples that were taken. Useseparate sheets as necessary.

Parameters of Concern - The applicant mustidentify what is contained or expected to containin the wastewater discharge. This listing shouldbe broad encompassing past or expected facilityoperation and identify all known and potentialchemicals or pollutants that could be in thedischarge in measurable quantity. At aminimum, the parameters should include BOD,suspended solids, nutrients, ammonia, dissolvedoxygen, pH, phosphorus, formalin(formaldehyde), diaquat and other therapeuticchemicals. This is where the applicant takes amore comprehensive look at the long-termoperation of the facility to identify all possiblepollutants including known or projected use of“exotic” chemicals. The applicant must provideinformation concerning various therapeuticchemicals or drugs used or expected to be usedat the facility. The information should contain,as a minimum, names of the chemicals ordrugs, related MSDS data, quantity, frequencyand concentrations.

Minimum Data Requirement: For existingfacilities, a minimum of four (4) representativesample data sets (four eight-hour composite orfour samples over a month time) is required withthe application. The samples should be takenduring raceway clearings and/or other times ofmaximum pollutant loading to the water. Thesamples should be analyzed using theDepartment’s attached standard protocol fordata collection and analysis. The sample datashall also include concentrations of therapeuticchemicals or drugs that may have been utilizedat the facility. New or proposed facilities mustprovide accurate estimates from similaroperations and provide the basis for suchestimated quality, concentration and amount ofthe waste waters to be discharged.

E. Potential Pollutant Sources - Please indicatewhether or not water pollutants or chemical(s)are or are likely to be discharged through one ormore discharge outfalls covered in thisapplication.

If you do not use, store, generate, process ordispose chemical solvents, or other hazardouswastes at the facility that may result in a stormwater discharge through one or more outfallscovered in this application, check the “No” box.

PPC Plan - All facilities that are seekingcoverage under this permit must develop,implement and maintain at site, aPreparedness, Prevention and Contingency

(PPC) Plan consistent with the regulations at 25Pa. Code §101.3, prior to the applicationsubmittal. The PPC plan must also identify anyBest Management Practices and PollutionPrevention and Control measures taken orplanned to be taken for the facility. An applicantmust submit a copy of the PPC Plan to theDepartment upon request. The Departmentmay require revisions and corrections to thePlan if it determines the Plan to be inadequate.A copy of the guidance document entitled,Guidelines for Development andImplementation of Environmental EmergencyResponse Plans can be obtained from anyregional office of the Department.

Description of Control Measures - Summarizeany existing control measures used to controlpollution from getting into storm water or wastewater discharges.

Description of Leaks or Spills - For existingfacility, summarize any available informationregarding the history of any significant leaks orspills of chemicals or toxic or hazardouspollutants at the facility in the last three years,including the approximate date and location ofthe spill or leak, and the type and amount ofmaterial released. Summarize steps that havebeen taken to avoid such spills or leaks in thefuture. Write N/A for a new facility.

F. Facility Improvements/Expansions - Pleasesummarize any improvements or expansionscurrently underway or planned at the facilitywhich may change the quality or quantity ofdischarges that have been described in thisapplication during the next five years. Pleaseprovide an estimated schedule of completion forthese improvements.

G. Compliance Review - Complete the compliancereview block, by listing all prior permits issuedby the Department, with compliance status oneach permit and, if applicable steps taken tobring the facility back into compliance. Addadditional sheet(s) if necessary to provide allinformation.

H. Wastewater Characteristics Information - Forexisting facilities, provide as much informationas available. For new facilities, provide bestestimates. For renewal, information requestedin this section must be completed.

Follow the instructions below to complete thissection.

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Item

(1) Describe sampling routine, numbers and typesof samples taken, and any other pertinentinformation relating to the sample results shown.Use additional sheets if necessary.

(2) These samples should reflect the quality of rawwaste prior to treatment. At existing industrialfacilities with flow-equalization units in place,samples may be taken before or after flow-equalization and prior to any treatmentprocesses, at the discretion of the applicant.

(3) Samples should be taken after existingtreatment units.

(4) Values reported should reflect expected effluentquality after proposed treatment, ormodifications to an existing treatment, is inplace.

(5) Indicate here, or on a separate page, theanalytical methods used for the parametersshown.

(6) If available, a summary of the treatmentfacility‘s influent and existing and/or expectedeffluent quality must be submitted to DEP onSection H for each facility outfall.

(7) Additional information pertaining to the samplingresults and waste characteristics.

Length of Sampling Period, Number and Typeof Samples and Other Information

The sampling period selected, and the numberand types of samples taken should be sufficientto reflect the nature (quantity/quality) andvariability of the waste stream described.Sample results should also be indicative of thequality of waste which the applicant feels willcontinue to be generated at the facility. Therequired minimum number of sampling eventsare three (3).

I. (1) Certification for NPDES Application(s) - Theapplicant must certify that the informationcontained in the application is true, accurateand complete.

a. For a Corporation - A responsiblecorporate officer:

1. A president, secretary, treasurer orvice-president of the corporation incharge of a principal businessfunction, or any other person whoperforms similar policy or decision-

making functions for thecorporation; or

2. The manager of one or moremanufacturing, production oroperating facilities employing morethan 250 persons or having grossannual sales or expendituresexceeding $25,000,000 (in secondquarter 1980 dollars) if authority tosign documents has been assignedor delegated to the manager inaccordance with corporateprocedures;

b. For a partnership or sole proprietorship -By a general partner or the proprietor,respectively; or

c. For a municipality - State, Federal orother public agency: by either aprincipal executive officer or rankingelected official. For purposes of thissection, a principal executive officer ofa Federal agency includes:

1. the chief executive officer of theagency, or

2. a senior executive officer havingresponsibility for the overalloperations of a principal geographicunit of the agency (e.g., RegionalAdministrator of EPA).

Note: DEP does not require specificassignments or delegation of authority toresponsible corporate officers identified.Corporate procedures governing authority tosign permit applications may provide forassignment or delegation to applicablecorporate positions rather than to specificindividuals.

The Clean Water Act provides for severepenalties for submitting false information onthis application form.

Section 309(c)(12) of the Clean Water Actprovides that “Any person who knowinglymakes any false statement, representation,or certification in any application, … shallupon conviction, be punished by a fine of nomore than $10,000 or by imprisonment formore than six months, or both.”

In addition, the Pennsylvania Crimes Code,18 Pa. C.S.A. §4904, provides penalties forfalse statements to authorities.

(2) Certification for Other Permit/Approvals -Complete this section if you are requestingpermits/approval (other than NPDESpermit) as a part of this application.

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If a proprietorship, the proprietor must sign.For a partnership, the general partner mustsign. For a Corporation, the president, vicepresident or other responsible official isrequired to sign. For a Political Subdivision,signatures of a chief officer or otherresponsible official empowered to sign isrequired with the seal affixed and attestedby the clerk. For Commonwealthdepartments, boards, commissions,receivers, trustees and authorities, adepartment head, bureau director, executivedirector, chairman, commissioner or otherresponsible official is required to sign.Signatures other than above must beaccompanied by a power of attorney orother notarized legal documentationindicating authorization to sign on behalf ofthe applicant.

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TABLE 1

SUMMARY MATRIX OF AQUACULTURE INDUSTRY RELATEDDEPARTMENT PERMITS/APPROVALS/AUTHORIZATIONS

Check“YES” Box

Ifapplicablefor your

ProposedOperation

RequiredApplicationProcessing

Fee

Type ofPermit/Approvalor Authorization

that may beneeded When Permit/ Approval is Needed

Which PermitApplication Form to

SubmitSchedule for Application

SubmissionThis Formis requiredof allapplicants

No fee isrequired

GeneralInformationForm (GIF)

Before or with application for anyDepartment permit, approval orauthorization.

GIF0130-PM-DPC0001

Before or with application for anyDepartment permit, approval orauthorization.

Only one GIF needs to be submitted.

YES$ 500 Individual

NPDESApplication

(1) When the Department requires anindividual permit for any permittee oroperation.

(2) Discharges from concentratedaquatic animal production facilities arerequired to obtain NPDES permitunder 40 CFR Part 122.

Individual NPDESapplication(3620-PM-WQ0024)

For new facilities, 180 days prior tocommencing a discharge,or

For existing facilities needing a permit,as soon as possible, but no later than90 days after a written notice from theDepartment.

YESNoAdditionalFee

StormwaterIndividualNPDES Permitfor stormwaterdischarge fromconstructionactivities.

(Module A)

(1) When construction activities,including clearing, grading, andexcavation activities involving five ormore acres of land area, or less thanfive acres of land area which is a partof a large common plan ofdevelopment which dischargestormwater into the surface waters ofthe Commonwealth.

Three (3) forms arerequired:(1) Individualapplication form.

(2) Cultural ResourceNotice

(3) PNDI Supplement#1

No later than 90 days prior tocommencement of construction for anindividual permit. (150 days for moneyback)

90 days prior to start of construction.

Required for any earth disturbance of five or moreacres of land. County conservation district may havean additional fee for review of the erosion andsediment control plan.

YES$ 500 Water Quality

ManagementPart II Permit

(Module B)

When construction and operation ormodification of a treatment facility isrequired or proposed to meet theNPDES effluent dischargerequirements

Water QualityManagement Part IIPermit Application forIndustrial WastewaterFacilities.

For new or modified facilities, 90 daysprior to commencing an activity leadingto any construction or modification ofthe treatment facility.

This is a Clean Streams Law Permit and is requiredof a new treatment facility or modification of anexisting facility.

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Check“YES” Box

Ifapplicablefor your

ProposedOperation

RequiredApplicationProcessing

Fee

Type ofPermit/Approvalor Authorization

that may beneeded When Permit/ Approval is Needed

Which PermitApplication Form to

SubmitSchedule for Application

Submission

YES* Water

Obstruction andEncroachmentPermit(Module C)

Water Obstruction and EncroachmentPermit is required before any personmay construct, operate, maintain,modify, enlarge or abandon a waterobstruction or encroachment.

