Appendix 1 — Liner Testing Report

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Water & Wastewater Facility Operators Mu.ifrba SCertification Program

Application for Wastewater Treatment Facility Classificationalso available online at http:/fwmanitoba.ca/certifioation

Please print clearly or type and follow the instructIons on the application form.NOTE: If using Adobe Reader text can be inserted into form and tab between fields.

This application is pursuant to the Water and Wastewater Facility Operators Regulation Issuedunder The EnvIronment Act.

Name of Facility:Wastewater Treatment Lagoon

Name of Facility Owner(Municipality/Commission! village cit WaskadaCorn pany/lndividualletc)

Civic Address of Facility: N 112 6-2-25

Mailing Address of Owner: Box 40 WASKADA, MB

Postal Code: i Telephone:(204) 673-2401RUM 2E0 I

Contact Person:Dane Woorjworth

Position:

Cell or Pager Fax: I Email:kadan@mymts.net(204) 522-5129 (204) 673-2663 was

Is this a REAPPLICATION?0

Please complete the following. The Information provided will be used to classify the wastewatertreatment facility under the Water and Wastewator Facility Operators Regulation. In some casesactual numbers or answers must be supplied, but Inmost cases it will only be necessary tocheck the appropriate criteria.

Forward the completed form to: Please direct questions to:

DirectorEnvironmental Assessment &Licensing BranchManitoba Conservation160—123 Main StreetWinnicea MB R3C 1A5

FOR MANITOBA CONSERVATION USE ONLYOperation ID #

Stakeholder ID 4

Approval ID #EO/DWO

Pace I o(S

Certification Program CoorxiinatorPhone: (2D4) 945-7065Fax: (204) 945-5229

Appkfion Wastawator Treatment Fadity asssfftarn--- 2008

Application for Wastewater Treatment Facility Classification

SYSTEM (choose all that apply)

___________ __________________________

New or proposed Facility seeking classification EElProposed start of operations (month 1 year)

Existing Facility seeking classification (in operation prior to December31, 2005)

Facility has been in operation since (approximate month/year) aj.jy i 166

The facility WILL employ mechanical treatment processes Q2.

The facility WILL NOT employ mechanical treatment processes 0SIZE (refer to Supplemental Information for point designation) (2 point minimum to 20 point maximum)

1. Maximum population or part served, peak day # 200 1-10

® n?Iday

Design flow average day Estimated or Actual 49.83 o gallday

2 (CIrcle volume option & units) Q 1 -10• ORPeak months flow average day Estimated or Actual C m3lday

0 0 0 gal/day

VARIATION IN RAW WASTE1 (choose all that apply) (0 point niininiuiii to (3 point maximum)

1. Variations do not exceed those normally or typically expected 0

Recurring deviations or excessive variations of 100-200% in strength D2. Recurring deviations or excessive variations of 100-200% in flow D 2

Recurring deviations or excessive variations of 100-200% In strength and flow flRecurring deviations or excessive variations of more than 200% in strength

3. Recurring deviations or excessive variations of more than 200% in flow DRecurring deviations or excessive variations of more than 200% in strength andflow

4. Raw wastes subject to toxic waste discharges 6

Septage or truck-hauled waste discharge is accepted at the facility.5. 0-4

Estimated number of loads per day in peak haul times

Application for Wastewater Treatment Facility classification Page 2 ofRevised October 2008

Application for Wastewater Treatment Facility Classification

PRELIMINARY TREATMENT (choose all that apply)

_____________ _________ _________

1. Facility pumping of main flow EEl2. Screening orcommlnution U

Grit removal U4. Equalinfion U__j1

PRIMARY TREATMENT (choose all that apply)—________________________

1. Clariflers fl 5

2. Anaerobic treatment with biogas flare fl 10

3. Maerobic treatment with biogas utilization facility 15

SECONDARY TREATMENT (cIoose all

1. Fixed-film reactor U 10

2, Activated sludge U 15

3. Stabilization ponds without aeration f.sewageIsgxn)

4. Stabilization ponds wilh aeration UTERTIARY TREATMENT (choos? all that apply)

1. Polishing ponds for advanced waste treatment U 2

2. Chemical! physical advanced waste treatment without secondary treatment U 15

3. Chemical / physical advanced waste treatment following secondary treatment 10

4. Biological or chemIcal I biological advanced waste treatment EEl 12

5. Nitrification by designed extended aeration only U6. Ion exchange for advanced waste treatment U 10

7. Reverse osmosis, electrodiatysis and other membrane flltraUon techniques U 10

8. Advanced waste treatment chemical recovery, carbon regenerabon UAppIicatn for Wastewater Treatment Focty Oass&ationRes October 2B

