2019-04-12 NPDES Permit Application-DischargingAppendix A NPDES Combined Form 1 & 2A National Pollutant Discharge Elimination System
Permit Application for a Facility Discharging Domestic Wastewater [New addition to regulation]
Nebraska Department
of Environmental Quality
Wastewater Section
Suite 400, The Atrium, 1200 `N' Street
PO Box 98922
Lincoln, NE 68509-8922
Tel. 402/471-4220 Fax 402/471-2909
NPDES Combined Form 1 & 2A
National Pollutant Discharge Elimination System
Permit Application for a Facility Discharging Domestic Wastewater
This Area is For Agency Use
NPDES Number NE IIS Number Date Rec'd
1. Facility Information
A. Owner of Facility (Permittee)
City of Blair, Nebraska
Street 218 South 16t"
City Blair
B. Name of Facility
Blair waste water treatment plant
Nebraska Zip 68008
C. Facility Contact Person
Al Schoemaker Ph 402-426-4191 Email ARSgblairnebraska.org
D. Facility Mailing Address
street 218 South 16' Street
city Blair State Nebraska Zip 68008
E. Facility Location (if different from above)
street 850 East Fairview Drive
city Blair State Nebraska Zip 68008
F. Facility Legal Description
South 1/4 of the Southeast 11/4, Section 6, Townshipl8 North, Rangel3 East Washington County, Nebraska
G. Standard Industrial Classification (SIC) Code(s)applicable to the Facility
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H. Operation/Maintenance Performed by Contractor(s)
Are any operational or maintenance aspects (related to wastewater treatment and effluent quality) of the treatment works the
responsibility of a contractor? X yes no If yes provide the following
Name S &S Pumping Ph 402-426-4671 Email sspumping_@abbnebraska.com
Sheet 651 Grant
City Blair State Nebraska Zip 68008
Responsibilities of contractor Hauling and land applying sludge
I. Compliance Sampling
Is compliance sampling of the discharge effluent the responsibility of a contract laboratory? es no If yes
provide the following
Name Midwest Labs Ph 402-334-7770 Email
Street 13611 "B Street
City Omaha State Nebraska Zip 68144
Responsibilities of laboratory Bio and ammonia monitoring and sludge analysis
2. Wastewater Sources (check applicable items)
A. Application Status (check one)
NPDES Permit Reapplication for Existing Source
B. Additional Forms Required
X Facility discharging domestic wastewater
Facility discharging industrial wastewater
Facility discharging nonprocess wastewater
Facility is a fish hatchery or fish farm
Industrial facility discharging stormwater
Land application of treated effluent
3. Other Existing Environmental Permits
X NPDES (discharge to surface water)
NPP (Nebraska Pretreatment Permit)
UIC (underground injection of fluids)
RCRA (hazardous waste)
Air Permit
Other (specify)
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NPDES Permit Application for New Source
Submit NPDES Form 2A
Submit NPDES Form 2C
Submit NPDES Form 2E
Submit NPDES Form 2B
Submit NPDES Form 2F
Submit Land Application Form
Permit Number
NER910442
4. Operator Information (continued on next page)
A. Treatment Facility Operator (Last, First,) and Phone Number
Robert Frahm Ph 402-426-5818 Email rfrahm e,blairnebraska.org
Operator Certification Number 0265
B. Operator's Mailing Address
Street 218 South 16th
Operator Class IV
City Blair State Nebraska Zip 68008
5. Wastewater Treatment System Information
Provide a brief description of the wastewater treatment process. Include a description of the collection system, primary treatment,
secondary treatment, and disinfection.
Blair uses an activated sludge wastewater treatment plant for treating domestic waste. There is a bar screen at the plant entry to
remove large solids followed by grit removal, then sludge removal and aeriation with secondary treatment with chlorine treatment
from May 1St through September 301h each year.
