2014-04-17 NPDES Discharging Domestic WastewaterAp pendix A NPDES Combined Form 1 & 2A National Pollutant Discharge Elimination Sy stem
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 I NE
IIS Number
1. Facility Information
A Owner of Facility (Permittee) City of Blair, Nebraska
Date Recd
Street 218 South 16 Street
City Blair
B Name of Facility Blair Waste Water Treatment Plant
State Nebraska
Zip 68008
C Facilily Contact Person Allen Schoemaker
Ph 402 - 426 -4191 Email ARS @ci.blair.ne.us
D Facility Mailing �Address
Street 218 South 16 Street
City Blair
E. Facility Location (if different from above)
Street 850 East Fairview Drive
City Blair
State Nebraska
State Nebraska
Zip 68008
Zip 68008
F Facility Legal Description
South 1 /4 of the Southeast 1 /4, Section 6, and North 1 /4 of the Northeast 1 /4, Section 7, Township 18 North, Range 12 East,Washington
County, Nebraska
G Standard Industrial Classification (SIC) CodeLsgpplicable to the Facility 4952 Sewerage Systems
A -1
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
Street 351 Grant Street
City
State Nebraska
Responsibilities of contractor Hauling and land applying sludge from Blair wastewater treatment plant
Zip 68008
I. Compliance Sampling
Is compliance sampling of the discharge effluent the responsibility of a contract laboratory? X yes
provide the following
Name Midwest Labs Ph 402 - 334 -7770 Email
Street 13611 `B" Street
City Omaha
State Nebraska
Responsibilities of laboratory Ammonia & Bio Monitoring sludge analysis
2. Wastewater Sources (check applicable items)
A. Application Status (check one
X 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)
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
001M & 001N
Zip 68144
NPDES Permit Application for New Source
no If yes
A -2
4. Operator Information (continued on next page)
A. Treatment FacilityOperator Last, First,) and Phone Number
Robert Frahm
Ph 402 - 426 -5818
Operator Certification Number 0265
B. Operator's Mailing Address
Street 218 South 16 Street
Email rfhram @ci.blair.ne.us
Operator Class IV
City Blair
5. Wastewater Treatment System Information
State Nebraska
Zip 68008
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. We have bar screen at plant entry to remove large solids, grit removal,
primary treatment w ith sl remo ae r a t i on, se tr and chlorine treatment from May is to September 30
Population served 9500
Average Daily Flow (MGD) 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 ime 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 From Highway 30 north on Marina Drive to Fairview Drive then
east on Fairview Drive for 1 /a mile to wastewater treatment plant
Location of Outfall(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 Tributaries River Basin
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
A -3
Are there any combined sewer (sanitary and storm) overflow points? yes X no. If yes describe below
Is the effluent discharge continuous or intermittent? Intermittent. If intermittent provide the following information
Number of times per year discharge occurs
Average duration of each discharge
Average flow per discharge
Months in which discharge occurs
Are industrial wastes discharged to this facility? yes X no. Identify all Significant Industrial Users below.
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 Average Organic
(MGD) 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.
A -4
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. seq. as amended to date) and all rules, regulations, orders, decisions promulgated
there under, and subject to any legitimate appeal available to the applicant under the Act
Cognizant Official's Signature Date ?11 Y
Cognizant Official's Printed Name James Realph Title Mayor
A -5
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