Form MO780-1634 (S) "Section 5. Sludge Disposal Lagoon" - Missouri

What Is Form MO780-1634 (S)?

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 June 1, 2004;
  • The latest edition provided by the Missouri Department of Natural Resources;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form MO780-1634 (S) by clicking the link below or browse more documents and templates provided by the Missouri Department of Natural Resources.

ADVERTISEMENT
ADVERTISEMENT

Download Form MO780-1634 (S) "Section 5. Sludge Disposal Lagoon" - Missouri

Download PDF

Fill PDF online

Rate (4.6 / 5) 10 votes
Page background image
MISSOURI DEPARTMENT OF NATURAL RESOURCES
WATER PROTECTION PROGRAM, WATER POLLUTION BRANCH
FORM S – SECTION 5. SLUDGE DISPOSAL LAGOON
PERMIT NO.:
REPORTING PERIOD: CALENDAR YEAR
FACILITY NAME
Complete this section if sludge has been left for more than two years in a sludge lagoon or inactive wastewater treatment lagoon and the lagoon has
not been closed in accordance with a closure plan approved by the department.
Applicable sludge requirements are listed under Part III Standard Conditions.
Show both the NPDES permit number (MO-) and the solid waste disposal permit number (SW) under 5.10.
5.10
Person Responsible for Final Sludge Disposal
5.11
FACILITY NAME
5.12
CONTACT PERSON
5.13
CONTACT ADDRESS
5.14
PHONE
PERMIT NO: MO-
SW
5.20
Sludge Disposal Lagoon Location
5.21
LEGAL
¼,
¼,
SEC
,
T
,
R
,
COUNTY
5.30
Lagoon Description
5.31
Sludge lagoon that has received sludge during the report period.
5.32
Sludge lagoon that did not receive sludge during the report period but has not been closed in accordance with a
closure plan approved by the department.
5.33
Inactive wastewater treatment lagoon that no longer receives wastewater or sludge but has not been closed in
accordance with a closure plan approved by the department.
5.34
SURFACE ACRES OF LAGOON
FEET OF SLUDGE DEPTH
5.35
CUBIC FEET (DESIGN)
CUBIC FEET SLUDGE (CURRENT)
5.36
AVERAGE % SOLIDS OF SLUDGE IN THE LAGOON
DAYS OF STORAGE
5.40
Groundwater Protection
5.41
DATE OF LAGOON CONSTRUCTION (APPROXIMATE IF NOT KNOWN)
5.42
GEOLOGIC REPORT
Attach a copy of recent (Since July 1, 1993) geologic evaluation report by the department’s Geological Survey & Resource
Assessment Division (GSRAD).
5.43
LAGOON SEAL – THE LAGOON SEAL MUST MEET BOTH OF THE FOLLOWING REQUIREMENTS:
-7
Lagoon bottom and side seal meets current sealing requirements of 10
cm/sec per 10 CSR 20-8.200(6)(C) or
8.020(13)(A).
Lagoon seal meets requirements for a composite liner per Solid Waste Management Law and regulations under 10
CSR 80.
5.44
GROUNDWATER MONITORING WELLS
Monitoring wells installed and approved by GSRAD.
Attach monitoring well test results for parameters listed under Section A of Form SA, plus nitrate nitrogen as N, and
any other groundwater testing required by the permit per 10 CSR 20-7.031.
Monitoring wells not installed.
MO 780-1634 (6-04)
MISSOURI DEPARTMENT OF NATURAL RESOURCES
WATER PROTECTION PROGRAM, WATER POLLUTION BRANCH
FORM S – SECTION 5. SLUDGE DISPOSAL LAGOON
PERMIT NO.:
REPORTING PERIOD: CALENDAR YEAR
FACILITY NAME
Complete this section if sludge has been left for more than two years in a sludge lagoon or inactive wastewater treatment lagoon and the lagoon has
not been closed in accordance with a closure plan approved by the department.
Applicable sludge requirements are listed under Part III Standard Conditions.
Show both the NPDES permit number (MO-) and the solid waste disposal permit number (SW) under 5.10.
5.10
Person Responsible for Final Sludge Disposal
5.11
FACILITY NAME
5.12
CONTACT PERSON
5.13
CONTACT ADDRESS
5.14
PHONE
PERMIT NO: MO-
SW
5.20
Sludge Disposal Lagoon Location
5.21
LEGAL
¼,
¼,
SEC
,
T
,
R
,
COUNTY
5.30
Lagoon Description
5.31
Sludge lagoon that has received sludge during the report period.
5.32
Sludge lagoon that did not receive sludge during the report period but has not been closed in accordance with a
closure plan approved by the department.
5.33
Inactive wastewater treatment lagoon that no longer receives wastewater or sludge but has not been closed in
accordance with a closure plan approved by the department.
5.34
SURFACE ACRES OF LAGOON
FEET OF SLUDGE DEPTH
5.35
CUBIC FEET (DESIGN)
CUBIC FEET SLUDGE (CURRENT)
5.36
AVERAGE % SOLIDS OF SLUDGE IN THE LAGOON
DAYS OF STORAGE
5.40
Groundwater Protection
5.41
DATE OF LAGOON CONSTRUCTION (APPROXIMATE IF NOT KNOWN)
5.42
GEOLOGIC REPORT
Attach a copy of recent (Since July 1, 1993) geologic evaluation report by the department’s Geological Survey & Resource
Assessment Division (GSRAD).
5.43
LAGOON SEAL – THE LAGOON SEAL MUST MEET BOTH OF THE FOLLOWING REQUIREMENTS:
-7
Lagoon bottom and side seal meets current sealing requirements of 10
cm/sec per 10 CSR 20-8.200(6)(C) or
8.020(13)(A).
Lagoon seal meets requirements for a composite liner per Solid Waste Management Law and regulations under 10
CSR 80.
5.44
GROUNDWATER MONITORING WELLS
Monitoring wells installed and approved by GSRAD.
Attach monitoring well test results for parameters listed under Section A of Form SA, plus nitrate nitrogen as N, and
any other groundwater testing required by the permit per 10 CSR 20-7.031.
Monitoring wells not installed.
MO 780-1634 (6-04)
5.50
Sludge Monitoring
Attach From SA for sludge monitoring.
If pretreatment, Form SB must also be attached.
5.60
Operating Requirements
Complete those that apply for 5.61 through 5.63.
5.61
Solid waste disposal permit (landfill permit) and NPDES sludge disposal permit will be obtained by
(date).
5.62
Sludge will be removed from the lagoon by
Starting date.
Ending date.
Lagoon closed by pushing in the berms and grading and seeding.
Lagoon used for storage only and accumulated sludge cleaned out every two years.
Lagoon closed by mixing sludge with equal parts of earth and pushing in the berms. The sludge and soil mixture
shall not exceed the cumulative agricultural loading for nitrogen and metals (see WQ 425 and 429 guides).
5.63
Are alternate limits or exceptions listed in the Special Conditions section of the NPDES permit?
YES
NO
If yes, attach explanation sheet.
MO 780-1634 (6-04)
Page of 2