Joint PermitApplication for a U.S.Army Corps ofEngineers Section404 Permit andPennsylvania WaterObstruction andEncroachment Permit

No later than 120 days prior to start ofconstruction.

Instructions to complete this module are attached atthe end. Completed Cultural Resource Notice andPNDI Supplement #1 forms are required for thispermit.**

YESNo Fee Environmental

AssessmentApproval fornon-jurisdictionaldam,jurisdictionaldam, and/orwaterobstruction andencroachment.

Module D)

When the proposed activity, dam orencroachment does not require a DamPermit, but is located in, along, orprojecting into a wetland or ExceptionalValue waters, or requires a WaterQuality 401 Certification.

Note: Waiver of dam permit under sub-sections 105.12(a)(4), 105.12(a)(11),105.12(a)(16), and 105.12(b)(2)requires the applicant to submitspecified information to DEP for itsreview and approval.

Two forms arerequired:(1) EnvironmentalAssessment Form

and

(2) EnvironmentalAssessmentInformation Sheet

No later than 120 days prior to start ofconstruction requiring a WaterObstruction and Encroachment Permitand no later than 220 days prior tostart of construction requiring a dampermit.

Instructions to complete this module are attached atthe end. Completed Cultural Resource Notice andPNDI Supplement #1 forms are required for thispermit.**

YES $1,500 $2,500 $3,000

(IncludeappropriateFee fromSection D ofthe Applica-tion)

Dam Permit

(Module E)

A Dam Permit is required before anyperson may construct, operate,maintain, modify, enlarge or abandon adam that is within the scope ascontained in §105.3 of DEP’sChapter 105 Rules and Regulationsand does not meet the waiver of permitrequirements contained in § 105.12 ofDEP’s Chapter 105 Rules andRegulations.

Dam PermitApplication

No later than 220 days prior to start ofconstruction of dam or otherencroachments

For construction of a dam on a natural or artificialwatercourse where maximum depth exceeds 15 feetor drainage area is in excess of 100 acres. Also, forconstruction of a dam not on a watercourse wheremaximum depth exceeds 15 feet and maximumstorage volume exceeds 50 acres feet. CompletedCultural Resource and PNDI Supplement #1 formsare required for this permit.**

Total Fee $ ____________ (Please add all fees in this column for all permits and send in one check. See detailed instructions.)

Submit the completed GIF and all appropriate Sections with the permit application fee check to the appropriate Department Regional Office listed in the Table 2.

* Stream enclosures or fills, levees, floodwalls - $350Channel changes or commercial dredging - $300Peat extraction - $750Bridges and other water obstructions and encroachments - $200Small Projects - $100

** NOTE: Cultural Resource Notice and PNDI Supplement #1 are included with the application foran individual NPDES permit for discharges of stormwater associated with construction activities(Module A)

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TABLE 2

FIELD OPERATIONS REGIONAL OFFICES

Office County Responsibility

Southeast Office - (610) 832-6000Permit CoordinatorLee Park, Suite 6010555 North LaneConshohocken, PA 19428-2233

Bucks, Chester, Delaware, Montgomery and Philadelphia

Northeast Region - (570) 826-25112 Public SquareWilkes-Barre, PA 18711-0790

Carbon, Lackawanna, Lehigh, Luzerne, Monroe,Northampton, Pike, Schuylkill, Susquehanna, Wayne &Wyoming

Southcentral Office - (717) 705-4700909 Elmerton AvenueHarrisburg, PA 17110

Adams, Bedford, Berks, Blair, Cumberland, Dauphin,Franklin, Fulton, Huntingdon, Juniata, Lancaster, Lebanon,Mifflin, Perry and York

Northcentral Office - (570) 321-6525208 W. Third Street, Suite 101Williamsport, PA 17701

Bradford, Cameron, Clearfield, Centre, Clinton, Columbia,Lycoming, Montour, Northumberland, Potter, Snyder,Sullivan, Tioga and Union

Southwest Region - (412) 442-4000400 Waterfront DrivePittsburgh, PA 15222-4745

Allegheny, Armstrong, Beaver, Cambria, Fayette, Greene,Indiana, Somerset, Washington and Westmoreland

Northwest Region - (814) 332-6945230 Chestnut StreetMeadville, PA 16335-3481

Butler, Clarion, Crawford, Elk, Erie, Forest, Jefferson,Lawrence, McKean, Mercer, Venango and Warren

DEP CENTRAL OFFICE CONTACTS

Responsible Agency Type of Permit

Bureau of Water Quality ProtectionDivision of Waterways, Wetlands and Erosion ControlP.O. Box 8775Harrisburg, PA 17105-8775717-787-6827

NPDES permits for discharges of stormwater associatedwith construction activities, water obstructions andencroachment permits (except for dams) includingactivities affecting wetlands.

Bureau of Waterways EngineeringDivision of Dam SafetyP.O. Box 8554Harrisburg, PA 17105-8554717-787-8568

Dam Permits

Bureau of Water Quality ProtectionDivision of Wastewater ManagementP.O. Box 8774Harrisburg, PA 17105-8774717-787-8184

NPDES permits for discharges from industrial facilities,Water Quality Management Part II permits.

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MODULE AAPPLICATION FOR AN INDIVIDUAL NPDES OR PERMIT FOR

DISCHARGES OF STORMWATER ASSOCIATED WITH CONSTRUCTION ACTIVITIES

GENERAL INFORMATION

This module is designed to assist the applicant incompleting the permit application materials necessary toobtain an Individual NPDES permit to authorize thedischarge of stormwater associated with constructionactivities in the development of concentrated aquaticanimal production facility. This individual permitapplication must be used if the one permit application isutilized and the following activities are present.

Construction activities, defined at §102.1 includeclearing, grading and excavation activities involving five(5) or more acres of total land area, or less than five (5)acres of total land area which is part of a larger commonplan of development or sale over the life of the project,which discharge stormwater from a point source into thesurface waters of the Commonwealth.

Persons proposing discharges of stormwater associatedwith construction activities, where the project activitydisturbs less than five (5) acres of total land area (whichis not part of a larger common plan of development orsale) do not require coverage under this permit, butmust comply with the requirements set forth in 25 Pa.Code Chapter 102.

Persons proposing stormwater discharges associatedwith construction and activities should file an adminis-tratively complete acceptable application at the earliestpossible date but no later than 90 days prior to theproposed commencement of construction. Constructionactivities which require an NPDES permit but have notobtained NPDES coverage are subject to possibleenforcement actions by the Department, ConservationDistrict or to third party litigation.

Operator Requirement.

Federal NPDES Regulations at 40 C.F.R. §§122.21(b)require that "when a facility or activity is owned by oneperson but is operated by another person, it is theoperator's duty to obtain a permit." When theoperator/contractor and owner/developer of the facilityor activity are not the same individual, corporation,partnership, or other entity, the Departmentrecommends that both the operator and owner apply forcoverage under a permit as co-permittees. If, prior toconstruction activities, an operator/contractor has notbeen selected, then once selected, the operator/contractor must either be made a co-permittee or thepermit must be transferred to the operator/contractor.

Erosion and Sediment (E&S) Control Plan Requirement.

An Erosion and Sediment (E&S) Control Plan must besubmitted to the appropriate conservation district officeeither prior to or at the same time as the submission ofthe completed application. If the district is not thereviewing entity, the E&S Control Plan must besubmitted to the regional office. Prior submission of theE&S Control Plan will facilitate the permit applicationapproval process. If the discharge of stormwater fromconstruction activities is in a special protectionwatershed classified pursuant to Chapter 93 of theDepartment's regulations, the required E&S Control Planmust incorporate the erosion and sediment controlBMPs in §102.4(b)(6).

Preparedness, Prevention and Contingency (PPC)Plan Requirement.

If there is the potential for causing accidental pollution ofair, land, or water, or for causing endangerment ofpublic health and safety through accidental release oftoxic, hazardous, or other polluting materials, theapplicant must also develop a Preparedness,Prevention, and Contingency (PPC) Plan in accordancewith 25 Pa. Code §91.34(a). For further information onPPC plan requirements, see the "Department'sGuidelines for Developing Preparedness, preventionand Contingency Plans for Operations that DischargeStormwater from Construction Activities" which isavailable from the local Environmental ProtectionAgency, Conservation District or a regional DEP office.

Processing of Permit Applications.

"Reviewing entity" for the purposes of the individualNPDES Permit shall generally mean the localConservation District if the Conservation District isparticipating as the reviewing entity for processingpermit applications. Persons seeking an IndividualNPDES permit for Discharges Associated withConstruction Activities must contact the localConservation District in the county in which theconstruction activity is located to ascertain if the districtis participating as the entity reviewing these permitapplications. The Department is the reviewing entity in agiven county if the local Conservation District haschosen not to participate in the NPDES StormwaterProgram.

An individual NPDES Permit for Discharges ofStormwater from Construction Activities will be issued,by the Department, in accordance with the proceduresset forth in 25 Pa. Code Chapter 92. Upon issuance of

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the Individual NPDES Permit, the permittee maycommence the construction activity. The Departmentand the district, when acting as the reviewing entity,reserve the right to notify the permittee to ceasedischarging should subsequent review and inspectionreveal a violation of the Department's regulations or acondition of the permit. If the application is not properlycompleted, or if all required information is not submitted,the application will be returned to the applicant forcorrections, or be denied.

Municipal Notification.

Please refer to Item C on page 3 of the instructions.

Permit Application Filing Fee.

There is no additional fee for this permit application.

