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Notice of Intent (NOI) NPDES General Permit for

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I. Facility/Operator Information Update Only
Name of Facility:
Facility Site Address:
City: State: County: ZIP:
Facility Latitude: degrees min sec Longitude: degrees min sec
Operator/Owner Name: Phone: ( )
Operator/Owner Mailing Address:
City: State: ZIP: Operator Status: Federal State Public Private
II. Facility Contact Information
Contact Name: Phone: FAX:
Contact Title: E-Mail Address:
Mailing Address:
City: State: ZIP:
III. Billing Information
Billing Company Name: Phone: FAX:
Billing Contact Name or Title: E-Mail Address:
Billing Address:
City: State: ZIP:
IV. Site and Discharge Information
A. SIC or Activity Codes: Primary:__________ 2nd:__________ 3rd: __________ 4th:__________
B. Does the facility currently have Utility Water General Permit coverage? Yes, SCG25 No
C. List any other NPDES or ND Permit numbers for the facility: SC SC ND
D. List the type of discharge (once through non-contact cooling water, recirculated non-contact cooling water, air washer water, boiler blowdown, steam
condensate, air conditioner condensate or other non-contact cooling water discharging from heating and cooling (HVAC) systems, other condensate or
any combination of these), the flow associated with each discharge, the latitude and longitude (to the nearest 15 seconds), and the name of the
receiving water or municipal separate storm sewer’s receiving water to which the discharge flows. List additional discharges on a separate page.
Discharge Type
Flow
(gpd)
Latitude
Longitude
Receiving Waters
Deg
Min
Sec
Deg
Min
Sec
Notice of Intent (NOI)
NPDES General Permit for
Utility Water Discharges SCG250000
Submission of this Notice of Intent constitutes notice that the party identified in Section I of this form intends to be authorized by an NPDES permit issued for Utility Water discharges in a State
location identified in Section I of this form. Becoming a permittee obligates such a discharge to comply with all terms and conditions of the permit. ALL NECESSARY INFORMATION MUST BE
INCLUDED WITH THIS FORM. AN ANNUAL OPERATING FEE OF $100 IS REQUIRED FOR COVERAGE UNDER THIS PERMIT. See Instructions.
DHEC 3632 (2/2015)
E. Provide a short description of the each discharge’s flow from the plant site to waters of the State, identifying the distance in feet and specifying if the
discharge flows through a pond. Indicate the type of discharge associated with each description.
F. Locate the facility and each discharge on a U.S. Geological Survey 7½ minute quad sheet. Highlight the path from the outfall to the point the
discharge reaches the receiving stream. An 8½ x 11 copy of the portion of the map with the facility and each outfall path identified should be submitted
with this NOI.
G. For each discharge described in D above, please provide concentrations of the following parameters and indicate whether the data is based on actual
sampling results or, if estimated, a source of the estimated value. The average daily value is typically based on an average of the last 365 days of data.
In the spaces provided, list any other pollutants believed present and their concentrations. If more than one discharge is present, make copies of the
table and provide data for each discharge attached to the NOI.
Type of Discharge: ____________________________________________________
Parameter
Maximum Daily
Value (mg/l)
Average Daily
Value (mg/l)
Number of Samples
Source of Estimate or
Actual Data
Biochemical Oxygen Demand (BOD
5
)
Total Suspended Solids (TSS)
Total Residual Chlorine (TRC)
pH (give high and low in range)
Temperature (summer)
Temperature (winter)
Total Dissolved Solids (TDS)*
Total Copper
Total Lead
Total Zinc
*if boiler blowdown is discharged
H. Describe your sludge disposal method.
No sludge generated.
Lagoon or other facility with no routine sludge disposal.
Disposal at an approved facility, such as a landfill or wastewater treatment facility. Attach a letter of approval from the receiving facility.
Disposal by land application. Indicate ND number, Construction Permit number or other approval by the Department.
I. List any additives used in the utility water systems. Describe their composition, provide aquatic toxicity information and attach Material Safety Data
Sheets for each product used. Attach an additional sheet if necessary.
J. Identify the source of water used at this facility for utility water.
Public water supply Groundwater Surface Water Intake Structure Other (please specify) ______________________________
Is there a potential for chlorine to be present in the discharge (from any other source than a public water supply source)?
No Yes (identify the source)
K. Use the space below to bring to the Department’s attention any additional information you feel should be considered in the permit decision. Attach an
additional sheet if necessary.
IV. 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 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.
Print Name: Title:
Signature: Date:
DHEC 3632 (2/2015)
INSTRUCTIONS
Notice Of Intent (NOI) For Utility Water Discharges To Be Covered Under the NPDES General Permit SCG250000
Who Must File A Notice of Intent (NOI) Form.
Federal law at 40 CFR Part 122 prohibits point source discharges to a water body(ies)
of the U.S. without a National Pollutant Discharge Elimination System (NPDES)
permit. The operator of a facility that has utility water discharges must submit a NOI to
obtain coverage under the NPDES General Permit for Utility Water Discharges. If you
have questions about whether you need a permit under the NPDES Program, or if you
need information as to whether a particular program is administered by EPA or a state
agency, contact S.C. DHEC at (803) 898-4300.
Where To File NOI Form.
Completed NOIs must be sent to the following address:
SC Department of Health & Environmental Control
Bureau of Water/NPDES Permit Administration
2600 Bull Street
Columbia, SC 29201-1797
Completing the Form
You must type or print all information. If you have any questions on this form, call S.C.
DHEC at (803) 898-4300.
Revisions to a previously-submitted NOI
If there are only changes in ownership, name, address, site contact information or
billing information, only those relevant sections of the NOI are required to be
completed. Please check the box at the top right of the NOI form labeled “Update
Only” if you are only updating information. A signature is required for all changes.
