EFTA01221870.pdf

FORM U.S. ENVIRONMENTAL PROTECTION AGENCY I. EPA I.D. NUMBER A c Di& GENERAL INFORMATION s F 1 IIIII Lill ri Consolidated Permits Program VI 0040525 VA C GENERAL (Read the "General Instructions" before starting.) , 2 13 14 15 LABEL ITEMS GENERAL INSTRUCTIONS If a preprinted label has been provided, affix it in the I. EPA I.D. NUMBER designated space. Review the information carefully; if any of a is incorrect, cross through k and enter the correct data in the appropriate Ellin area below. II. FACIUTY NAME Also, if any of the preprinted data Is absent (the area to the left of the label space lists the information that should appear), please provide it in III. FACIUTY MAILING PLEASE PLACE LABEL IN THIS SPACE the proper fdl-in area(s) below. If the label is ADDRESS complete and correct you need not complete hems I, III, V, and VI(except VIER which must be completed regardless). CompSeto al irons if no IV. FACILITY LOCATION label has been proved. Refer to the instructions for detailed item descriptions and for the legal authorization under which this data Is collected. II. POLLUTANT CHARACTERISTICS INSTRUCTIONS: Complete A through no detentewhether you need to submit any permit application forms to the EPA. I you answer *yes* to any questions, you must submit this form and the supplemental from listed In the parenthesis following the question. Mark 'X' in the box in the third column it the supplemental norm is attached. If you answer *no- to each question. you need not submit any of these forms. You may answer 'no' if your activity is excluded from permit requirements; see Section C of the instructions. See also, Section D of the OMR:Aims for delnitions of boldfaced terms. MARK "r SPECIFIC QUESTIONS MARK "FORM SPECIFIC QUESTIONS FORM YES NO ATTACHED YES NO ATTACHED A. Is this facility a publicly owned treatment B. Does or will this facility (Sher existing or works which results in a discharge to waters of • irIl . proposed) Include a concentrated animal 0 MI 9 the U.S.? (FORM 2A) feeding operation or aquatic animal production facility which results in a discharge 16 17 18 to waters of the U.S.? (FORM 2B) 19 20 21 C. ts this facility which currently results I '. ❑ 0 D. Is this proposal faddy (other than those . cli ❑ discharges to waters of the U.S. other than described in A or a above) which will result in a those described in A or B above? (FORM 2C) n 23 24 discharge to waters of the U.S.? (FORM 20) 25 28 27 E. Does or will this facility treat, store, or dispose of F. Do you cr win you inject at cis facility industrial a hazardous wastes? (FORM 3) ❑ 0 . municipal effluent below the lov.orrost stratum COntaning, within one quarter mte of the well bore. . 0 ❑ 28 29 30 underground sources of drinking water? (FORM 4) St 32 33 0. DOWN a will you inject at this facility any produced H. Do you or will you infect at this facility fluids for walla caber fluids which are brought to the surface special processes such as mining of suffer by the in connection with conventional oil or natural gas production, 0 9 ❑ Frasch process, solution mining of minerals, in . 