Required Attachments (see applicant checklist onback pages of this application)

In order to demonstrate compliance with water qualitystandards and effluent limits, an applicant must submit,at a minimum:

a. A demonstration that the discharge associated withthe construction activity is composed entirely ofstormwater. If a non-stormwater evaluation has notbeen completed, demonstrate by what other meansit has been ascertained that the facility willdischarge only stormwater from the outfalls soughtto be covered under the Permit;

b. A summation of the best management practices(BMPs) which have been designed and will beimplemented at the facility, including a descriptionof: (1) the Preparedness, Prevention, andContingency (PPC) Plan, if any; (2) the Erosion andSediment Control Plan; (3) other pollutionprevention measures implemented at the facility;and (4) any other measures or documentation whichensures and demonstrates that water qualitystandards and effluent limits will be attained.

c. The required certification statement on theapplication, signed by a responsible official pursuantto the instructions for Part D of the application formand properly notarized, which certifies that allmeasures set forth in paragraph (b) above havebeen designed and will be fully implemented to: (1)reduce and prevent pollution on-site; (2) ensure thatthe quantities and rates of pollutants in anystormwater discharge sought to be covered underthis NPDES Permit are eliminated or minimized;and (3) meet applicable water quality standards andeffluent limitations under this NPDES permit.

SECTION A - APPLICANT IDENTIFIER

For purposes of identifying and tracking complete permitpackages, enter the following requested information.

Applicant Name - Company, corporation, partnership orindividuals applying for the Individual NPDES permit.List all applicants as detailed in the Permit Application -General Information form.

SECTION B - PROJECT INFORMATION

1., 2. Facility Latitude/Longitude - Provide thelatitude and longitude of the approximate centerof the facility to the nearest 15 seconds. Locatethe facility property on a 8.5 x 11.0 inch USGStopo map. The map must include the name of theappropriate 1:24,000 scale USGS 7.5 minuteseries quadrangle map where the facility islocated.

3. Total Project Acres - Enter the total acreage ofthe planned project, including support areas suchas offsite staging, borrow or spoil areas.

Total Disturbed Acres - Enter the total acreageof the project that will be disturbed by allearthmoving activities over the life of the project.

4. Existing and Previous Land Uses - List theexisting and prior uses of the land under proposedconstruction for the previous 50 years, or a longerperiod if known.

5. Quantitative Data - Provide any availablequantitative data on existing stormwaterdischarges and soil conditions. Provide thepollutants that were analyzed, the concentrationspresent, where the samples were taken, thesample type, and the date(s) and number ofsamples that were taken. Use separate sheets asnecessary.

6. Estimated Timetable for Major ConstructionActivities - Provide an estimate of the timetablefor major phases during construction. For eachmajor phase, the total acres associated with thephase, the amount of acres that will be disturbed,and the starting and end dates for each phase ofthe construction activity. If additional space isneeded please attach an additional sheet(s).

7. Runoff Coefficient - Provide an estimated runoffcoefficient of the site and the increase inimpervious area following completion ofconstruction activities. This information is afederal requirement of the EPA and must beprovided.

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8. Description of Any Fill Materials - Provide adescription that characterizes any proposed fillmaterials.

9. Summary of BMPs - Summarize the proposedstructural or nonstructural BMPs to be used tocontrol pollution in stormwater discharges duringconstruction and after construction has beencompleted.

SECTION C – PROJECT DISCHARGE

Stormwater Discharges - Indicate whether thestormwater is discharged to surface waters of theCommonwealth, including to a municipal separate stormsewer or a privately-owned storm sewer.

• If the stormwater is discharged to surface watersof the Commonwealth - provide the name of thereceiving water, secondary water and/or thewatershed which will receive the drainage fromthe project.

• If the stormwater is discharged to a municipalseparate storm sewer - provide the name of themunicipal storm sewer operator, the county whereit s located, and the ultimate receiving waters andwatershed which will receive the drainage fromthe facility or project.

• If the stormwater is discharged to a - provide thename of the municipal storm sewer operator, thecounty where it s located, and the ultimatereceiving waters and watershed which will receivethe drainage from the facility or project.

• If the stormwater is discharged to a private stormsewer - provide the name of the private stormsewer operator, the municipality and county whereit is located, and the ultimate receiving waters andwatershed which will receive the drainage fromthe project.

If the discharge is to something other than thoselisted above, provide a description of where thestormwater is discharged (a separate sheet maybe attached).

Provide the receiving water classification for thosedischarges to waters of the Commonwealth.Receiving water classifications are made pursuantto from Chapter 93 of the Department’sregulations.

SECTION D - OTHER POLLUTANTS; PPC PLANREQUIREMENT

Potential Pollutant Sources - Indicate whether or notyou use, store, process or dispose of chemicals,solvents, toxics, hazardous wastes or any other materialwith the potential for causing accidental pollution of air,

land, or water at the site. If yes, a Preparedness,Prevention and Contingency (PPC) Plan, consistent withthe regulations at 25 PA. Code, must be developed priorto filing the application. An owner or operator, mustsubmit a copy of the PPC Plan to the processing entityupon request. A copy of the guidance document entitledGuidelines for Developing Preparedness, Preventionand Contingency Plans for Operations that DischargeStormwater from Construction Activities can be obtainedfrom the local county conservation district or theregional office. Also, based upon your knowledge of theproposed construction activities to be conducted at thesite, indicate if you know or have reason to believe toxicpollutants are or may be discharged through one ormore of the stormwater discharges covered in theapplication.

SECTION E - EROSION AND SEDIMENT CONTROLPLAN PREPARATION

E & S Control Plans are required to be developed,implemented and approved for all construction activitiessubject to this permit. The E&S Control Plan must beprepared and submitted to the local conservation districtor DEP regional office, and the most current approvedversion kept on site. The plan shall consist of drawingsand a narrative. Plan requirements are listed in thePennsylvania Erosion and Sediment Pollution ControlProgram Manual, available from the conservationdistrict. If applying for an Individual NPDES Permit forDischarges of Stormwater from Construction Activitiesinto "special protection watersheds" as listed in Chapter93 of the Department'’ regulations, the applicant mustincorporate into the E&S Control Plan therecommendations of Appendix 5, Erosion Control, of theDepartment’s Special Protection Waters ImplementationHandbook. The conservation district or DEP RegionalOffice will review the E&S Control Plan and may requirecorrections and revisions if it is inadequate indemonstrating compliance with Chapter 102 andensuring that accelerated erosion will be minimized andsediment pollution will not occur. Provide the name,qualification, title, affiliation, address and telephonenumber of the individual who prepared the E&S ControlPlan.

SECTION F - CERTIFICATION

The applicant(s) must complete the certification underSection H(1) of the NPDES permit application forAquaculture Operations

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COMMONWEALTH OF PENNSYLVANIADEPARTMENT OF ENVIRONMENTAL PROTECTION

INSTRUCTIONS FOR COMPLETINGCULTURAL RESOURCE NOTICE

GENERAL INFORMATIONThis package is designed to assist the applicant in completing thenecessary documentation regarding archaeological sites and historicstructures encountered while undertaking permitting projects.This form is to be completed, signed, and dated by applicants for certainDEP permits or plan approvals. Please refer to the List of Exemptions fora list of applications which are exempt from this requirement. It is theresponsibility of the applicant to complete this form and mail it to thePHMC at the following address:

Bureau of Historic PreservationPennsylvania Historical and Museum CommissionP.O. Box 1026Harrisburg PA 17108-1026

Please be aware that PHMC will keep the Notice and submitted materialsfor its files. Therefore, keep a copy of the Notice and any materialssubmitted with it. Applicants should mail all Cultural Resource Notices“Certified Mail Return Receipt Requested” in order to prove submissionand the date PHMC received the Notice.

Attach a copy of your completed Cultural Resource Notice and the returnreceipt to your permit application.

SECTION A. APPLICANT IDENTIFIERFor purposes of identifying and tracking complete permit packages, enterthe following requested information.APPLICANT NAME. Please insert applicant name using the same nameas will be used with the Permit Application. Also, please insert applicantaddress and phone number.PROJECT TITLE. Please enter the title of the project as will be usedwith the Permit Application.

SECTION B. LOCATION OF PROJECTMUNICIPALITY. Indicate the municipality(ies) in which the site islocated. If the site is located in more than two municipalities, attach aseparate sheet of paper.COUNTY. Indicate the county(ies) in which the site is located. Write outthe county name and also give the DEP county code. If the site is locatedin more than two counties, attach a separate sheet of paper. The list oftwo-digit county codes can be found on the list of Type Codes included atthe end of these instructions.

SECTION C. PERMITS AND APPROVALIdentify specific permit or approval requested for this activity. Mark anyother anticipated federal permits.

SECTION D. FUNDING SOURCESIndicate local, state, federal or other funding sources (in percentage).

SECTION E. RESPONSIBLE DEP REGIONAL,CENTRAL, DISTRICT MINING, OR OIL AND GASMANAGEMENT OFFICECheck the appropriate box that identifies the DEP Regional, Central,District Mining, or Oil and Gas Management Office that is responsible forthe review of this permit application. A list of DEP offices and countiessupported is included in Table 2 of instructions (page 8).

SECTION F. RESPONSIBLE COUNTY CONSERVA-TION DISTRICTSome permit applications are reviewed by County Conservation Districts.If this is the case, give the name of the district office and the telephonenumber, if known.

SECTION G. CONSULTANTFor purposes of avoiding confusion should the consultant submit thedetermination notice to PHMC for the applicant, enter the followingrequested information: Consultant Engineer Name, Address andTelephone Number.

SECTION H. PROJECT BOUNDARIES ANDDESCRIPTIONAssure that the following items are attached and submitted with theNotice form:• 7.5' USGS Map indicating boundaries of the proposed activity.• Narrative description of the proposed activity.• Photographs of any buildings over 50 years old. Indicate what is to be

done to all buildings in the project area.• Indicate the total acres in the property under review. Of this acreage,

indicate the total acres of earth disturbance for the proposed activity.• The return receipt of delivery of this Notice to the Pennsylvania

Historical and Museum Commission.

PHMC requests the following items:• Photographs of any buildings over 40 years old.