Page 3 of 6

Application for Wastewater Treatment Facility Classification

9. MedIa filtration D -

ADDITIONAL TREATMENT PROCESSES (choose all that apply)

Tchernical addition: (Please list chemicals used, 2,Ms per chemical to max. of 6)I. 0-6

2. DsoIved air Iloatation (other than for sludge thickening) - B

3. Intermittent sand filler [J 2

4. RecirculatIng intermittent sand filter [E]5. Miaoscreens D I

6. Generation of oxygen D [SOLIDS HANOLING (choose all that 9Pp1y!

1. Storage (other than for stabilization) 2

2. Stabilization by storage (including any storage afterwards) 4

3. Gravity thickening D 2

4. Mechanical dewatering fl B

5. Anaembic digestion of solids I 1)

6. UtIlization of digester gas for heating or cogeneratlon 07. Aerobic digestion of solids 8

8. Air-drying of sludge D 2

9. Solids reduction (including incineration and wet oxidation) 12

10. Disposal in landfill EEl 2

1 I Solids composting U i C

12. Land application of biosolids by contractor U 2

H Land application of biosolids by facility personnel 10

AppcaLon fzr Wasawater Treatment FaciLty CJassfcattnReEd Ocaber 2a38

Page 4 of 6

Application for Wastewater Treatment Facility Classification

DISINFECTION (choose all that apply) (0 point minimum to 10 point maximum) —-

Chlorination

1. 5Ultraviolet irradiation LEI

2. Ozonizatlon iE1 10

EFFLUENT DISCHARGE (choose all that apply) (0 point minimum to 10 point maximum)

1. Discharge to surface water (ditch or lake or iàAS’$ockt Crte\ a

2. Mechanical post-aeration 2

3. Direct recycling and reuse fl 6

4. Land treatment and surface or subsurface disposal 4

INSTRUMENTATION (chooso one) (0 point minimum to 6 poTht nlaxi;rlum)

1. SCADA or similar instrumentation systems are used to provide:

. Data with no process operation 0

. Data with limited process operation Q 2

. Data with moderate process operation 0

. Data with extensive or total process operation Q 6

LABORATORY CONTROL’ (choose all that apply) (0 point minimum to 15 point maximum)

1. Bacteriological I Biological (0 point minimum to 5 point maximum)

. Lab work done outside the facility I1 0

. Membrane filter procedures U

. Use of fermentation tubes or any dilution method of fecal coliformdetermination

2. Chemical / Physical (0 point minimum to 10 point maximum)

. Lab work done outside the facility 0

Application for Wastawater Treatment Fadlity classification Page 5 of 6Revised Octaber 2000

Application for Wastewater Treatment Facility Classification

1The key concepts are frequency or intensity of deviation, or excessive variation from normal or typical fluctuations.The deviations in strength, toxicity, ratio of infiltration to inflow, or shock loads.

2 The key concept is to credit laboratory analyses done on-site by facility personnel under the dIrection of anoperator-in-charge with points from 0-15.

Applicant must be an authorized representative of the owner/operating authority (i.e. manager, P. Eng., or overallresponsible operator).

LPrint Application Form

(List tests)

• Push button or sual methods for simple tests such as pH orsettleable solids

—I

D• Additional procedures such as 00, COO, BOO, gas analysis,

titration, solids content or volatile content• (List tests) 5

BOD,Tcandrcbyrnpn [].

• More advanced detenninallons such as specific constituents,: nutrients, total oils or phenols, (List tests) 7

. HIghly sophistIcated instrumentation such as atomic absorption orgas chromalograph

(Lisltests) ‘0

APPLICANT VERIFICATiON

I HEREBY DECLARE ThAT ALL INFORMATiON IN This APPLICA11ON IS TRUE

Name of Applicant(Print) Village of Waskada as per Diane WDOdWOrth

The: GAO

Telephone:(204) 673-2401 ( Fax:

(204) 637-2663

Email:waskadan@mymts.net

Date:

08/25/2014

Application for Wastewater Treatment Facility ClassificalionRevIsed October 2008

Pao 6 of 6

Water & Wastewater FadllHy Operators •A . .. -

Certification Program flUfI4{000

Wastewater Treatment Form Supplemental Information

This is supplemental Information for completing the Application for Wastewater TreatmentFacility Classification Form only.