0 0 intect fluids used for enhanced recovery situ combustion of fossil fuel, or recovery of of oil or natural gas, or seed fluids for 36:4890 01 geothermal energy? (FORM 4) liquid hydrocarbon? (FORM 4) 34 35 36 37 38 39 I. Is this facility a proposed stationary source J. N this facility a proposed stationary source which Is one of the 28 industrial categories listed in the instructions and which will potenhally emit 0 0 • which is NOT one a the 28 industrial categories listed in the instructions and which will potentially ip 0 0 100 tons per year of any air pollutant regulated emit 250 tons per year of any air pollutant under the Clean Air Act and may affect or be regulated under the Clean Air Act and may affect located in an attainment area? FORM 5 40 41 42 or be located in an attainment are? FORM 5 43 44 45 III. NAME OF FACILITY C SKIP 1 15 113-29 30 130 IV. FACILITY CONTACT A. NAME A TITLE (last, first, 8 title) B. PHONE (area code & no) C Gordon Brice Manager 340 513 9855 2 15 113 46 46 48 49 61 62 65 V. FACILITY MAILING ADDRESS A. STREET OR P.O. BOX C 16100 Red Hook Quarters B-3 3 16 16 ws S. CITY OR TOWN C. STATE D. ZIP CODE c Saint Thomas VI 00802 4 16 16 40 41 42 47 61 VI. FACILITY LOCATION A. STREET, ROUTE NO. OR OTHER SPECIFIC IDENTIFIER c Little St. James Island 5 16 16 45 B. COUNTY NAME USA 46 70 C. CITY OR TOWN D. STATE E. ZIP F. COUNTY CODE CODE N/A VI 00802 N/A 15 16 40 41 42 47 51 62 64 EPA FORM 3510.1 (8.60) CONTINUED ON REVERSE EFTA01221870 CONTINUED FROM THE FRONT VII. SIC CODES 4-di it, in order of nont A. FIRST B. SECOND c N/A I (sax*/ 7 N/A I (specify) 7 7 15 18 17 15 16 19 C. THIRD D. FOURTH c N/A 4PecifY) 7 N/A (specify)) 7 15 16 17 15 16 19 VIII. OPERATOR INFORMATION A. NAME B. Is the name listed in Item C I Arran Mc Ginnis VIVA also the owner? 8 ❑YES ❑ NO 18 19 55 C. STATUS OF OPERATOR (Enter the appropriate letter into the answer box; if "Other;" specify.) D. PHONE (area code 6 no.) F • FEDERAL M = PUBLIC (other than federal or state) I p I (specify) c 340 690 1487 S is STATE On OTHER (Specify) A P a PRIVATE 16 16 16 19 21 I 22 25 E. STREET OR PO BOX 6100 Red Hook Quarters B-3 ze 55 F. CITY OR TOWN G. STATE H. ZIP CODE IX. INDIAN LAND St. Thomas VI 00802 Is the facility located on Indian lands? B 15 16 40 42 42 47 51 ❑ YES 0 NO X. EXISTING ENVIRONMENTAL PERMITS A. NPDES (Discharges to Surface Wafer) D. PSD (Air Emissions from Proposed Sources) 6 7 4 9 C NT I I i N/A 9 P 15 I 18 I 17 I le 3D 15 16 17 18 30 B. UIC (Underground Injection of Fluids E. OTHER (specify) (Specify) C T I N/A c T s 15 U 9I 16 17 18 30 15 16 17 18 30 C. RCRA (Hazardous Wastes) E. OTHER (specify) (Specify) C T I C • N/A • 9 R 9 16 16 17 18 30 16 16 17 IS 30 XI. MAP Attach to this application a topographic map 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. See instructions for recise re uirements. XII. NATURE OF BUSINESS (provide a brief description) Private Residence, Domestic Use, Irrigation use. XIII. CERTIFICATION see instructions I certify under penalty of law that I have personally examined and am familiar with the information submitted in this application and all attachments and that, based on my inquiry of those persons immediately responsible for obtaining the information contained in the application, I believe that the information is true, accurate and complete. I am aware that there are significant penalties for submitting false information, including the possibilit of fine and imprisonment. A. NAME & OFFICIAL TITLE (type or print) B. SIGNATURE C. DATE SIGNED Brice Gordon - Island Manager COMMENTS FOR OFFICIAL USE ONLY c C 15 16 56 EPA FORM 3510-I (8-90) EFTA01221871  EPA ID Number (Copy from item 1 of Form 1) Form Approved VI 0040525 OMB No. 040-0086 Please type or print in the unshaded areas only Approval expires 8-31-98 Form u.