• Site maps of the proposed activity, if available

SECTION I. SIGNATURE BLOCKA legally responsible agent of the applicant should complete and sign thenotice. If this form was prepared by someone else, such as a consultantor contractor, that individual should complete and sign the notice.

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TYPE CODES. The following list of codes is to identify specifictypes of requested information .

SECTION B. LOCATION OF PROJECTCounty Codes:

01 Adams 24 Elk 47 Montour02 Allegheny 25 Erie 48 Northampton03 Armstrong 26 Fayette 49 Northumberland04 Beaver 27 Forest 50 Perry05 Bedford 28 Franklin 51 Philadelphia06 Berks 29 Fulton 52 Pike07 Blair 30 Greene 53 Potter08 Bradford 31 Huntingdon 54 Schuylkill09 Bucks 32 Indiana 55 Snyder10 Butler 33 Jefferson 56 Somerset11 Cambria 34 Juniata 57 Sullivan12 Cameron 35 Lackawanna 58 Susquehanna13 Carbon 36 Lancaster 59 Tioga14 Centre 37 Lawrence 60 Union15 Chester 38 Lebanon 61 Venango16 Clarion 39 Lehigh 62 Warren17 Clearfield 40 Luzerne 63 Washington18 Clinton 41 Lycoming 64 Wayne19 Columbia 42 McKean 65 Westmoreland20 Crawford 43 Mercer 66 Wyoming21 Cumberland 44 Mifflin 67 York22 Dauphin 45 Monroe23 Delaware 46 Montgomery 99 Out of State

Refer to Table 2 of instructions on page 8.

PA Dept of Environmental ProtectionGreensburg District OfficeArmbrust BldgRD 2 Box 603-CGreensburg PA 15601-0982 Phone: (412) 925-8115

Counties: Allegheny, Armstrong, Beaver, Fayette, Greene, Washingtonand Westmoreland

PA Dept of Environmental ProtectionEbensburg District Office437 South Center StreetPO Box 625Ebensburg PA 15931-0625 Phone: (814) 472-1900

Counties: Bedford, Blair, Cambria, Fulton, Huntingdon, Indiana andSomerset

PA Dept of Environmental ProtectionPottsville District Office5 West Laurel BoulevardPottsville PA 17901-2454 Phone: (717) 621-3118

Counties: Adams, Berks, Bucks, Carbon, Chester, Columbia, Dauphin,Cumberland, Delaware, Franklin, Juniata, Monroe, Lebanon, Lehigh,Luzerne, Mifflin, Montgomery, Pike, Montour, Northampton, Perry,Northumberland, Philadelphia, Schuylkill, Snyder, Susquehanna, Union,Wayne, Wyoming, and York

PA Dept of Environmental ProtectionHawk Run District OfficeEmpire RdPO Box 209Hawk Run PA 16840-0209 Phone: (814) 342-8200

Counties: Bradford, Cameron, Centre, Clearfield, Clinton, Potter,Lycoming, Sullivan, and Tioga

PA Dept of Environmental ProtectionMcMurray District Office3913 Washington RdMcMurray PA 15317-2532 Phone: (412) 941-7100

Counties: All counties where bituminous underground mining andsubsidence occur.

PA Dept of Environmental ProtectionKnox District OfficeWhite Memorial BldgPO Box 669Knox PA 16232-0669 Phone: (814) 797-1191

Counties: Butler, Clarion, Crawford, Elk, Erie, Forest, Warren, Jefferson,Lawrence, McKean, Mercer, and Venango

PA Dept of Environmental ProtectionOil and Gas ManagementRachel Carson State Office Building5th Floor400 Market StreetP.O. Box 8765Harrisburg, PA 17105-8765 Phone: (717) 772-2199

PA Dept of Environmental ProtectionOil and Gas ManagementNorthwest Regional Office230 Chestnut StreetMeadville PA 16335 Phone: (814) 332-6860

PA Dept of Environmental ProtectionOil and Gas ManagementSouthwest Regional Office400 Waterfront DrPittsburgh PA 15222-4745 Phone: (412) 442-4000

DEP REGIONAL AND CENTRAL OFFICES

DEP DISTRICT MINING OFFICES

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MODULE B

APPLICATION FOR WATER QUALITY MANAGEMENTPART II PERMIT - INDUSTRIAL WASTEWATER FACILITIES

GENERAL INFORMATION

1. APPLICATION DESCRIPTION

This module consists of a one-page application formand a series of supplemental information pages andchecklist designed to insure completeness anduniformity of materials submitted. The narrativesummarizes required exhibits, tables, charts, plansand specifications will comprise the DESIGNENGINEERS REPORT for the project.

This application must be prepared by, or under thesupervision of, a Professional Engineer, registeredin Pennsylvania and competent in the field ofindustrial waste treatment. An outline describing thecontents of the DESIGN ENGINEER‘S REPORTcan be found in Appendix C of the Bureau of WaterQuality Protection‘s Industrial Waste Manual.

2. WHO NEEDS TO OBTAIN AN INDUSTRIALWASTEWATER QUALITY MANAGEMENTPART II PERMIT?

The WQM Part II permit provides for the approval ofplans and specifications for waste treatmentfacilities and the construction and operation of thesefacilities. Treatment facilities which dischargedirectly to surface or groundwaters of theCommonwealth are required to obtain this permit. Itis the responsibility of the treatment facility owner toobtain the WQM Part II Permit.

For further information regarding what permits arerequired for various activities, refer to A User‘sGuide to DEP Permits.

The requirements for preparing applications andobtaining a Part II permit are included in Chapter 91of the Department‘s Rules and Regulations.

3. DESIGN ENGINEER‘S SEAL

The application form, cover page of the designengineer‘s report, and the front cover of each set ofdrawings and specifications must bear the name,signature and seal of the registered professionalengineer responsible for preparing the application.Each drawing must also bear the imprint orreasonable facsimile of this seal.

4. REQUIRED NUMBER OF COPIES AND WHERETO SUBMIT

Five copies of the completed application forms,design engineers report and supplementalinformation shall be submitted to the appropriateDepartment Regional Office.

5. APPLICATION FEE

An application fee for this permit is $500. Refer toTable 1 of the instructions for the total fee.

6. PROOF OF PUBLIC NOTICE

The applicant must attach acceptable evidence offulfillment of the public notification requirements ofSection 30(b) of Pennsylvania‘s Clean Streams Lawas described in the Bureau of Water QualityProtection‘s Industrial Waste Manual. Thisevidence may consist of either a properly notarized“Proof of Publication“, or clippings of theadvertisement, intact with the datelines, of the fourrequired publication dates.

7. SUPPLEMENTAL INFORMATION TO AC-COMPANY THE APPLICATION AND DESIGNENGINEER‘S REPORT -

a. USGS Topographic Map - A 7½ minute seriesUSGS topographic map showing the location ofthe industrial establishment, waste treatmentfacilities, and discharge points. If only a portionof the topographic map is used, the quadrangleidentification and date should be indicated.

b. Soil Erosion and Sedimentation Control Plan - Ifthe construction of any project involves thedisturbance of five acres or more, an Erosionand Sediment Control (E&SC) Plan must beprepared and submitted for review and approvalto the appropriate county conservation district.A copy of the E&SC plan approval letter mustbe submitted with the Part II permit application.

For additional information regarding thecontents of an E & SC Plan, refer to thedepartment‘s Soil Erosion and Sediment ControlProgram Manual and Chapter 102 of theDepartment‘s Rules and Regulations.

c. Preparedness, Prevention and Contingency(PPC) Plan - All industrial activities which have

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the potential for accidental release of pollutionalmaterials to surface or groundwater mustprepare a PPC Plan. If not already preparedand submitted in conjunction with an NPDESpermit application for the industrial operations,three copies of the PPC Plan should besubmitted with the WQM Part II permitapplication. For further information on PPCplanning requirements, see the DEP‘sGuidelines for the Development andImplementation of Environmental EmergencyResponse Plans contained in Appendix B of theBureau of Water Quality Protection‘s IndustrialWaste Manual.

d. Section F - A summary of the flow data,wastewater source, and treatment unitinformation, requested in this section, must beincluded as part of the facility’s general projectdescription (see instructions for completing thissection).

e. Application Submittal Checklist - The last pageof the application form consists of a listing ofitems to be submitted as part of this applicationpackage. The listing should be used as achecklist for assembling the applicationpackage.

8. DEFINITIONS

a. “Monthly Average“ - means the arithmeticaverage (or geometric average for fecalcoliform) of all the daily determinations ofconcentration made during a calendar month.

b. The “daily determination of concentration“means either the concentration of a compositesample taken during a calendar day or thearithmetic average of all grab samples takenduring a calendar day.

c. “24-hour maximum“ - means the dailydetermination of concentration for any calendarday.

d. The terms “minimum“ and “maximum“ refer tothe lowest and highest values, respectively,observed in any grab samples.

NOTE: Pollution Incident Prevention (PIP) Plansprepared in conjunction with DEP‘s Water QualityProtection Program or other previously preparedemergency response and prevention plans, shouldalready encompass some of the basic PPC Planelements and may only need to be revised oramended.

SECTION A - APPLICANT IDENTIFIER

Applicant Name - Give the name, as it is legally referredto, of the person, firm, public organization, or any otherentity which owns the treatment facility described in thisapplication.

SECTION B - SIC CODES

SIC Code - List, in descending order of significance, thefour-digit standard industrial classification (SIC) codeswhich best describe your facility in terms of the principalproducts or services you produce or provide. Also,specify each SIC classification in words. A listing ofcommon industrial SIC codes can be found in the“Standard Industrial Classification Manual“ prepared bythe Executive Office of the President, Office ofManagement and Budget. The SIC Manual is availablefrom the Government Print Office.

SECTION C - GENERAL DESCRIPTION ANDNATURE OF BUSINESS

Description of Business - Use this space to furtherdescribe the nature of your business (e.g., productsproduced, or services provided).

SECTION D - LIST OF PERMITS

Presently Held Permits - Use this space to list all (pastand present) NPDES and Part II Water QualityManagement permits issued by DEP for this facility.

