"Registration Statement - Vehicle Wash & Laundry Facilities General Permit" - Virginia

Registration Statement - Vehicle Wash & Laundry Facilities General Permit is a legal document that was released by the Virginia Department of Environmental Quality - a government authority operating within Virginia.

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REGISTRATION STATEMENT FOR THE GENERAL VIRGINIA POLLUTANT DISCHARGE
ELIMINATION SYSTEM (VPDES) PERMIT FOR VEHICLE WASH FACILITIES AND LAUNDRY
FACILITIES 2012 REISSUANCE
Revised August 20, 2014
1. APPLICANT INFORMATION
A. Name of Facility: _____________________________________________________________________
B. Facility Owner: _______________________________________________________________________
C. Owner's Mailing Address
a. Street or P.O. Box __________________________________________________________________
b. City or Town _________________________ c. State _____________ d. Zip Code _______________
e. Phone Number _____________________________________________________________________
f. Email _____________________________________________________________________________
g. Indicate if the applicant would like the permit to be transmitted electronically. Yes
No
D. Facility Street Address _________________________________________________________________
E. Is the operator of the facility also the owner? Yes
No
If "No", complete F & G.
F. Name of Local Operator: _______________________________________________________________
G. Operator's Mailing Address
a. Street or P.O. Box __________________________________________________________________
b. City or Town ________________________ c. State ______________ d. Zip Code _______________
e. Phone Number _____________________________________________________________________
f. Email ____________________________________________________________________________
2. FACILITY INFORMATION
A. Will the facility discharge to surface waters? Yes
No
If yes, name of receiving stream __________________________________________________________
If no, describe the discharge: _____________________________________________________________
____________________________________________________________________________________
Does the facility discharge to a Municipal Separate Storm Sewer System (MS4)? Yes
No
B.
If yes, please provide the name of the MS4 owner: ____________________________________________
If "yes," the facility owner must notify the owner of the municipal separate storm sewer system of the
existence of the discharge within 30 days of coverage under the general permit and provide the following
information: the name of the facility, a contact person and phone number, the location of the discharge, the
nature of the discharge, and the facility's VPDES general permit number.
. Does this facility currently have a VPDES permit? Yes
No
C
If yes, give permit number. ________________
D. Does your locality require connection to central wastewater treatment facilities? Yes
No
E. Are central wastewater treatment facilities available to serve the site? Yes
No
If "yes," the option of discharging to the central wastewater facility must be evaluated and the result of that
evaluation reported here (use additional sheets if necessary):
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
REGISTRATION STATEMENT FOR THE GENERAL VIRGINIA POLLUTANT DISCHARGE
ELIMINATION SYSTEM (VPDES) PERMIT FOR VEHICLE WASH FACILITIES AND LAUNDRY
FACILITIES 2012 REISSUANCE
Revised August 20, 2014
1. APPLICANT INFORMATION
A. Name of Facility: _____________________________________________________________________
B. Facility Owner: _______________________________________________________________________
C. Owner's Mailing Address
a. Street or P.O. Box __________________________________________________________________
b. City or Town _________________________ c. State _____________ d. Zip Code _______________
e. Phone Number _____________________________________________________________________
f. Email _____________________________________________________________________________
g. Indicate if the applicant would like the permit to be transmitted electronically. Yes
No
D. Facility Street Address _________________________________________________________________
E. Is the operator of the facility also the owner? Yes
No
If "No", complete F & G.
F. Name of Local Operator: _______________________________________________________________
G. Operator's Mailing Address
a. Street or P.O. Box __________________________________________________________________
b. City or Town ________________________ c. State ______________ d. Zip Code _______________
e. Phone Number _____________________________________________________________________
f. Email ____________________________________________________________________________
2. FACILITY INFORMATION
A. Will the facility discharge to surface waters? Yes
No
If yes, name of receiving stream __________________________________________________________
If no, describe the discharge: _____________________________________________________________
____________________________________________________________________________________
Does the facility discharge to a Municipal Separate Storm Sewer System (MS4)? Yes
No
B.
If yes, please provide the name of the MS4 owner: ____________________________________________
If "yes," the facility owner must notify the owner of the municipal separate storm sewer system of the
existence of the discharge within 30 days of coverage under the general permit and provide the following
information: the name of the facility, a contact person and phone number, the location of the discharge, the
nature of the discharge, and the facility's VPDES general permit number.
. Does this facility currently have a VPDES permit? Yes
No
C
If yes, give permit number. ________________
D. Does your locality require connection to central wastewater treatment facilities? Yes
No
E. Are central wastewater treatment facilities available to serve the site? Yes
No
If "yes," the option of discharging to the central wastewater facility must be evaluated and the result of that
evaluation reported here (use additional sheets if necessary):
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
MAP
3.