& ENVIRONMENTAL PROTECTION AGENCY a APPLICATION FOR PERMIT TO DISCHARGE WASTEWATER 2C EXISTING MANUFACTURING, COMMERCIAL, MINING AND SILVICULTURAL OPERATIONS Consolidated Permits Program NPDES % EPA I. Outfall Location For this Duffel', list the latitude and longitude, (degrees, min.xxxx) and name of the receiving water(s) Outfall Latitude Longitude Receiving Water (name) Number (8) Deg Min Deg Min 001 18 18 64 49 Drainage System of RO Local II. Flows, Sources of Pollution, and Treatment Technologies A. Attach a line drawing showing the water flow through the facility. Indicate sources of intake water, operations contributing wastewater to the effluent, and treatment units labeled to correspond to the more detailed description in Item B. Construct a water balance on the line drawing by showing average flows between intakes, operations, treatment units, and outfalls. If a water balance cannot be determined (e.g., for certain mining activities), provide a pectoral description of the nature and amount of any sources of water and any collection or treatment measures. B. For each mitten, provide a description of (1) AN operations contributing wastewater to the effluent, including process wastewater. sanitary wastewater. cooling water, and storm water runoff; (2) The average flow contributed by each operation; and (3) The treatment received by the wastewater. Continue on additional sheets if necessary. 1. Outfall No. 2. Operations Contributing Flow 3. Treatment (list) a. OPERATION (list) b. AVERAGE FLOW a. DESCRIPTION b. LIST CODES FROM TABLE 2C-1 (include units) 001 R.O. gpd Discharge Reverse 1S 300,000 Osmosis Surface Water Discharge Water 4-A is pumped to a Brine Well on land then filtered out to sea EPA Form 3510-2C (8-90) Page 1 of 4 CONTINUE ON REVERSE EFTA01221872  PLEASE PRINT OR TYPE IN THE UNSHADED AREAS ONLY. You may report some or EPA M. NUMBER (copy from Item 1 of Form 1) all of this information on separate sheets (use the same format) instead of completing VI 0040525 these oaoes. SEE INSTRUCTIONS. V. INTAKE AND EFFLUENT CHARACTERISTICS (continued from page 3 of Form 2-C) PART A - You must provide the results of at least one analysis for every pollutant in this table. Complete one table for each outfall. See instructions for additional de ails. 2. EFFLUENT 3. UNITS 4. INTAKE (optional) 1. POLLUTANT a MAXIMUM DAILY b NAXialule 30 DAY VALUE C. LONG TERM AVRG. VALVE (specify if blank) a. LONG TERM VALUE (II 0I avallatM) avaaab.$O d. NO. OF AVERAGE VALUE b. NO. OF ie in NI ANALYSIS a. coNcEN. I o LIASS to ANALYSES COMCENTRAR 121 MASS CONCENTRATI MKS ectievereari d) moss COWIN-MAR (2) MASS ON ON TRATeON ON ON a. Biochemical Oxygen Demand (BOD) N/A b. Chemical Oxygen Demand (COD) N/A e. Total Organic Carbon (70C) N/A d. Total Suspended Solids (75S) N/A I e. Ammonia (as N) N/A Value Value Value Value f. Flow 30 Day 300 000 9,000,000 Value Value Value Value g. Temperature (winter) Daily °C h. Temperature (summer) Value Value Value Value Daily °C Minimum Maximum Minimum Maximum i. pH 30 Day STANDARD UNITS 7.6 7.8 7.6 7.8 PART B - Mark "X" in column 2-a fo each pollutant you know or have reason to believe is present. Mark 'X" in column 2-b for each pollutant you believe to be absent. If you mark column 2a for any po lutant which is limited either directly, or indirectly but expressly in an effluent limitation guideline, you must provide the results of at least one analysis for that pollutant. For other pollutants for which you mark column 2a, you must provide quantitative data or an explanation of their presence in your discharge Complete one table for each outfall. See the instructions for additional details and requirements. 