SECTION E - CERTIFICATION AND SIGNATURE OFAPPLICANT

A. The application must bear the name, signature andseal of the registered professional Engineerresponsible for preparing the application. Theengineer responsible for preparing this applicationmust be registered in Pennsylvania and becompetent in the field of industrial waste treatment.

B. The applicant(s) must complete the certificationunder Section I(2) of the NPDES permit applicationfor Aquaculture Operations.

SECTION F - SUMMARY OF FLOW WASTEWATERSOURCES AND TREATMENT UNIT INFORMATION

Item(1) Describe the source of wasteflow. Be as brief and

concise as possible (e.g., nickel plating line washer,spent hot rolling lubricants, etc.)

(2) List the outfall or suboutfall.

(3) Indicate the type of wastewater flowing from thisoutfall (e.g., sanitary waste, process waste, non-contract cooling water, etc.).

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(4) Indicate the wasteflow pattern and period of flowwhich best describes the operation(s).

(5) Indicate the daily waste volume, using the mostappropriate units.

(6) Indicate the average and maximum design flow foreach outfall or suboutfall and where appropriate, thegeneral sequence of treatment units. Use a briefdescription (e.g., carbon absorption, extendedaeration activated sludge, etc.) and use theappropriate unit code from Table 1. Indicatewhether or not it is a proposed or existing unit. Useadditional sheets if necessary.*

* If impoundments are being proposed, and thewastewater entering the impoundments meets thedefinition of Residual Waste at 25 PA CodeChapter 287, the design and operation must be inaccordance with 25 PA Code Chapters 287 and 299.

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MODULE C

INSTRUCTIONS FOR COMPLETING THE JOINT PERMIT APPLICATION FORMS

Instructions for completing the U.S. Army Corps of Engineers Section 404 permit application and Pennsylvania WaterObstructions and Encroachment permit application are included at the end (after Module E instructions). Theseapplications are currently going through a revision process however, until the revisions are completed, the existing jointapplication (Module C) should be used. When the revisions are finalized, they will be replaced by the revisedapplications and related instructions and the final instructions will be incorporated here in the Module C.

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MODULE D

INSTRUCTIONS FOR COMPLETINGENVIRONMENTAL ASSESSMENT FORM

PART 1 - RESOURCE IDENTIFICATION

1. INDICATE WATER RESOURCES WHICH EXIST ON THE PROJECT SITE: For a desk analysis of the waterresources which exist on the project site, refer to the United States Geological Service quadrangle maps for theproject area. These maps are available for reference at the local county conservation district office. Refer totelephone directory under the County for the Conservation District. Also, these maps may be purchased from oneof the retail establishments listed on the internet at www.usgs.gov.

Floodway and Floodplain information is available from the Department of Community and Economic Development,Strategic Planning and Operations Office, Floodplain Management Division, Forum Building, Harrisburg,PA 17120 or by calling 717-787-7403. Federal Emergency Management Agency (FEMA) maps are oftenavailable for reference at county and municipal planning offices.

The Soil Survey for your county along with the list of hydric soils for the county are helpful office referencesregarding wetlands. These are available from the County Conservation District. Refer to telephone directoryunder the County for the Conservation District.

In identifying and delineating wetlands on site, the 1987 Corps Wetland Delineation Manual and the 1988 WetlandPlan List for the Northeast Region 1 are essential. They may be obtained by contacting the following:

* The 1988 Wetland Plant List for the Northeast Region 1Publication No. PB89-128680Available from -

The National Technical Information Service (NTIS)Springfield, VA 22161Price: $26.00 plus $3.00 for shipping and handlingMajor credit cards acceptedFor information call: 703-487-4650Fax orders call: 703-321-8547

* The 1987 Corps Wetland Delineation ManualPublication No. ADA 176734Available from -

The National Technical Information Service (NTIS)Springfield, VA 22161Price: $27.00 plus $3.00 for shipping and handlingMajor credit cards acceptedFor information call: 703-487-4650Fax orders call: 703-321-8547

2. FOR INFORMATION ON THE RESOURCES LISTED, THE FOLLOWING REFERENCES ARE HELPFUL:

U.S.G.S. quadrangle maps contain valuable information, such as wild, natural, or wilderness areas, andNational wildlife refuges and sanctuaries.

A current PA Recreation Guide Map locating state parks, state forests and state game lands is available fromDCNR by calling 1-800-63PARKS or from state-owned recreation areas in Pennsylvania.

Prime farm land information is available from the County Conservation District Office.

Be sure to mark either the “YES” or “NO” column for all questions.

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3 & 4. Information on stocked waters and wild trout streams may be obtained from the Pennsylvania Fish and BoatCommission at:

Bureau of FisheriesDivision of Fisheries Management450 Robinson LaneBellefonte, PA 16823-9620Telephone: 814-359-5110

5. Copies of Chapter 93 are available from the Water Management Program in the DEP Regional Offices. A listof DEP Field Operations Regional Offices can be found in Appendix II of this section.

6. For information on National Wild or Scenic River corridors, and waterways designated as “Wild” or “Scenic”under the Pennsylvania Scenic Rivers Act, refer to the brochure provided with this Environmental Assessmentform. If your project area appears to be in a wild or scenic river corridor, contact the DCNR, Division ofConservation Partnerships, Scenic Rivers Program, P.O. Box 8475, Harrisburg, PA 17105-8475, phone717-787-2316.

7. Contact the Bureau of Water Supply and Community Health in the appropriate DEP Regional Office forinformation on public water supplies. A list of DEP Field Operations Regional Offices can be found inAppendix II of this section.

8. Enclosure C - Description of Aquatic Habitat: This information is site specific and is based on data collected inthe project area, observations and best professional judgment. The level of detail necessary in this studyshould be discussed with the Department. Contact the Soils and Waterways Section of your DEP RegionalOffice to arrange a preapplication meeting. For projects affecting one acre or more of wetlands or projectsimpacting more than 200 feet of stream, please refer to the listed references in Appendix I of this section.

PART 2 - PROJECT DESCRIPTION

9. Project Impacts - Enclosure D

A. Discuss the Impacts:

If project will take place within or adjacent to any of the areas listed in 9A(1) through 9A(9) please discuss theproposed project’s impact on the resource. Include the aerial extent of impacts such as the acreage ofwetlands which will be filled, excavated, or inundated or the length of stream which will be relocated,enclosed, or inundated.

B. Discuss the Environmental Impacts:

Consider immediate and long term impacts on the entire local and regional ecosystems. Major areas ofconcern include:

(1) Aquatic habitats - In addition to the items listed, please address the following concerns. Does theproject impact fisheries? Will the activity impair the ability of these watercourses to continue toprovide habitat or aquatic species? Special attention should be given to wild and stocked troutstreams. Does the project demonstratively reduce or degrade habitat for terrestrial, aquatic and, oravian species? Is the degradation significant in a local or regional context? Will the degradation havean effect on biodiversity?

(2) Water Quantity and Streamflow - Please discuss the items listed.

(3) Water Quality - In addition to the items listed, please address the following concerns. Does the projectdegrade the water quality? Does it have an impact on water quality to the extent that the watershed’s

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designated or existing water use classification is impaired? (Refer to question #5 designated water useas indicated in Chapter 93).

(4) Recreation - In addition to the items listed, please address the following concerns. Recreationalboating may also need to be considered, regardless of the official designation, where there is adocumented on-going use of the watercourse for boating, canoeing or other types of recreation.

(5) Upstream And Downstream Property - Riparian rights are those rights which are derived from theownership of real property underlying or bordering streams and rivers. The holder of riparian rights hasno property right in the water itself but only a nonexclusive right to the water. No right to divert orconsume a specific quantity of water is obtained.

Historically, riparian rights have focused upon use. Recent court decisions also have held that riparianrights can be extended to the aesthetics of the watercourse for personal satisfaction or enjoyment.Riparian rights must be considered in cases where an increase or diminution of flow would result fromthe proposed activity and in cases where the direction of flow would be altered.

(6) Other Environmental Factors - Include the impacts from any other environmental factors notspecifically listed herein.

C. Environmental Impacts On Other Adjacent Land And Water Resources

Consideration should also be given to impacts of the project on adjacent water resources. Will the projectadversely impact those resources indirectly, i.e. loss of hydrology, wildlife corridors, habitat, etc? Secondaryimpact assessment is intended to identify all potential permit issues and project impacts for the entire parcelof land.

D. Cumulative Environmental Impacts To The Resource

Identify and evaluate the cumulative impact of this project and other potential or existing projects like it.Cumulatively, do these piecemeal changes have a significant adverse impact on the resource?

E. Describe Additional Dams, Water Obstructions Or Encroachments

Dams, water obstructions and encroachments should be designed in consideration of future land use toassure proper adequacy for future development. The Department may require additional data relating toplanning, subdivision and zoning.

PART 3 - CERTIFICATION

The Environmental Assessment will not be accepted unless the form is signed and dated.

* Note: Appendix II and III of this section provide addresses and telephone numbers for key DEP and U.S.Army Corps of Engineer’s offices.

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Please consult the appropriate Regional Office before embarking on any of the studies listed below.

WET II

Assessment:WET II assesses wetland functions and values. It is a

version of the Federal Highway Method (or AdamusMethod) originally published as “A method forWetland Functional Assessment, FHWA ReportNo. IP-82-24.”

Document:Wetland Evaluation Technique (WET),Volume II:Methodology Operational Draft; 271 pp.PB 89-143-028 (order number)

Source:National Technical Information Service (NTIS)Springfield, VA 22161 (703) 487-4650

IFIMInstream Flow Incremental Methodology

Assessment:IFIM assesses stream habitat. Plans (methodologies)of study, logic, and skills for decision-making aredetailed in this technique.