Attach a USGS 7.5 minute topographic or equivalent computer generated map extending to at least one mile
beyond property boundary. The map must show the location of the facility, and the location of each of its
existing and/or proposed intake and discharge points. Include all springs, rivers and other surface water bodies,
including the receiving water body.
4. NATURE OF BUSINESS: (provide a brief description of the type of washing activity (vehicles, laundry
or both). Include (as applicable) the type of vehicles washed, number of vehicle washing bays and the
number of laundry machines)
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
5. FLOW RATE
Provide the highest average monthly flow rate measured or estimated to be discharged. For existing facilities
calculate this by adding the flows for each day during the month that the washing facility had a discharge
divided by the number of days that the facility discharged. For new facilities estimate the flow rate based on
similar facilities. ___________ Gallons per day
6. FACILITY DRAWING AND TREATMENT SYSTEM
Attach a line drawing of the facility showing the source of the water and its flow through the facility. Show all
bays for vehicle washes. Provide dimensions or capacities for each unit in the treatment system. This can be
hand drawn but must be legible.
Describe the method and frequency of solid wastes disposal
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
7. CHEMICALS
Provide the name of the chemical(s) used at the facility (including detergents, soaps, waxes and other
chemicals).
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
8.
PHOSPHATE DETERGENT USE
Will detergent used for washing vehicles contain more than 0.5% phosphorus by weight? Yes
No
If yes, approximately how many gallons are used per month of this detergent? ________________________
9. CERTIFICATION (see Part II K of your permit to see who can sign the certification)
“I certify under penalty of law that this document and all attachments were prepared under my direction or
supervision in accordance with a system designed to assure that qualified personnel properly gather and
evaluate the information submitted. Based on my inquiry of the person or persons who manage the system or
those persons directly responsible for gathering the information, the information submitted is to the best of my
knowledge and belief true, accurate, and complete.
I am aware that there are significant penalties for
submitting false information including the possibility of fine and imprisonment for knowing violations."
Signature: __________________________________________________ Date: _______________________
Name of person signing above: ______________________________________________________________
(printed or typed)
Title: __________________________________________________________________________________
REQUIRED ATTACHMENTS:
1. Map (#3 of Registration Statement)
2. Facility Drawing (#8 of Registration Statement)
__________________________________________________________________________________________
For Department use only:
Accepted/Not Accepted by: ________________________________________ Date: _______________________
Basin ________________________________ Stream Class _____________ Section ______________________
Special Standards ____________________________________________________________________________
INSTRUCTIONS FOR COMPLETING THE REGISTRATION STATEMENT
FOR THE GENERAL PERMIT FOR VEHICLE WASH FACILITIES AMD LAUNDRY FACILITIES
Revised August 20, 2014
WHO MUST FILE THE REGISTRATION STATEMENT
This registration statement must be completed and submitted by any vehicle wash facilities and/or laundry facilities
requesting coverage under the above general permit for processing wastewater discharges.
WHERE TO FILE THE REGISTRATION STATEMENT
The completed registration statement should be sent to the Department of Environmental Quality Regional Office for
your area. The applicant should send the fees and fee form to the following address: Department of Environmental
Quality, Receipts Control, P. O. Box 10150, Richmond, VA 23240
Checks, drafts and money orders (payable to "Treasurer of Virginia") and, in the case of other state agencies, IAT's (as
a credit to DEQ) are acceptable forms of payment. No cash will be accepted.
COMPLETENESS
Complete all items except where indicated, or enter NA for "not applicable" in order for your registration statement to
be accepted. If you need more space than the form allows, write on and attach extra sheets of paper.
DEFINITIONS
Outfalls means a discharge pipe, drain or anyplace where wash water leaves or could leave the plant and discharge to
surface waters.
Receiving Stream is the particular surface water, or stream, creek, or any other body of water, or a ditch or ground
surface or storm sewer that runs off into such a body of water, into which the wastewater discharges.
Laundry Facilities means any self-service facility where the washing of clothes is conducted as designated by SIC
7215. However, it does not include facilities that engage in dry cleaning even though dry cleaning is included in SIC
code 7215.
SIC Code means the "Standard Industrial Classification" codes listed in the Federal Office of Management and Budget
(OMB) SIC Manual, 1987 and used as identifiers of industries with certain characteristics and can be found online
here:
http://www.osha.gov/pls/imis/sicsearch.html
Vehicle Wash Facilities are industrial establishments or businesses that fixed or mobile facility where the manual,
automatic, or self-service exterior washing of vehicles is conducted. It includes, but is not limited to, automobiles,
trucks (exceptions below), motor homes, buses, motorcycles, ambulances, fire trucks, tractor trailers, and other devices
that convey passengers or goods on streets or highways. This definition also includes golf course equipment and lawn
maintenance equipment. It also includes any incidental floor cleaning wash waters associated with facilities that wash
vehicles where the floor wash water also passes through the vehicle wash water treatment system. Vehicle wash does
not mean engine, acid caustic metal brightener, or steam heated water washing. It does not include cleaning the interior
of bulk carriers. It does not include tanker trucks, garbage trucks, logging trucks, livestock trucks, construction
equipment, trains, boats, or aircraft. It does not include floor cleaning wash waters from vehicle maintenance areas.
