Form MO780-2804 "Antidegradation Review Submittal Voluntary Tier 2 - Significant Degradation for Domestic Wastewater Facilities With Design Flow Less Than 50,000 Gallons Per Day" - Missouri

What Is Form MO780-2804?

This is a legal form that was released by the Missouri Department of Natural Resources - a government authority operating within Missouri. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2019;
  • The latest edition provided by the Missouri Department of Natural Resources;
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  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form MO780-2804 by clicking the link below or browse more documents and templates provided by the Missouri Department of Natural Resources.

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Download Form MO780-2804 "Antidegradation Review Submittal Voluntary Tier 2 - Significant Degradation for Domestic Wastewater Facilities With Design Flow Less Than 50,000 Gallons Per Day" - Missouri

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MISSOURI DEPARTMENT OF NATURAL RESOURCES
FOR DEPARTMENT USE ONLY
WATER PROTECTION PROGRA M, WATER POLLUTION CONTROL BRANCH
APP NO.
ANTIDEGRADATION REVIEW SUBMITTAL
CHECK NO.
CHECK NO.
VOLUNTARY TIER 2 – SIGNIFICANT DEGRADATION FOR DOMESTIC
WASTEWATER FACILITIES WITH DESIGN FLOW LESS THAN 50,000
DATE RECEIVED
GALLONS PER DAY
1. APPLICABILITY
If you answ er “Yes” to any of the below questions, a site-specific alternatives analysis may be required.
The Missouri Department of Natural Resources’ alternatives analysis is not applicable to facilities that have a Total Maxim um
Daily Load (TMDL) or are 303(d) or 305(b) listed for the pollutants of concern addressed in this alternatives analysis, w ith an
exception for E. coli since disinfection w ill be required.
Facilities currently under enforcement will need to coordinate w ith the Water Protection Program ’s com pliance and
enforcem ent section to determine applicability for the departm ent’s alternatives analysis.
1.1 Does the receiving w aterbody or dow nstream w aterbody have a Total Maximum Daily Load (TMDL)?
Yes
No
1.2 Is the receiving w aterbody or dow nstream w aterbody 303(d) or 305(b) listed as impaired
or potentially impaired?
Yes
No
1.3 Is the facility currently under enforcement w ith the department or the U.S. Environmental Protection Agency?
Yes
No
1.4 Is the design flow 50,000 gallons per day or more?
Yes
No
1.5 Is a non-discharging system a viable option?
Yes
No
Subm it the follow ing w ith this form :
Regionalization and No Discharge Evaluation Form – Available on the department’s website
Copy of the Geohydrologic Evaluation – Submit request through the Missouri Geological Survey website
Copy of the Missouri Natural Heritage Review from the Missouri Department of Conservation website
2. FACILITY
NAME
COUNTY
ADDRESS (PHYSICAL)
CITY
STATE
ZIP CODE
3. OWNER
NAME
ADDRESS
CITY
STATE
ZIP CODE
EMAIL ADDRESS
TELEPHONE NUMBER WITH AREA CODE
4. CONTINUING AUTHORITY The regulatory requirement regarding continuing authority is found in 10 CSR 20-6.010(2).
NAME
SECRETARY OF STATE CHARTER NUMBER
ADDRESS
CITY
STATE
ZIP CODE
EMAIL ADDRESS
TELEPHONE NUMBER WITH AREA CODE
Page 1
MO 780-2804 (09-19)
MISSOURI DEPARTMENT OF NATURAL RESOURCES
FOR DEPARTMENT USE ONLY
WATER PROTECTION PROGRA M, WATER POLLUTION CONTROL BRANCH
APP NO.
ANTIDEGRADATION REVIEW SUBMITTAL
CHECK NO.
CHECK NO.
VOLUNTARY TIER 2 – SIGNIFICANT DEGRADATION FOR DOMESTIC
WASTEWATER FACILITIES WITH DESIGN FLOW LESS THAN 50,000
DATE RECEIVED
GALLONS PER DAY
1. APPLICABILITY
If you answ er “Yes” to any of the below questions, a site-specific alternatives analysis may be required.
The Missouri Department of Natural Resources’ alternatives analysis is not applicable to facilities that have a Total Maxim um
Daily Load (TMDL) or are 303(d) or 305(b) listed for the pollutants of concern addressed in this alternatives analysis, w ith an
exception for E. coli since disinfection w ill be required.
Facilities currently under enforcement will need to coordinate w ith the Water Protection Program ’s com pliance and
enforcem ent section to determine applicability for the departm ent’s alternatives analysis.