For exact definitions and text refer to Manitoba Regulation 7712003. Water and WastewaterFacility Operators Regulation and amendment MR. 16212005. under The Environment Act(C.C.S.M. C E125).

A copy of tie regulaton Is available by following the link (or Manitoba Reguiatlons at:

http://wwwgovmbcaiconservaUor/envaporovals/uoIs1index.hIml

Facilities are classified as follows:

Small system classA wastewater treatment facihty that otherwise meets the aiteria of a class 1 wastewater treatment facility shaHbe classified in the small system class if

a) it treats wastewater from a population of no more than 500; andb) no mechanical treatment processes are empioyed at the facility.

Classes I to4Wastewater treatment facilities shall be classified in classes ito 4 in accordance with the following table, onthe basis of the number of classification points assessed under the classification point system set out in theWater and Wastewater Facility Operators Regulation.

Ranoe of Classifition Points Classification

0 to 3D Class 131to55 CIass256 to 75 Class 3

78 or more Class 4

Size

Points for size: (2 point minimum to 20 paint maximum)

Maximum population or part served, peak day (I paint minimum to ID point maximum). Points are assignedat 1 point per 10000 populatIon or part.

Design flow average day or peak month’s flow average day, whichever Is larger (1 point minimum to 10 pointmaximum). Points are assigned at I point per 4.5 rnegalitres per day or part.

AuthorIzed Representative

Signatures for the Applicant Verification section must be an individual recognized by the Owner of the facilityas able to sign official documentation (ie. PEng., Manager, CÁO, ott).

ReAsed October 2008 Page 1 of I

Water & Wastewater Facility OperatorsCertification Program

____ _____ _____ — ______

Application for Wastewater Collection Facility Classificationalso available online at http://www.manitoba.ca/certification

Please print clearly or type and follow the instructions on the application form.NOTE: If usie Reader text can be inserted into form and tab between fields.

application Is pursuant to the Water and Wastewater Facility Operators Regulation Issuedunder The EnvIronment Act.

_____

-- --_____ —

______

-—

____

—

_____

- —Name of Facility:

Wastewater Treatment Lagoon

Name of Facility Owner:(MunicipalitylCommission/ Village of WaskadaCompany/lndlvidualletc)

Mailing Address of Facility:Dcx 40, Waskada

Postal Code:ROM 2E0 Telephone:

6724D1

Contact Person: I Position:Diane Woodwortli CAO

Cell or Pager: I Fax: I Email:(234) 522-5129 (204) 673-2663 waskadan©mynits.net

Is this a REAPPLICATION?YesNorPlease complete the following. The information provIded wIll be used to classify the

wastewater collection facility under the Water and Wastewater Facility Operators RegulatIon.

Forward the completed form to: Please direct questions to:

DirectorCertification Program CoordinatorEnvironmental Assessment &Phone: (204) 945-7065Licensing BranchFax: (204) 945-5229Manitoba Conservation

160— 123 Main StreetWinnipeg MB R3C lAS

FOR MANITOBA CONSERVATION USE ONLYOperation ID #

Stakehoder D #

Approval ID #

EO/DWO

Pagal o12

ManiIobaConservation

ApØion for Wastowala, CadM, FIlyRsaad Oc*ober 2008

Application for Wastewater Collection Facility Classification

SYSTEM

New or proposed facility seeking classification [ EProposed start of operations (month/year)

Existing fac4lity seeking classification (In operation prior to August 30, 2005) []: Facility has been in operation since (approximate month/year) a 1

SIZE (choose_one)

Population Served is LESS THAN or EQUAL TO 500 (small system) jPopulation Served is 501 to 1,500 (class 1) (3Population Served is 1,501 to 15,000 (class 2) (3Population Served is 15,001 to 50000 ctass 3) (3Population Served is 50,001 or more (class 4) (3

APPLICANT VERIFICATION

I hereby declare that all Information In this application Is true.

Name of Applicant1(PRINT) Village of Wasicada as per Diane Woodworth

Title: CAO

Telephone:(204) 673-2401

Fax:(204) 673-2663

Email waskadanmymts.net

Signature of Authorized Date:Representative: 08/25/2014

‘ ApplTtant must be an authorized representative ofthe ownorloperatlng authority (I.e. manager, P. Eng., or overall responsib(o operatcr),

Print Application Form

ApX&n for Wastewatar Collection Faulty Classification Page 2 of 2Revised Octba 2038