Population served 9500
Average Daily Flow (MGD) 1.1 MGD
6. Sludge Disposal Methods
Design Daily Flow (MGD) 2 MGD
Design Maximum Flow(MGD) 2 MGD
Describe sludge management practices and utilization. The disposal of domestic sewage sludge is subject to the requirements of 40
CFR Part 503. This is a Federal regulatory program administered by E.P.A. Region VII
Sludge is removed from waste stream, thickened and treated with lime for stabilization and land
applied in Iowa
7. Discharge Information (continued on next page)
(Include an attachment to the permit for the following if there is more than one outfall)
How many separate outfalls discharge to the receiving waters? One
Facility Location (Street/Directions) 852 East Fairview Drive Directions: North from Highway 30 on Marina Drive to Fairview
Drive then east on Fairview Drive for t/4 mile to wastewater treatment plant
Location ofOutfall(s).
Northwest Quarter,Northwest Quarter, Section 8, Township 18 North, Range 12 East Washington County, NE Provide lat/long
of outfall if known. Latitude 4133'06.2" North Longitude 98 05'48.3" West Name of receiving waters Missouri River
Name of watershed if known Missouri River/ Papio Creek
Does the treatment works land -apply treated wastewater? Yes X no
Are there any constructed emergency overflows prior to the headworks? Yes X_no. If yes describe below
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Are there any combined sewer (sanitary and storm) overflow points? Yes X no. If yes describe below
Is the effluent discharge continuous or intermittent?,
Number of times per year discharge occurs
.verage duration of each discharge
verage flow per discharge
Months in which discharge occurs
If intermittent provide the following information
Are industrial wastes discharged to this facility? es X no. Identify all Significant Industrial Usersbelow.
A Significant Industrial Users is defined as a user that discharges 25,000 gallons per day or more of process water or contributes a
process wastestream which makes up 5 percent or more of the average dry weather hydraulic or organic capacity of the POTW
treatment plant. Any industrial users subject to Categorical Pretreatment Standards (e.g. metal finishing) are also classified as
Significant Industrial Users. (provide an attachment if there are more than four industries).
Industry
Industrial Process
Average flow Rate
MGD
Average Organic
Loading lbs
8. Process Flow Diagram or Schematic
Provide a diagram showing the processes of the treatment plant, including all bypass piping, and all backup power sources or
redundancy in the system. Also provide a water balance showing all treatment units, including disinfection. The water balance
must show daily average flow rate at influent and discharge points and approximate daily flow rates between treatment units.
Include a brief narrative description of the diagram.
9. Map
Attach to this application a topographic map (7.5 minute USGS) of the area extending to at least one mile beyond property
boundaries. The map must show the outline of the facility, the location of each of its existing and proposed intake and discharge
structures, each of its hazardous waste treatment, storage, or disposal facilities, and each well where it injects fluids underground.
Include all springs, rivers, and other surface water bodies in the map area.
10. Additional Information
Use the space below to expand upon any of the above questions or to bring to the attention of the reviewer any other information
you feel should be considered in establishing permit limitations for the facility.
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11. Certification (see Signatory Authorization Form for designation of Cognizant Official)
I certify that I am familiar with the information contained in the application, that to the best of my knowledge and belief such
information is true, complete, and accurate, and if this permit is granted, I agree to abide by the Nebraska Environmental
Protection Act (Neb. Rev. Stat. Secs. 81-1501 et. sea. as amended to date) and all rules, regulations, orders, decisions promulgated
there under, and subject to any legit' eal availabl e applicant under the Act
Cognizant Official's Signature Z Date `
Cognizant Official's Printed Name Richard Hansen Title Mayor
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Nebraska Department of Environmental Quality
NPDES/NPP SIGNATORY AUTHORIZATION FORM
This form is to be used to identify or update information pertaining to the facility. THIS FORM MUST BE SIGNED BY
THE COGNIZANT OFFICIAL. The Cognizant Official and Authorized Representative can be the same person.
