Schedule E: Emergency Pollution Permit Wr-82E

STATE OF VERMONT AGENCY OF NATURAL RESOURCES DEPARTMENT OF ENVIRONMENTAL CONSERVATION

SCHEDULE E: EMERGENCY POLLUTION PERMIT WR-82E

CHAPTER 47 of TITLE 10 V.S.A.

E-1 APPLICANT: ACTIVITY:

E-2 DISCHARGE PERMIT NO.: DISCHARGE POINT:

E-3 EXACT LOCATION ON RECEIVING WATER (Describe, Locate & Include on Map):

E-4 (a) DATE EMERGENCY DISCHARGE WILL

COMMENCE:

DATE EMERGENCY DISCHARGE WILL TERMINATE:

E-5 DESCRIBE WASTES TO BE DISCHARGED WHICH WILL EXCEED CURRENT PERMIT LIMITS (Document expected parameters such as maximum and average BOD, TSS, TKN E. coli, chlorine, phosphorus, etc):

E-6(a) VOLUME OF DISCHARGE:

MAXIMUM MGD AVERAGE MGD

E-6(b) FREQUENCY OF DISCHARGE:

E-7(a) IS THIS EMERGENCY DISCHARGE THE RESULT OF UNFORESEEN EVENTS OR DUE TO PLANNED

MAINTENANCE OR UPGRADE WORK? DESCRIBE THE EVENTS OR PLANNED WORK:

E-7(b) DESCRIBE IN DETAIL THE REASON WHY AN EMERGENCY DISCHARGE IS NEEDED:

E-8(a) DESCRIBE THE TYPE AND EXTENT OF TREATMENT TO BE USED DURING THE EMERGENCY DISCHARGE PERIOD (use flow diagram):

E-8(b) DESCRIBE, IN DETAIL, ALL OTHER PROCEDURES TO BE IMPLEMENTED DURING THE EMERGENCY DISCHARGE PERIOD THAT ARE DESIGNED TO MINIMIZE THE DISCHARGE OF POLLUTANTS TO WATERS OF THE STATE:

E-9 DESCRIBE ANY ALTERNATIVE MEANS OF DISPOSING OF THE WASTE (OTHER THAN BY DISCHARGING INTO WATERS OF THE STATE) DURING THE LIMITED PERIOD OF TIME OF THE EMERGENCY. IF AN ALTERNATIVE WAS CONSIDERED BUT REJECTED DUE TO COST, INCLUDE THE COST ESTIMATE FOR THAT ALTERNATIVE:

E-10 DESCRIBE ANY HARDSHIP THAT WOULD OCCUR UPON THE APPLICANT IF THE EMERGENCY POLLUTION PERMIT WERE DENIED:

E-11 DESCRIBE THE PUBLIC BENEFIT THAT WOULD RESULT BY THE GRANTING OF AN EMERGENCY POLLUTION PERMIT:

E-12 DOCUMENT THAT THE EMERGENCY DISCHARGE WILL NOT BE UNREASONABLY DESTRUCTIVE TO THE QUALITY OF THE RECEIVING WATER (Use expected effluent quality such as BOD, TSS, TKN etc., receiving water information such as stream flow, temperature, and include appropriate calculations as necessary):

CERTIFICATION

I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION SUBMITTED ABOVE IS TRUE, ACCURATE AND COMPLETE. BASED ON THE ABOVE RESPONSES AND AS REQUIRED BY THE PROVISIONS OF 10 V.S.A. SECTION 1268, I HEREBY CERTIFY THAT:

A. THERE IS NO PRESENT, REASONABLE ALTERNATIVE MEANS OF DISPOSING OF THE WASTE OTHER THAN BY DISCHARGING INTO THE WATERS OF THE STATE DURING LIMITED PERIOD OF TIME OF THE EMERGENCY;

B. THE DENIAL OF AN EMERGENCY POLLUTION PERMIT WOULD WORK AN EXTREME HARDSHIP UPON THE APPLICANT;

C. THE GRANTING OF AN EMERGENCY POLLUTION PERMIT WILL RESULT IN SOME PUBLIC BENEFIT;

D. THE DISCHARGE WILL NOT BE UNREASONABLY DESTRUCTIVE TO THE QUALITY OF THE RECEIVING WATERS;

E. THE CAUSE OF REASON FOR THE EMERGENCY IS NOT DUE TO WILLFUL OR INTENDED ACTS OR OMISSIONS OF THE APPLICANT.

I RECOGNIZE BY SIGNING THIS APPLICATION I AM GIVING CONSENT TO EMPLOYEES OF THE VERMONT AGENCY OF NATURAL RESOURCES TO ENTER THE SUBJECT PROPERTY FOR THE PURPOSE OF PROCESSING THIS APPLICATION.

SIGNATURE: Authorized Representative Title Date

SEND TO: DEPARTMENT OF ENVIRONMENTAL CONSERVATION WATERSHED MANAGEMENT DIVISION ONE NATIONAL LIFE DRIVE – Main 2 MONTPELIER VT 05620-3522

QUESTIONS, CALL:TELEPHONE: (802) 490-6118

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