1. POLLUT- 2. MARK 'X' 3. EFFLUENT 4. UNITS 5. INTAKE (optional) a. MAXIMUM DAILY b. MAXIMUM 30 DAY VALUE C. LONG TERM AVRG. VALUE (specify if blank) a. LONG TERM ANT AND tj" . ti- BE. (iavaaabla) (if avaaabia) d. NO. OF AVERAGE VALUE b. NO. OF CAS NO. (if : Es- O A. ANALYSIS 0 ANALYSES SENT In VALUE (I) oi a. CONCEN. b MASS 00.441i7AATIOW CI W.11 available) ENT comENTRe 0)444$ coreetrteAno CO MASS ccroceirekno (2) MASS TRATION TAN N N a. Bromide ii (24959-87-9) ❑ b. ClIceine. _4 Tat/ Residue/ c. Color • Cli d. Fecal l) Coliforrn e. Fluoride ci (16964-48-6) f. Nitrate- • e Nitrite (as NI EPA FORM 3510-2C (Rev. 8-90) Page V-1 CONTINUE ON REVERSE EFTA01221873  U.S. ENVIRONMENTAL PROTECTION AGENCY I. EPA I.D. NUMBER FORM a EDA GENERAL INFORMATION s T/A C 1 4110IGI—ni Consolidated Permits Program D F VI 00 t /t0 Sa 5 GENERAL (Read the "General Instructions" before starting.) , 2 13 14 15 LABEL ITEMS GENERAL INSTRUCTIONS Hamannled label has been trended, elk it in the I. EPA I.D. NUMBER designated space. Review the infcanagon careful; if any incorrect, moss through it and calor the correct data in the appropriate SI-In wee below. II. FACILITY NAME Also, if any of the preprinted data Is absent (the area to the left of the label space lists the that ould appear). p103513 pecAide II M III. FACILITY MAILING PLEASE PLACE LABEL IN THIS SPACE iithe nbr proper Bin ashrea(s)beicw.li Ihe label is ADDRESS complete and correct, you need not complete Items I, III, V, aid Vtexcept Vl-B which must be completed regardless). Complete ill dens if no IV. FACILITY LOCATION label has been proved. Refer to Ilse instructions *or detailed item descriptions and for tie legal authorization under Midi this data is collected II. POLLUTANT CHARACTERISTICS INSTRUCTIONS: Complete A through J 10 determine whether you need to submit any permit our -Moen forms to the EPA. I you answer 'yes to any questions, you must submit this lam and the supplemental from filed in the parenthes s (Mown the question. Mark ')C in the box in the tend column if the supplemental ken is attached. If you answer to -ne each question. you need not submit any el these terms. You may answer 'no' it your act* is exduded tom permit requirements; see Section C of the instructions. See also. Section 0 of the instructions for detains of bold-faced terms. " MARK "X" SPECIFIC QUESTIONS MARK 'X FORM SPECIFIC QUESTIONS ram YES NO YES NO ATTACHED ATTACHED A. Is this facility a publicly owned treatment B. Does or will this feebly (either existing or works which rears by a discharge lo waters of the U.S.? WORM 2A) ❑ LSI O proposed) include a concentrated animal teeing operation or aquatic animal II rgi ❑ production facility which results n a discharge Hi 17 18 10 wawa of the U.S.? (FORM 2B) if. 20 21 C. Is this facility which currently results in rj '' . Exi D. Is this proposal facility (other then those desafbed In A or B above) al will result in a ii 0 ❑ discharges to waters of the U.S. other than those deathbed in A or B above? (FORM 2C) 22 23 24 discharge lo waters of the U.S.? (FORM 20) 25 28 27 F. Do you or will you inject at this lac* industrial a E. Does or will this facility best store, or dispose of hazardous wastes? (FORM 3) ❑ g • municipal elite* below the limearmst stratum containing. Within am quarter ride of the wel taw ❑ a O 26 29 30 undargroind sources Or thigh° wider? WORM 4) 31 32 33 G. Do you awl you teed *Its ridgy any produced H. Do you a wd you inject at this facility fluids for water other luids which we brought to the surface n connection with ccrwenlional cd or nand gas production. Intact kids used fa enhanced recovery El 0 Ill medal processes sudi as mining of aver by the Fran% process, solution mining of miner.