Document:Instream Flow MethodologyPB-80-181-100 (order number)

Source:National Technical Information Service (NTIS)Springfield, VA 22151 (703) 487-4650

Additional Information:National Ecological Research CenterU.S. Fish & Wildlife Service/Aquatic Systems Br.4512 McMurray StreetFort Collins, CO 80525 (303) 226-9445Course fees: Various; ranging from $440to $550 per training session

HEPHabitat Evaluation Procedure

Assessment:HEP assesses environmental impacts andestablishes guidelines for resource management. Itutilizes a Habitat Suitability Index (HSI) which is asystem a mathematical models employed tocompute values for selected species from fieldmeasurements of habitat variables. Developed in1980 by the United States Fish and Wildlife Service.

Document:Habitat Evaluation ProcedurePB-81-189-896 (order number)

Source:National Technical Information Service (NTIS)Springfield, VA 22161, (703) 487-4650

Additional Information:Courses are available on HEP through:National Ecological Research CenterU.S. Fish and Wildlife Service Service/Terrestrial Br.4512 McMurray StreetFort Collins, CO 80525 (303) 226-9421Course fees, approx. $600.00 per session

PAMHEPPennsylvania Modified Habitat

Evaluation Procedure

Assessment:PAMHEP is the Habitat Evaluation Proceduremodified for specific use in Pennsylvania. It is utilizedby the Fish and Game Commissions and otheragencies in the Commonwealth.

Document:PAMHEP Manual

Source:The text is out of stock; 300 original copies werepublished.

Cost:Not in print

Contact Person:Mr. Richard McCoyUnited States Fish and Wildlife Service315 South Allen Street, Suite 322State College, PA 16801 (814) 234-4090Mr. McCoy will supply a “loaner-copy” that must bereturned. It may be photocopied; 155 pagesapproximate.

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U.S. ARMY CORPS OF ENGINEERS DISTRICT OFFICES

Delaware River Basin

Philadelphia District Corps of EngineersWanamaker Bldg.

100 Penn Square EastPhiladelphia, PA 19107

Phone: 215-656-6725Phone: 215-656-6729 (to report violations)Fax: 215-656-6724

Ohio River BasinPortions of Lake Erie and

Genesee River Basins Located in Pennsylvania

Pittsburgh District Corps of EngineersRoom 1817 Federal Bldg.

1000 Liberty AvenuePittsburgh, PA 15222

Phone: 412-644-6874Fax: 412-644-2811

Susquehanna River Basin

Baltimore District Corps of EngineersP.O. Box 1715

Baltimore, MD 21203-1715

Phone: 410-962-1846 (concerning projects in PA)or 814-466-7756

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MODULE E

INSTRUCTIONS FOR COMPLETINGDAM PERMIT APPLICATION

GENERAL INFORMATION

The following instructions are intended to assist theapplicant in properly completing a DEP Dam PermitApplication. DEP is committed to the explanation of itspermitting requirements and assisting, to the fullestextent possible, those persons whose activities requirethem to secure a DEP Dam Permit.

Upon receipt of the complete application packages andrequired fee, DEP will begin to review the application.The Department will also determine if the project iseligible for Federal authorization under the terms of thePennsylvania State Programmatic General Permit(PASPGP-1). If required, the Department will forward acopy of the permit application to the appropriate U.S.Army Corps of Engineer’s District Office. The addressand telephone numbers of the three U.S. Army Corps ofEngineers District Offices covering Pennsylvania arelisted on page 23 of the instructions (Module D).

Please review the application form and attachmentscarefully before submitting to the Department. TheDepartment will only begin its review after receipt of acomplete application package. Errors, omissions andother irregularities must be resolved before detailedreviews of the application may begin. Accordingly, it isimportant that the following instructions be followed veryclosely.

ACTIVITIES WHICH REQUIRE A PERMIT:

A Dam Permit is required from DEP before any personmay construct, operate, maintain, modify, enlarge orabandon a dam that meets any one of the followingcriteria.

1. The dam is located across a watercourse and thecontributory drainage area to the dam exceeds100 acres.

2. The dam is located across a watercourse and themaximum depth of water, measured from theupstream toe of the dam to the top of the dam atmaximum storage elevation, is greater than 15feet.

3. The dam is located across a watercourse and theimpounding capacity (storage volume) atmaximum storage elevation is greater than 50acre-feet.

4. The dam stores water, is not located on awatercourse, and has no contributory drainage,but the maximum depth exceeds 15 feet and themaximum storage volume exceeds 50 acre-feet.

5. The dam is used for storage of fluids or semi-fluids other than water, the escape of which mayresult in air, water, or land pollution or in danger topersons or property.

If the proposed dam does not require a Dam Permit, butis located in, along or projecting into a wetland orExceptional Value Waters, or requires 401 WaterQuality Certification, Department approval of anEnvironmental Assessment is required. AnEnvironmental Assessment form will be provided by theDepartment with the notification of our jurisdictionaldetermination or upon request. County ConservationDistrict Offices also have copies of this form. Anyexcavation of wetlands within the impoundment areawould require a Water Obstruction and EncroachmentPermit from the Department. Excavation in theimpoundment area, not in wetlands but within thefloodway of a watercourse, may also require a WaterObstruction and Encroachment Permit. Thisdetermination will be made by the Department uponreceipt of the information discussed above.

PERMIT WAIVERS:

Before preparing a Dam Permit Application, theapplicant should review the availability of permitwaivers. These waivers are listed under Section 105.12of DEP’s Chapter 105 Rules and Regulations and havebeen reproduced below. Most of the waivers areautomatic and do not need prior DEP approval. Anyperson using such waivers needs only to develop andretain such information that will verify their qualificationto use a waiver. This information would be madeavailable to DEP only if so requested as a result of ageneral inquiry or in the investigation of a complaint.The only exceptions to the “automatic” waivers concernsub-sections 105.12(a)(4), 105.12(a)(11), 105.12(a)(16)and 105.12(b)(2). These subsections require that anyperson wishing to use these permit waivers must firstsubmit specified information to DEP for its review andapproval.

§105.12 Waiver of permit requirements (for dams)

(a) Under Section 7 of the act (32 P.S. §693.7), therequirements for a permit are waived for the followingstructures or activities, regardless of when commenced.If the Department upon complaint or investigation findsthat a structure or activity which is eligible for a waiver,has a significant effect upon safety or the protection oflife, health, property or the environment, the Departmentmay require the owner of the structure to apply for andobtain a permit under this chapter.

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(1) A dam not exceeding 3 feet in height in astream not exceeding 50 feet in width, except wild troutstreams designated by the Pennsylvania Fish and BoatCommission.

(b) The requirements for a permit for existingstructures or activities, as provided in section 6(c) of theact (32 P.S. §693.6(c)), are waived for the followingstructures or activities, if construction was completedprior to July 1, 1979. If the Department upon complaintor investigation finds that a structure or activity which iseligible for a waiver, has a significant effect upon safetyor the protection of life, health, property or theenvironment, the Department may require the owner ofthe structure or activity to apply for and obtain a permitunder this chapter.

(1) A dam not exceeding 5 feet in height in anonnavigable stream operated and maintained for watersupply purposes.

(2) A dam which the Department determines,on the basis of preliminary data submitted by theapplicant, is of Size Classification C and HazardPotential Classification 3, as defined in §105.91 anddoes not have a significant effect on coastal resourcesor an adverse impact on the environment.

401 WATER QUALITY CERTIFICATION:

Applications submitted to the Bureau of WaterwaysEngineering for projects requiring a Dam Permit will alsobe considered a request for Water Quality Certificationunder Section 401 of the Federal Water PollutionControl Act (33 U.S.C.A. 1341(a)) for either a U.S. ArmyCorps of Engineers’ (ACOE) individual permitnationwide permit or Pennsylvania State ProgrammaticGeneral Permit.

COMPLETING THE APPLICATION FORMS

SECTION A. APPLICANT IDENTIFIER

Applicant Name: Please list the name(s) of theapplicant and individual who will be signing certificationunder Section I(2) of the NPDES permit application forAquaculture Operations.

SECTION B. PROJECT LOCATION DATA

� Provide the USGS name of the stream, river orbody of water. If none, enter “unnamed”.

� Place an “X” on the appropriate Corps District line.Baltimore covers the Susquehanna River basin;Philadelphia covers the Delaware River basin;Pittsburgh covers the Ohio River, Genesee Riverand Lake Erie basins.

� Provide the name of the USGS 7½ minuteQuadrangle map where the project is located andprovide the other site location information asrequested.

� Provide a concise and accurate narrative of theproject’s purposes and need.

SECTION C. PROJECT DATA

Please provide the project’s physical data in the unitsrequested. Most of the requested items are selfexplanatory, but attention is drawn to the following:

� Maximum depth to top of dam.

� Size and Hazard Classification - Thedetermination of size and hazard classificationsshall be made in accordance with therequirements of section 105.91 of theDepartment’s Chapter 105 Rules and Regulations.Additionally a narrative providing justification forselection of the Hazard Classification must beprovided. In most cases, a dam breach analysisshould be completed to determine downstreamimpacts resulting from a failure of the dam.Continue the justification narrative on additionalsheets of referenced paper if required.

SECTION D. DETERMINATION OF APPLICATIONFEES (DEP FEES ONLY)

The determination of application fees shall be made inaccordance with Section 105.13(b)(1) and Section105.91. Include appropriate fee in Table 1 of theinstructions. All fees are waived for Federal, State,county, municipal agencies or municipal authorityapplications.

SECTION E. APPLICATION COMPLETENESSCHECKLIST

CHECKLIST ITEMS:

(Applicant must place an entry - Y = Yes, N = No, N/A =Not Applicable - in each left side column space).

The Department’s review of all applications begins witha determination of completeness. If an applicationpackage is incomplete, the Department will correspondwith the applicant and request submission of correctedand/or previously omitted documents. The department’sreview of permit applications will not begin until acomplete application has been received. See Section105.13 of the DEP’s Chapter 105 Rules and Regulationsfor specific requirements. Additional guidance for therequired checklist items is as follows:

CHECKLIST ITEMS

1. Permit application properly signed, sealed andwitnessed: The applicant(s) must complete thecertification under Section H(2) of the NPDES permitapplication for Aquaculture Operations.