1.1 Does the receiving w aterbody or dow nstream w aterbody have a Total Maximum Daily Load (TMDL)?
Yes
No
1.2 Is the receiving w aterbody or dow nstream w aterbody 303(d) or 305(b) listed as impaired
or potentially impaired?
Yes
No
1.3 Is the facility currently under enforcement w ith the department or the U.S. Environmental Protection Agency?
Yes
No
1.4 Is the design flow 50,000 gallons per day or more?
Yes
No
1.5 Is a non-discharging system a viable option?
Yes
No
Subm it the follow ing w ith this form :
Regionalization and No Discharge Evaluation Form – Available on the department’s website
Copy of the Geohydrologic Evaluation – Submit request through the Missouri Geological Survey website
Copy of the Missouri Natural Heritage Review from the Missouri Department of Conservation website
2. FACILITY
NAME
COUNTY
ADDRESS (PHYSICAL)
CITY
STATE
ZIP CODE
3. OWNER
NAME
ADDRESS
CITY
STATE
ZIP CODE
EMAIL ADDRESS
TELEPHONE NUMBER WITH AREA CODE
4. CONTINUING AUTHORITY The regulatory requirement regarding continuing authority is found in 10 CSR 20-6.010(2).
NAME
SECRETARY OF STATE CHARTER NUMBER
ADDRESS
CITY
STATE
ZIP CODE
EMAIL ADDRESS
TELEPHONE NUMBER WITH AREA CODE
Page 1
MO 780-2804 (09-19)
5. RECEIVING WATER BODY SEGMENT #1
NAME
5.1 Upper end of segment – Location of discharge
UTM: X=
, Y=
OR Lat
, Long
5.2 Low er end of segment –
UTM: X=
, Y=
OR Lat
, Long
Per the
Missouri Antidegradation Implementation Procedure (AIP), the definition of a segment is: “A section of w ater that is bound, at a
minimum, by significant existing sources and confluences w ith other significant w ater bodies.”
6. WATER BODY SEGMENT #2 (If Necessary)
NAME
6.1 Upper end of segment – End of Segment #1
UTM: X=
, Y=
OR Lat
, Long
6.2 Low er end of segment –
UTM: X=
, Y=
OR Lat
, Long
7. SOCIAL AND ECONOMIC IMPORTANCE OF THE PREFERRED ALTERNATIVE
This section must be completed w ith adequate and thorough descriptions of the social and economic importance associated w ith the
proposed project in accordance w ith the Antidegradation Implementation Procedure Section II.E. for discharge to be allow ed.
Social and economic importance is defined as the social and economic benefits to the community that w ill occur from any activity
involving a new or expanding discharge.
7.1 Identify the affected com m unity:
(The affected community is defined in 10 CSR 20-7.031(2)(B) as the community “in the geographical area in w hich the w aters
are located.” Per the Antidegradation Implementation Procedure Section II.E.1, “the affected community should include those
living near the site of the proposed project as w ell as those in the community that are expected to directly or indirectly benefit
from the project.”)
7.2 Identify the im portant social and econom ic developm ent associated with the project:
Will the proposed discharging activity:
Create or expand employment?
Yes
No
Don’t know
N/A
Increase median family income?
Yes
No
Don’t know
N/A
Reduce the number of households below the poverty line?
Yes
No
Don’t know
N/A
Increase the community tax base?
Yes
No
Don’t know
N/A
Increase needed housing supply?
Yes
No
Don’t know
N/A
Provide necessary public services (e.g., school, infrastructure, fire
Yes
No
Don’t know
N/A
department, etc.)?
Correct a public health, safety, or environmental problem?
Yes
No
Don’t know
N/A
Other:
Page 2
MO 780-2804 (09-19)
7.3 Describe the im portant social and econom ic developm ent associated w ith the project:
The applicant must describe the expected changes in the factors identified in question 7.2 that are associated w ith the project and
provide information on any additional items demonstrating important social and economic development. The applicant should first
describe the existing condition of the affected community. This base condition should then be compared to the predicted change
(benefit) in social and economic condition after the discharge is allow ed. The social and economic measures identified above do
not constitute a comprehensive list. Each situation and community is different and w ill require an analysis of unique social and
economic factors in accordance w ith the Antidegradation Implementation Procedure Section II.E.1.
7.4 Is any other w ritten correspondence or docum entation included w ith this application to provide further evidence of
social and econom ic im portance:
No
Yes
Letter(s) from the mayor or community in support of the proposed project
Rezoning approval
Other:
8. NO DISCHARGE ALTERNATIVES EVALUATION
According to the Antidegradation Implementation Procedure Sections I.B. and II.B.1., the feasibility of no-discharge alternatives must
be considered. No-discharge alternatives may include connection to a regional treatment facility, surface land application, subsurface
land application, and recycle or reuse.