* in situ combustion of fossil fuel, or recovery of . isi O of oil a natal gas, or need Odds for storage of geothermal energy? (FORM 4) iquid hydrocartcns? (FORM 4) 34 35 38 37 38 39 I. Is this MOW a proposed stationary source M this facility a proposed stationary source which is one of the 28 industrial categories listed ri J which is NOT one of No 28 industrial cremate O 5( O in the instructions and Mach will potentially anvil 100 tons per year of any air pollutant regulated L-I ❑ igi • listed in the insbvctions and which will potentially emit 250 tons per r of any air pollutant under the ClM Act and may affect a be regulated under the Chen Mr Ad and mat ailed located in an ent area? FORM 40 41 42 or be located In an attainment are? FORM 43 44 45 III. NAME OF FACILITY c1 SKIP 15 16-29 30 69 IV. FACILITY CONTACT A. NAME & TITLE (last, first, & title) B. PHONE (area code & no.) , . c----.) . 2 LO" C) C ac r i -C\ V -) e x ( e. 6\ A, i•-)< • 3L/c S i r-, 9 Vc S- 15 16 45 46 46 49 51 52 55 V. FACILITY MAILING ADDRESS c 12/-ea s 121- 34 3 lobo 1-24.8wor,IQ....torez: A. STREET OR BOX 16 to B. CITY OR TOWN C. STATE D. ZIP CODE 4 C—i T. 7 --- \re:, vvvikc, 3z2 E ✓2 0 oEre 7— Is 14 40 41 42 47 51 VI. FACILITY LOCATION A. STREET, ROUTE NO. OR OTHER SPECIFIC IDENTIFIER 5 1"--I 4 -4- I e.. St. -3- 4\ tm-e s ..r. sky\ •--) ci es 15 M B. COUNTY NAME (A 5 A a 70 C. CITY OR TOWN D. STATE E. ZIP F. COUNTY CODE CODE C 5 16 A/ A- 40 vi 41 42 ocwoz_ 47 51 l AVA 52 54 EPA FORM 3510-I (8-90) CONTINUED ON REVERSE EFTA01221874  CONTINUED FROM THE FRONT VII. SIC CODES (4-digit, in order of priority) A FIRST B. SECOND I AyA I OnecifY) OW:thy) 1 7 A) 6 6 17 16 18 19 C. THIRD D. FOURTH 7 (5/29000 77 14 (spice) 15 / 17 16 16 19 VIII. OPERATOR INFORMATION A. NAME B. Is the name listed in Item VIII-A also the ownef? tI 18 19 741-Z. R_ A ts.) tkAe- CO 1 " r\ ‘ S 55 • YES 0 NO C. STATUS OF OPERATOR (Enter the appropriate letter into the answer box; if "Other snooty) D. PHONE ame code .4 no.) F = FEDERAL M= PUBLIC (other than federal or Stale) ? (specify) S =STATE O = OTHER Oman A 3q0 640 / eleY 7 P = PRIVATE —Fr 16 18 19 21 22 26 E. STREET OR PO BOX j, 10 0 lecel_ Root,- G., AR_ A- (r. 13 - 3 26 ea F. CITY OR TOWN G. STATE H. ZIP CODE IX. INDIAN LAND c B 16 18 —) I . -r kexcvn ikS 40 42 42 ti_T corm? 47 SI Is the facility located on Indian lands? 0 YES igi NO X. EXISTING ENVIRONMENTAL PERMITS A. NPDES (Discharges to Surface Water) D. PSD (Air Emissions front Proposed Sources) C T I C T I 9 N A) A 9 P 15 16 17 18 / 30 15 16 117 1 16 30 B. UIC (Undo round Injection ofFluids E. OTHER (specify) (Specify) C T I C T 9 U 4 9 16 15 17 18 30 16 16 IT T 1 18 30 C. RCFtA (H zardous Wastes) E. OTHER (specify) (Specify) T I C T I 9 16 R IC IT 18 N A 30 9 16 IC 17 ILI 30 XI. MAP Attach to this application a topographic map 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. See instructions for • ecise r • uirements. XII. NATURE OF BUSINESS (provide a brief description) • 7-) NniN. . 7 `- 7--, I r . u 4..14 / -C__ Ta<.--,.1 8 -e—AA CC— , ler ', ce r ktiCre m LA- C a-12- 1 ) XIII. CERTIFICATION (see instructions) I certify under penalty of law that 1have personally examined and am familiar with the information submitted in this application and all attachments and that, based on my inquiry of those persons immediately responsible for obtaining the information contained in the application, I believe that the information is true, accurate and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment. A. NAME & OFFICIAL TITLE (type or print) — i B. SIGNATURE C. DATE SIGNED SI vr \, ce Go va r -1 1 A IN2, r COMMENTS FOR OFFICIAL USE ONLY C C 15 IC 65 EPA FORM 3510-1 (8-90) EFTA01221875  Fo Approved. PA I.D. NUMBER(eOPY from Item 1 of Form I) Okrm