2. Permit Application General Information Form.Only one form is required for all permits.

3. Application Fee enclosed: see Section D

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4. Copies and proof of receipt - Act 14notification: Please refer to Item C on page 3 of theinstructions.

5. Determination of historic/archaeological sites:Complete and attach to each copy of the applicationpackage, completed form “CULTURAL RESOURCENOTICE” and the Return Receipt that shows that thePHMC received this notice. Additional instructions forcompleting this notice are listed in Module A.

6. Completed and approved Supplement No. 1Form (PNDI): This form (included in the application)must be submitted to the department and returned toyou before the application is prepared. The final projectdesign and the application package that is preparedmust reflect the presence of, and potential impacts to,any endangered or threatened species or critical habitatwithin the project area discovered in the PNDI(Pennsylvania Natural Diversity Inventory) search. Acopy of this form must be attached to each copy of theapplication package.

7. Site plan (including cross sections andlocation maps): Each set of plan must be legible, andmust include the following:

(a) All drawings shall contain a title block at thelower right corner of the sheet. The title block shallcontain the project name, name of the applicant, nameof the plan PREPARER (if different then the applicant)and the date the plan was prepared.

(b) Location Maps: The submission mustcontain a project location map drawn to, or otherwiseutilizing an existing 1:24,000 scale (1 inch equals 2,000feet). This is the scale used on U.S.G.S. 7.5 minutetopographic maps. A photocopy of the appropriateU.S.G.S. topographic map, with the project siteidentified in red, is the recommended method to complywith this requirement. The photocopy must include a 3inch radius of map coverage around the project site. Ifa U.S.G.S. photocopy is used for a location map, all therequirements of Subsection 105.13(d)(1)(ii) of the DEP’sregulations will be satisfied. Refer to that subsection forrequired location map features if another type, or handdrawn map is used.

(c) Site Plans: A site plan must be includedwhich provides a complete plan view of the proposedstructure or activity and those adjoining upstream anddownstream areas where potential and/or actualhydraulic or environmental impacts will occur. Specificrequirements for site plans include:

(i) Plans shall clearly show existing andproposed limits for all regulated waters of theCommonwealth (edges of streams, rivers, lakes, etc.)and the limits of their floodplains. When the proposedworksite is located within a detailed Federal EmergencyManagement Agency (FEMA) flood study area, theexisting and proposed FEMA 100-year frequency

floodway limits must be shown on the site plan. Whenthe project involves impacts to wetlands, the wetlandboundaries must be delineated in accordance with theDepartment’s Wetland Delineation Policy (seeinstructions for completing the EnvironmentalAssessment form).

(ii) Plans must be drawn to a scale of 1inch equals 200 feet or larger and show all proposedstructures or activities and all existing roads, utility lines,lots (show property lines and names of adjoiningproperty owners), buildings and other man-madestructures in the area of the proposed project. Naturalfeatures such as contours, surface drainage patternsand other prominent topographic features should beillustrated. Place a north arrow on the site plan.

(iii) Cross Sectional Drawings: A crosssectional drawing of existing and proposed conditions atthe project site must be included on the site plan or on aseparate plan. If the proposed project causes changesin upstream or downstream flood water surfaceelevations, cross sectional drawings are required for thechannel and floodway conditions in these areas. Allcross sections must show existing and proposed designdischarge water surface elevations and the 100 yearfrequency flood water surface elevation.

8. Project description narrative: Provide adetailed description of the project including structuretype(s), amounts of excavation/fill and what purpose thestructure or activity will serve. The narrative must alsodescribe in detail what effects the project will have onpublic health, safety and the environment. Informationfor this part of the narrative can be obtained fromcompletion of the “Environmental Assessment”(Section E, item 15.) The narrative must contain astatement on why the project must be built in, along,across or over a watercourse, floodway of body of water.Is there an alternative to the proposed project that wouldnot require such impacts? Be sure to discuss this indetail under the Section E, item 16. “AlternativesAnalysis” requirements.

9. Color photographs with map showing locationtaken: Color photographs (one set for each of the threeapplication packages) must be taken of the site whichillustrate watercourse, floodway or body of waterconditions at the project site and for areas extendingboth upstream and downstream. The number ofphotographs needed to meet this requirement will varywith the size and/or length of proposed work. Forsingular or small worksites such as a stormwaterdetention dam, two photographs taken at the site, onelooking upstream and one looking downstream, may beall that is required if the impoundment area is notobscured by trees, brush or similar visual impediments.Additional photos will be needed if the impoundmentarea is obscured or for larger dams to show the relativelocation, elevation and condition of nearby buildings andthe are that the dam embankment will occupy and the

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pool will inundate. The location that the photographswere taken from the direction of view must be indicatedon a separate site plan drawing. Usual practice is tonumber each photograph, mount in transparentphotoholders, mark the numbers on the plan and thendraw an arrow from the number in the direction of view.

10. Erosion and Sedimentation Control Plan andapproval letter: Application for an NPDES Permit forstormwater discharge associated with constructionactivity is required as a part of this application.

11. Hydrologic and hydraulic analysis: This shouldbe prepared as a separate report and contain the sealand certification statement of the licensed ProfessionalEngineer who prepared the report.

12. Stormwater Management Analysis withconsistency letter: Dams requiring DEP permits areoften additionally regulated under local municipalstormwater control ordinances adopted under theStormwater Management Act (32 P.S. §§680.1–680.17).If such an ordinance exists, an analysis of the proposedproject’s impact on the Stormwater Management Planmust be undertaken and reviewed by the localmunicipality. The analysis and a letter from themunicipality indicating consistency with the StormwaterManagement Plan must be included in the applicationpackage.

13. Floodplain Management Analysis withconsistency letter: If the proposed dam is locatedwithin a floodway delineated on a FEMA map, ananalysis of the project’s impact on the floodwaydelineation and water surface profiles will be required.The analysis and a letter of review from the municipalitymust be included in the application package.

14. Risk Assessment: If the stormwater and/or thefloodplain management analysis conducted under items12 or 13, indicate increases in peak runoff rates or floodelevations, include as a separate document, adescription of property and land uses which may beaffected and an analysis of the degree of increased riskto life, property and the environment.

15. Environmental Assessment form: Anincomplete Environmental Assessment form will resultin the entire application being consideredINCOMPLETE. Please refer to the instructions oncompleting the Environmental Assessment form underModule E.

16. Alternatives Analysis: Provide, as a separatereport, a detailed analysis of alternatives to theproposed dam, or other activities, including alternativelocations, designs and routings.

17. Mitigation Plan: As defined under Section 105.1of DEP’s Chapter 105 Rules and Regulations, Mitigationis:

(a) An action undertaken to accomplish oneor more of the following:

(i) Avoid and minimize impacts bylimiting the degree or magnitude of the action andits implementation.

(ii) Rectify the impact by repairing,rehabilitating or restoring the impactedenvironment.

(iii) Reduce or eliminate the impactover time by preservation and maintenanceoperations during the life of the action.

(b) If the impact cannot be eliminated byfollowing clauses (i)— (iii), compensate for theimpact by replacing the environment impacted bythe project or by providing substitute resources orenvironments.

The mitigation plan must be a separatedocument which describes how project planningemployed mitigation concepts as defined in DEP’sChapter 105 Rules and Regulations. If these impactscannot be eliminated, then the mitigation plan mustinclude details and plans for replacing the impactedenvironment. The specific replacement resources orenvironments must be itemized and construction,operation and maintenance activities must be detailed inthe plan.

18. Proof of title or adequate flowage easements:Included with the application package shall be copies ofdeeds showing ownership and/or copies of fullyexecuted flowage easements for all land areas belowthe top of the dam elevation that is subject toinundation. Show all property lines on the site plan.

19. Data on site and construction materials:Attached to the application shall be a report which liststhe results of investigations and tests to determine thesafety, adequacy and suitability of design for the damand, when applicable, include:

(a) Data concerning subsoil and rock foundationconditions and the materials to be used in construction.

(b) Data on exploratory pits, drilling, coring andseepage rate tests.

(c) Data on strength tests to measure thephysical properties and behavior of foundation andembankment materials at the dam site.

(d) Data on the dam site geology includingpossible hazards.

(e) Data on the availability and quality ofconstruction materials.

(f) Other information as may be required,including dam design calculations.

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20. Design drawings, reports and technicalspecifications: The application must include a designreport, construction plans and specifications in sufficientdetail to evaluate the safety, adequacy and suitability ofthe proposed work.

21. Emergency Action Plan: Applicants for any damor reservoir that may cause loss of life or seriousdamage to property if a failure of the dam occurs shalldevelop (and attach to the application) an emergencyaction plan to be followed in the event of a dam hazardemergency. The plan shall be prepared in accordancewith the requirements of Section 105.134 and theEmergency Action Plan Guidelines available from theDivision of Dam Safety.

22. Instrument performance monitoring plan:Submit plans for proposed permanent monitoring ofdam performance by instrument installations in the dam.If none are proposed, explain the reasons why.

23. Proof of financial responsibility: For dams thatpresent a substantial potential risk to life or property, theapplication must include proof of the applicant’sfinancial responsibility or security for continuedoperation and maintenance during the lifetime of thefacility. Refer to Section 105.20 for detailed instructionon completing this requirement.

24. Data on chemical content, viscosity and othercharacteristics: For projects involving storage of fluidsor semifluids other than water, information concerningthe chemical content, viscosity and other pertinentphysical characteristics of the fluid or semifluidimpounded.

25. Operation and Maintenance Manual: Aseparate Operation and Maintenance Manual must beprepared in accordance with the requirements of Section105.131 and include a schedule of inspections asrequired under Section 105.53.