You m ust subm it the Regionalization and No-Discharge Evaluation Form (780-2805) to dem onstrate that a non-discharging
alternative is not feasible. If sufficient information is not provided on the No-Discharge Evaluation Form to demonstrate that a non-
discharging facility is not feasible, a more detailed evaluation of no discharge options must be submitted.
9. IDENTIFY PREFERRED TREATMENT ALTERNATIVE
Describe your preferred treatment alternative that has been recommended or approved by a registered professional engineer licensed
to practice in Missouri. The preferred treatment alternative must be capable of meeting the effluent limits in the table under item 10 of
this form.
Applicants choosing to use a new w astew ater technology considered an “unproven technology” in Missouri must comply w ith the
requirements set forth in the Innovative Technology factsheet found on the department’s w ebsite.
ENGINEERING CONSULTANT NAME
COMPANY NAME
ADDRESS
TELEPHONE NUMBER WITH AREA CODE
STATE
ZIP CODE
SIGNATURE
EMAIL ADDRESS
Page 3
MO 780-2804 (09-19)
10. SUMMARY OF THE POLLUTANTS OF CONCERN AND EFFLUENT LIMITS
Pollutants of concern to be considered include those pollutants reasonably expected to be present in the discharge per the
Antidegradation Implementation Procedure Section II.A. and assumed or demonstrated to cause significant degradation.
The tier protection levels are specified and defined in rule at 10 CSR 20-7.031(2). All POCs in this alternatives analysis w ere
considered to be Tier 2 and significantly degrading in the absence of existing w ater quality.
As a result of this alternatives analysis review , the department has determined, depending on site specific conditions, there are
treatment technologies available that may be economically efficient and practicable, w hich are capable of meeting the effluent
limitations below . If the facility ow ners do not believe there is a treatment technology that is economically efficient, affordable, or
practicable for their facility to meet these limits, a site-specific alternatives analysis w ill be required.
The chosen alternative m ust be capable of m eeting the follow ing effluent lim itations:
E
L
– O
L
FFLUENT
IM ITS
UTFALLS TO
AKES
Pollutant of Concern*
Units
Daily Maxim um
Weekly Average
Monthly Average
/L
MG
BOD
15
10
5
/L
MG
TSS
20
15
SU
pH
6.5– 9.0
6.5 – 9.0
/L
MG
Ammonia as N Summer
3.6
1.4
/L
MG
Ammonia as N Winter
7.5
2.9
/L
MG
Total Phosphorus****
*
0.5
Escherichia coli (E. coli)
#/100
L
630***
126
M
E
L
– A
O
O
FFLUENT
IM ITS
LL
THER
UTFALLS
BOD
mg/L
15
10
5
TSS
mg/L
15
10
pH
SU
6.5– 9.0
6.5 – 9.0
Ammonia as N Summer
mg/L
1.7
0.6
Ammonia as N Winter
mg/L
5.6
2.1
Total Phosphorus****
mg/L
*
0.5
WBC(A)
WBC (B)
#/100
L
630***
126
AND
M
Escherichia coli
(E. coli)
Losing Stream**
#/100
L
126***
Monitoring only
M
*
Permit limits for other parameters, including oil and grease, total residual chlorine and nitrates, w ill be included in the operating
permit based on applicable w ater quality standards and criteria.
Total residual chlorine (TRC) effluent limits of 0.017 mg/L daily maximum, 0.008 mg/L monthly average are recommended if
chlorine is used as a disinfectant. Standard compliance language for TRC, including the minimum level (ML), may be included in
the operating permit.
**
For any facility that w ill discharge to a w aterbody designated as a losing stream or w ithin tw o miles flow distance upstream of a
losing stream.
*** Publicly ow ned treatment w orks w ill receive a w eekly average limit and private facilities w ill receive a daily maximum limit.
**** Total Phosphorus limits are only applicable to discharges to a lake or w atershed of a lake that is a w ater of the state and has an
area of at least 10 acres during normal pool conditions
If any Tier 1 Pollutants of Concern not addressed in this alternatives analysis w ill be discharged, the applicant must submit
Attachment D: Tier 1 Review for those pollutants.
MO 780-2804 (09-19)
11. APPLICATION FEE
CHECK NUMBER
JETPAY CONFIRMATION NUMBER
12. SIGNATURE
I am authorized and hereby certify that I am familiar w ith the information contained in this document and to the best of my know ledge
and belief such information is true, complete and accurate.
SIGNATURE
DATE
PRINT NAME
TITLE
PLEASE IDENTIFY YOUR STATUS FOR THIS PROJECT:
OWNER
CONTINUING AUTHORITY
CONSULTANT
Page 4
MO 780-2804 (08-19)
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