Facility Name: Blair wastewater plant Permit No. NE0021482
Address: 842 East Fairview Drive City Blair Zip 68008 County Washington
Location (Street/Directions to) 852 East Fairview Drive Directions: North from Highway 30 on Marina Drive to Fail -view
PERMITTEE
List the NAME of the company, business, governmental entity, or person that owns the facility and that will be responsible for the
permit compliance: Al Schoemaker
COGNIZANT OFFICIAL
This person is responsible for the permit, signing reapplications, signing DMRs or designating someone to sign DMRs (Authorized
Representative) and other correspondence. For a municipal, only the mayor, chairperson or city manager may sign as the
Cognizant Official. Seepage orr Wr`ements.
Name Richard Hansen Title Mayor
*Mailing Address 218 South 16t11 Street City Blair
State Zip Phone Home Ph (optional)
AUTHORIZED REPRESENTATIVE (Do not complete if same as Cognizant Official)
This person is designated by the Cognizant Official and is responsible for receiving, completing and signing DMRs, and receiving
other correspondence (i.e., city clerk, plant operator). Seepage 6 for requirements.
Name Al
Title Director of Public Works
*Mailing Address City,
State Nebraska _Zip 68008 Phone 402-426-4191 Home Ph (optional)
If You Represent this Facility as/for a Contractor, list: Contractor's N
Contractor's Address Phone
OPERATOR This person is responsible for the operation and maintenance of the plant. Seepage 6 for requirements.
Name Bob Frahm Title Supervisor Certification # 0265
Mailing Address 218 South 161h Street, Blair, Nebraska 68008 Phone 402-426-5818
If You Represent this Facility as/for a Contractor, list: Contractor's Name
Contractor's Address
Phone
*Mailing Address: DMRs will be mailed to this address. DO NOT use a home or personal address unless
necessary. Please use city/village office address or facility/corporate address, etc. This address should remain
the same, even with changes in the facility's Cognizant Official or Authorized Representative.
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NPDES/NPP SIGNATORY AUTHORIZATION FORM (continued)
Facility Name: Blair wastewater treatment plant Permit No. NE0021482
COMMENTS
COGNIZANT OFFICIAL SIGNA
PRINTED NAME OF COGNIZANT OFFICIAL Richard Hansen
SIGNATORY AUTHORIZATION FORM REQUIREMENTS
TE //Z/
Cognizant Official. Nebraska Department of Environmental Quality, Title 119, Chapter 10 and Title 127, Chapter 29. All permit
applications submitted to the Department shall be signed:
1_1 in the case of a corporation, by a principal executive officer of at least the level of vice-president;
1_2 in the case of a partnership, by a general partner;
1_3 in the case of a sole proprietorship, by the proprietor; and
1_4 in the case of a municipal, state or other public facility, by either a principal executive officer or ranking elected official.
Authorized Representative. Nebraska Department of Environmental Quality, Title 119, Chapter 10 and Chapter 127, Chapter 29
002. All other correspondence, reports and DMRs shall be signed by a person designated in 00 1.0 1 through 001.04 above or a
duly authorized representative if such a representative is responsible for all the overall operation of the facility from which the
discharge originates; the authorization is made, in writing, by the person designated under 001.01 through 001.04 above; and the
written authorization is submitted to the Director. Any change in the signatures shall be submitted to the Department, in writing,
within 30 days after the change.
Operator. Nebraska Department of Environmental Quality, Title 123, Chapter 15
001 A competent operator familiar with the principles of wastewater treatment and disposal and skilled in the operation of the
plant equipment, shall be in charge of each wastewater works. The operator shall make such operations tests as may be specified
by the Department.
The operator may be required to be certified according the NDEQ Title 197.
Nebraska Department of Environmental Quality
ATTN: NPDES Permit Unit
Suite 400,1200 N Street, The Atrium
PO Box 98922
Lincoln, Nebraska 68509-8922
Telephone (402) 471-4220
Fax (402) 471-2909
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