26. Copies of the most recent inspection reports:Applicable to existing dams.

27. Professional Engineer’s Seal and Certification:All plans, specifications and reports accompanying theapplications shall be affixed with the seal of a registeredprofessional engineer and a certification, signed by theregistered professional engineer, which shall read asfollows:

“I (name) do hereby certify pursuantto the penalties of 18 Pa. C.S.A.,Section 4904 to the best of myknowledge, information and belief,that the information contained in theaccompanying plans, specificationsand reports has been prepared inaccordance with acceptedengineering practice, is true andcorrect, and is in conformance with

Chapter 105 of the rules andregulations of the Department ofEnvironmental Protection.”

28. Pertinent Construction Dates: Proposed timefor commencement and anticipated completion ofconstruction.

SECTION F. LIST APPROVALS, CERTIFICATION,DENIALS OR NOTICES OF VIOLATION RECEIVEDFROM FEDERAL, INTERSTATE, STATE OR LOCALAGENCIES FOR STRUCTURES, CONSTRUCTION,DISCHARGES OR OTHER ACTIVITIES DESCRIBEDIN THIS APPLICATION:

Use additional sheets of paper, if required, and attach toapplication.

CERTIFICATION AND SIGNATURE

The applicant(s) must complete certification underSection I(2) of the NPDES permit application forAquaculture Operations.

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INSTRUCTIONS FOR COMPLETING AN ENVIRONMENTAL ASSESSMENT FORNON-JURISDICTIONAL DAMS, JURISDICTIONAL DAMS,AND WATER OBSTRUCTIONS AND ENCROACHMENTS

GENERAL INFORMATION

The term “non-jurisdictional dam” refers to theconstruction of those dams that do not meet any of theminimum criteria established for requiring a DEP dampermit under Section 105.3 (scope) of the Department’sChapter 105 Rules and Regulations. From Section105.3, the criteria for dams across a watercourse are:

(i) The contributory drainage area exceeds 100acres.

(ii) The greatest depth of water measured byupstream toe of the dam at maximum storageelevation exceeds 15 feet.

(iii) The impounding capacity at maximum storageelevation exceeds 50 acre-feet.

In addition to “non-jurisdictional dams”, the Departmenthas waived permit requirements for eight categories ofdam construction and maintenance. From Section105.12 of the Department’s Rules and Regulations,these waivers are:

§105.12 Waiver of permit requirements.

(a) Under Section 7 of the act (32 P.S. §693.7), therequirements for a permit are waived for the followingstructures or activities, regardless of when commenced.If the Department upon complaint or investigation findsthat a structure or activity which is eligible for a waiver,has a significant effect upon safety or the protection life,health, property or the environment, the Departmentmay require the owner of the structure to apply for andobtain a permit under this chapter.

(1) A dam not exceeding 3 feet in height in astream not exceeding 50 feet in width, except wild troutstreams designated by the Pennsylvania Fish and BoatCommission.

(b) The requirements for a permit for existingstructures or activities, as provided in section 6(c) of theact (32 P.S. §693.6(c)), are waived for the followingstructures or activities, if construction was completedprior to July 1, 1979. If the Department upon complaintor investigation finds that a structure or activity which iseligible for a waiver, has a significant effect upon safetyor the protection of life, health, property or theenvironment, the Department may require the owner ofthe structure or activity to apply for an obtain a permitunder this chapter.

(1) A dam not exceeding 5 feet in height in anon-navigable stream operated and maintained forwater supply purposes.

(2) A dam which the Department determines,on the basis of preliminary data submitted by theapplicant, is of Size Classification C and HazardPotential Classification 3, as defined in §105.91 anddoes not have a significant effect on coastal resourcesor an adverse impact on the environment.

REQUIREMENT FOR ENVIRONMENTALASSESSMENT

1. Non-jurisdictional Dams: An EnvironmentalAssessment and supporting documentation mustbe reviewed and approved by the Departmentbefore a non-jurisdictional dam may beconstructed in any of the following situations:

(a) When a dam is located in, along orprojecting into a wetland.

(b) For a dam located in, along or projectinginto an exceptional value waters as definedin Chapter 93 of the Department’s Rulesand Regulations.

(c) Where water quality certification is requiredunder Section 401 of the Clean Water Act(33 U.S.C.A. §1341), an EnvironmentalAssessment is required for every damlocated in, along, across or projecting intothe regulated waters of this Commonwealth.These activities include but are not limitedto Federal Nationwide Permits (NWP) No.2, No. 12, No. 14, No. 16, No. 17, No. 18,No. 23, No. 26, No. 33, No. 36 and No. 40.

2. Waived Dams: An Environmental Assessmentand supporting documentation must be reviewedand approved by the department before waiversfor dams may be granted under Sections105.12(a)(11) and 105.12(a)(16).

ENVIRONMENTAL ASSESSMENT INFORMATIONSHEET

SECTION A. OWNER INFORMATION

Provide the owner’s name, address, telephonenumber and contact person.

SECTION B. AGENT/PREPARER INFORMATION

Provide all firms or individuals who prepared orassisted in preparing the Environmental Assessmentforms and accompanying documentation.

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SECTION C. PROJECT LOCATION DATA

� Provide the USGS name of the stream, river orbody of water. If none, enter “unnamed”.

� Place an “X” on the appropriate Corps District line.Baltimore covers the Susquehanna River basin;Philadelphia covers the Delaware River basin;Pittsburgh covers the Ohio River basin and theGenesee River and Lake Erie basins.

� Provide the name of the USGS 7½ minutequadrangle map where the project is located andprovide the other site location information asrequested.

� Provide a concise and accurate narrative of theproject’s purpose and need.

SECTION D. PROJECT LOCATION DATA

Please provide the project’s physical data in the unitsrequested. Most of the requested items are selfexplanatory, but attention is drawn to the following:

� Maximum depth to top of dam.

� Size and Hazard Classification – Thedetermination of size and hazard classificationsshall be made in accordance with therequirements of section 105.9 of the Department’sChapter 105 Rules and Regulations. Additionallya narrative providing justification for selection ofthe Hazard Classification must be provided.Continue the justification narrative on additionalsheets of referenced paper if required.

NOTE: All forms, plans, reports, photographs andother information required for this submission mustbe submitted in triplicate to the Department.

SECTION E. INFORMATION COMPLETENESSCHECKLIST

CHECKLIST ITEMS:

a. Location Map: Submit a photocopy of theU.S.G.S. 7½ minute quadrangle map where the site islocated. Locate the site on the map.

b. Determination of historic/archaeological sites:Complete and attach to each copy of this package,completed forms “CULTURAL RESOURCE NOTICE”and the return receipt that shows that the PHMCreceived this notice. Additional instructions forcompleting these notices are in Module A.

c. Completed and approved Supplement No. 1Form (PNDI): This form (included in this package) mustbe submitted to the department and returned to youbefore the Environmental Assessment is prepared. Thefinal project design and the environmental assessmentmust reflect the presence of, and potential impacts to,any endangered or threatened species or critical habitat

within the project area discovered in the PNDI(Pennsylvania Natural Diversity Inventory) search.

d. Site plan (including cross sections): Each setof plan drawings (a total of three is required) must belegible, and must include the following:

(1) A site plan drawing which clearly showsproperty lines, all regulated waters of theCommonwealth (streams, rivers, lakes, swamps, bogs,marshes, wetlands, ponds or reservoirs) and allproposed structures and activities.

(2) Drawings which provide a plan view andcross sections of each proposed structure or activity.

e. Project description narrative: Provide adetailed description of the project including structuretype(s), amounts of excavation/fill and what purpose thestructure or activity will serve. The narrative must alsodescribe in detail what effects the project will have onpublic health, safety and the environment. Informationfor this part of the narrative can be obtained fromcompletion of the “Environmental Assessment” (Part2 - PROJECT DESCRIPTION, items 9 and 10.) Thenarrative must contain a statement on why the projectmust be built in, along, across over a watercourse,floodway of body of water. Is there an alternative to theproposed project that would not require such impacts?Be sure to discuss this in detail under the item“Alternatives Analysis” requirements.

f. Color photographs with map showing locationtaken: Color photographs must be taken of the sitewhich illustrate watercourse, floodway or body of waterconditions at the project site and for areas extendingboth upstream and downstream. The location that thephotographs were taken from and direction of view mustbe indicated on a separate site plan drawing. Usualpractice is to number each photograph, mount intransparent photoholders, mark the numbers on the planand then draw an arrow from the number in the directionof view.

g. Environmental Assessment Forms: Pleaserefer to the instructions on completing theEnvironmental Assessment form. (Refer to Module A).

h. Mitigation Plan: As defined under Section 105.1of DEP’s Chapter 105 rules and regulations, Mitigationis:

(i) An action undertaken to accomplish oneor more of the following:

(A) Avoid and minimize impacts bylimiting the degree or magnitude of the action andits implementation.

(B) Rectify the impact by repairing,rehabilitating or restoring the impactedenvironment.

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(C) Reduce or eliminate the impactover time by preservation and maintenanceoperations during the life of the action.

(ii) If the impact cannot be eliminated byfollowing clauses (A)— (C), compensate for theimpact by replacing the environment impacted bythe project or by providing substitute resources orenvironments.

The mitigation plan must be a separate documentwhich describes how project planning employedmitigation concepts as defined in DEP’s Chapter 105Rules and Regulations. If these impacts cannot beeliminated, then the mitigation plan must include detailsand plans for replacing the impacted environment. Thespecific replacement resources or environments mustbe itemized and construction, operation andmaintenance activities must be detailed in the plan.

i. Alternatives Analysis: As a separatedocument, an analysis must be performed detailingpracticable alternatives to the proposed activities,including alternative locations routings, designs, etc., toavoid or minimize adverse environmental impacts.

*For non-jurisdictional dams located in an exceptionalvalue watershed, additional information (items j-o) mustbe submitted.

**NOTE: Depending on the functions and complexity ofthe proposed dam, the Department may requestadditional information to be submitted after its initialreview.