Fees
The annual NPDES administration fee of $100 is required to be submitted with the NOI
for coverage of a new facility. Make check payable to S.C. DHEC.
Section I: Facility/Operator Information.
Give the legal name, physical address, including city, state, zip and county, and the
latitude and longitude of the facility to be permitted. If the facility lacks a street
address, indicate the state or county Highway number, the nearest town or city, or the
quarter section, township, and range (to the nearest quarter section) of the approximate
center of the site.
Give the legal name of the person, firm, public organization, or any other entity that
operates the facility or site described in this application. This name should be the name
as registered with the SC Secretary of State to do business in SC. The name of the
operator may or may not be the same name as the facility. The operator of the facility
is the legal entity that controls the facility's operation, rather than the plant or site
manager. Enter the complete mailing address and telephone number of the operator.
This name is not the name of the person who operates the wastewater treatment plant.
Operator Status: Indicate the legal ownership status of the facility.
Section II: Facility Contact Information
Enter the name, title and complete address, phone number and electronic mail (e-mail)
address of the person who is familiar with the operation of the facility and with the facts
reported in this NOI and to whom all permitting correspondence should be sent.
Section III. Billing Information
Enter the company name to which invoices should be sent. Name the person or title to
which the annual invoice should be mailed and provide his address, phone and e-mail
information.
Section IV: Site and Discharge Information.
A. List, in descending order of significance, up to four 4-digit standard industrial
classification (SIC) codes that best describe the principal products or services
provided at the facility or site identified in Section I. If you are not sure of the SIC
code to use, go to
http://www.osha.gov/pls/imis/sicsearch.html to search by
keywords.
B. Indicate whether the facility is currently covered by the Utility Water General
Permit and give the permit number, if applicable.
C. List any other NPDES or ND (land application) permits issued for the facility, if
applicable.
D. List each discharge for which coverage is sought. Actual or estimated flow data
should be included for each discharge. If coverage is sought for more than one
discharge of the same type, please note that the discharges are distinct. If more
space is needed, attach a separate sheet. The following are the stated flow limits for
the types of discharges authorized by the General Permit for Utility Water
Discharges:
1. Once-through, non-contact cooling water of 500,000 gallons per day
(gpd) on the maximum day or less.
2. Recirculated, non-contact cooling water of 200,000 gpd on the maximum
day or less.
3. Air washer water of 100,000 gpd on the maximum day or less.
4. Boiler blowdown of 10,000 gpd on the maximum day or less.
5. Steam condensate of 10,000 gpd on the maximum day or less.
6. Combined discharges of any of the discharges in 1 - 5 above of 500,000 gpd on the
maximum day or less in which the flow limits on the individual waste streams above
are not exceeded.
7. No limit on air conditioner condensate or other non-contact cooling water discharging
from heating and cooling (HVAC) systems and other condensate as defined in the
NPDES General Permit SCG250000.
Give the latitude and longitude (to the nearest 15 seconds) for each discharge and the
name of the receiving waters. Name all waters to which discharge is made and which
flow into significant receiving waters. For example, if the discharge is made to a ditch
that flows into an unnamed tributary which in turn flows into a named river, you should
provide the name or description (if no name is available) of the ditch, the tributary and
the river.
E. Describe the discharge flow path.
F. Provide an 8½ x 11 copy of the applicable portion of a US Geological Survey 7½ minute
quad map locating the facility and discharge point(s). The quad sheet name must be
provided with the map.
G. Sampling data is required to characterize each discharge to be covered by the general
permit. If the discharge is proposed and cannot be sampled, or if there has been no
discharge due to the absence of a particular waste stream for some time, an estimate of
each parameter shall be included based on data from an existing or similar facility or
data source. Indicate the source of the data in the last column. Data up to three (3) years
old may be used on this form provided the data is representative of current operations.
The following waste streams are not required to be sampled for the purpose of this NOI:
1. Once-through, non-contact cooling water of less than 5000 gpd.
2. Recirculated, non-contact cooling water of less than 2500 gpd.
3. Air washer water of less than 1000 gpd.
4. Boiler blowdown of less than 1000 gpd.
5. Steam condensate of less than 1000 gpd.
6. Combined discharges of any of the discharges in 1 - 5 above less than 2000 gpd.
7.Air conditioner condensate or other non-contact cooling water discharging from
heating and cooling (HVAC) systems and other condensate as defined in the NPDES
General Permit SCG250000.
H. Describe your facility’s sludge disposal.
I. List chemical additives used. Attach Material Safety Data Sheets (MSDS) for each
product used that is discharged.
J. Identify the source of the water used at this facility for utility water. Is chlorine added
such that chlorine could be in the discharge? This information will be used to determine
whether Total Residual Chlorine (TRC) limits are needed.
K. Provide any other relevant information.
Section IV: Certification
Please print the name and title of the authorized person and sign and date in accordance with
the following:
Federal statutes provide for severe penalties for submitting false information on this
application form. Federal regulations require this application to be signed as follows:
For a corporation: by a responsible corporate officer, which means: (I) president, secretary,
treasurer, or vice-president of the corporation in charge of a principal business function, or
any other person who performs similar policy or decision making functions, or (ii) the
manager of one or more manufacturing, production, or operating facilities employing more
than 250 persons or having gross annual sales or expenditures exceeding $25 million (in
second-quarter 1980), if authority to sign documents has been assigned or delegated to the
manager in accordance with corporate procedures:
For a partnership or sole proprietorship: by a general partner or the proprietor; or
For a municipality, State, Federal, or other public facility: by either a principal executive
officer or ranking elected official.
DHEC 3632 (2/2015)
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Completed 19 October 2020

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