Fillable Application Submittal: submit application to the 208 Program. (Arizona Dept of Environmental Quality)

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Application Submittal: submit application to the 208 Program. (Arizona Dept of Environmental Quality)

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BROWSE ARIZONA DEPT OF ENVIRONMENTAL QUALITY (AZ) FORMS
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June 20, 2016 Page 1 of 2
APPLICANT: PLEASE COMPLETE SECTIONS 1-10
Application Submittal: submit application to the 208 Program. Email application to emv@azdeq.gov; call (602) 771-4606
for assistance, or go to http://azdeq.gov/environ/water/watershed/regional.html
for further information. Along with
this completed application, the applicant MUST submit a map with the information noted in item 4 below. Failure to
include the map will result in the application being considered incomplete.
Part A. Is your application for any of the following:
A new domestic (publicly or privately owned) Wastewater Treatment Plant (WWTP)
An existing domestic (publicly owned or privately owned) WWTP that is adding an AZPDES discharge
outfall or changing the location of a previously approved AZPDES discharge outfall
More than a 10% increase in permitted design flow
Expansion of the service area
Change of ownership of a domestic (publicly or privately owned) WWTP (Pima County only)
Approval of Sanitary Facilities utilizing on-site wastewater treatment (APP only)
If you answered “yes” to any question above, please complete the remainder of this form
Part B. Facility Information
Explanation
(Provide a brief description)
1. Facility Name
Name of Owner
Name of Applicant
Contact Phone Number
Contact Email Address
2. Permit Type
a. AZPDES (existing or new)
b. APP (existing or new)
c. If AZPDES, give name of surface
water receiving the discharge
Current surface water discharged to:
_____________________________________________
Future surface water discharged to:
______________________________________________
3. Facility Location
County
Latitude/Longitude (for AZPDES,
lat/long of the outfall)
4. Attach a map(s) that
includes at a minimum
a. Facility/site location
b. Discharge location(s)
c. Other disposal options
d. Service area (for expansion include current and future area)
5. Describe the
application action(s)
checked in Part A.
a. New WWTP facility
b. New outfall or change in
outfall location
208 CONSISTENCY
Douglas A. Ducey,
Governor
June 20, 2016 Page 2 of 2
above.
c. Capacity expansion (million
gallons per day (MGD))
d. Expansion of service area
e. Change in WWTP
ownership (Pima County only)
f. Approval of Sanitary
Facilities using on-site
wastewater treatment
systems (APP only)
6. Facility Information
a. Treatment process: Current ___________________; Future___________________
b. Design capacity (annual average daily flow): Current_____________; Future____________
c. Effluent disposal method: Current:___________________; Future___________________
9. What type of entity
will operate the
facility?
a. Municipal/public utility Name:______________________________________
b. Private utility
Name:______________________________________
c. Semi-public (sanitary
district, improvement
district)
Name:_________________________________________
d. Other (explain)
Explain type:
Name:__________________________________________
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Application Submittal: submit application to the 208 Program. (Arizona Dept of Environmental Quality)

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Completed 12 August 2020

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