Wastewater or Process wastewater is water that was used in the washing that occurs in the facility definitions above,
that is then discharged through an outfall to a receiving stream. Sewage discharges are wastewater, but not process
wastewater, and are not covered by this general permit.
LINE BY LINE INSTRUCTIONS
Part 1.
APPLICANT INFORMATION
Item A: Put the name of the business here (e.g. Joe's Car Wash).
Item B:
Put the name of the person or corporation that owns the business. This does not have to be the owner of the
building (e.g. if the business is on leased property) but who is responsible for the business and wants
coverage under the general permit.
Item C:
Put the mailing address, phone number and email of the owner here. Also indicate if you would like the
permit to be transmitted via email.
Item D: Indicate here the '911' address of the facility.
Item E:
If someone other than the owner listed in item B runs the plant and is the person with whom business will be
conducted, check No. Otherwise check Yes.
Item F.
If No was checked above, indicate the name of the person other than the owner who operates the facility.
Item G.
Put the address, phone number and email of the person other than the owner here.
Item 2.
FACILITY INFORMATION
Item A. Indicate if your discharge goes to surface waters. If you don't believe it does, answer "no" and describe the
discharge scenario. DEQ may want to investigate the need for a permit. If there is a wastewater discharge
from this facility that does not go to a public sewer system or septic tank drainfield system then it probably
discharges to surface waters or a storm sewer. If so, indicate the name (or names, if more than one) of the
receiving stream that the discharge goes into. This is the particular surface water, stream, creek or any other
body of water that receives the wash water. It can also be a ditch, ground surface or storm sewer that runs
off into such a body of water. If it discharges to an unnamed body of water, for name of receiving stream, put
"Unnamed tributary to..." and then the name of the closest named body of water towards which water in the
ditch, etc. would flow.
Item B. Indicate if the facility discharges to a municipal separate storm sewer and the MS4 owner. If yes, provide the
information noted. A list of MS4 owners can be accessed here:
http://www.deq.virginia.gov/Portals/0/DEQ/Water/Publications/MS4Permittees.xlsx
Separate storm sewers are considered connected to surface waters and MS4 owners are required to know
about your discharge.
Item C. If the facility has an individual VPDES permit that you want revoked to obtain coverage under this general
permit, or if you have an expiring or expired individual permit, please indicate "yes" so we can clear our
records with regard to that permit.
Item D. Indicate if you locality has an ordinance which requires connection to central wastewater treatment
facilities (sanitary sewer).
Item E. Indicate if these central wastewater treatment facilities are available to serve your location. If they are
available you must tell us why you have not connected. Please provide any information to help DEQ make
an informed decision of whether you can be provided coverage under this permit (e.g. cost of connecting
and using central sewer, how it will affect your business, quality of receiving stream, how often to you
discharge to the stream per month, are you currently connected to a central sewer for your domestic
waste?)
Part 3.
MAP
Attach a United States Geological Survey (USGS) topographic (a copy of a 7.5 Minute, 1:24,000 Scale) or
computer generated map (e.g. Google Maps) extending to at least one mile beyond property boundary.
The map must show the location of the facility, and the location of each of its existing and/or proposed
intake and discharge points. Include all springs, rivers and other surface water bodies, including the
receiving water body. Items not shown on the topographic map or computer generated map can be added
by hand.
Part 4.
NATURE OF BUSINESS
Follow the instructions on the form. If you are covered by the general permit, we will only send you the
parts of the permit that you say apply. If you add a laundry or car wash later, another registration statement
and fee will have to be submitted.
Part 5.
FLOW RATE
Follow the instructions on the form for calculating flow rate. Try to get your data from a 'typical' operating
month. You may have to estimate based on your best professional judgment. E.g. you discharge 5 days on
any month and your flows on each of those 5 days was 100, 150, 200, 250 and 300 gallons each day.
100+150+200+250+300 = 1,000 total gallons per month. Divide total gallons per month by days of
discharge 1,000/5 = 200 gallons per day highest average monthly flow rate. Report 200 gallons per day.
Part 6.
FACILITY DRAWING AND TREATMENT SYSTEM
Follow the instructions on the form. The line drawing can be a schematic representation, or basically a
"map" of the building showing intake water, flow through the facility and where the discharges (outfalls) are.
Also provide a description of the treatment system (oil water separator, sedimentation basin, etc..) and
dimensions or capacities of these systems. If vehicle wash explain any methods and frequency of solids
disposals.