mgh institute of health professions, 36 first avenue ......mgh institute of health professionals...
TRANSCRIPT
NCCW GP Appendix 5
APPENDIX~
Suggested Notice of Intent Format -~ ~~~~~J~ UNITED STATES ENVIRONMENTAL PROTECTION AGENCY- REGION 1
FIVE POST OFFICE SQUARE SUITE 100 BOSTON MASSACHUSETTS 02109-3912
Request for General Permit Authorization to Discharge N6ncontact cooling Water Notice ofIntent (NOl) to be covered by the General Permit
Noncontact Cooling Water General Permit (NCCWGP) NPDES General Permits No MAG250000 and NHG250000
A Facility Information
I Indicated applicable General Permit for discharge MAG250000 ~ NHG250000 0
2 Facility InformationLocation or iT ~ 1
1
Facility Name (Y)i~-JJsTDlJI Or rJttmt Proftss ioJVS StreetPO Box~~a$T JYliJYE City taraquolbiV State mA Zip Code 022Q Latitude 4 2 deg 22 2amp-i11 H Longitude rJ lo 3JS 3 ~ W Type ofBusiness Co Ll~ ~rofessioNAL SCbooL SIC Codes(s) -e$1-JI2211oooLI________ ____________ _
3 Facility Mailing address (ifdifferent from Location Address)
Facility Name--- -------------------- ------ - - shyStreetPOBox-------- --- City - - --------shyState ---- - -------- Zip Code ____
4 Facility Owner ~
i=~~~~~~~~e~~CN State poundrA Zip Code 022~ Contact Person Ro (J eH(r lAlrElM) Tel lO I 1-tlikbs zq Owner is (check one) Federal __State_ Tribal Private V Other(describe) _ _ ________ _______ _ ___ ______
6 Current permit coverage yes~ no 0 a) Has a prior NPDES permit (individual or general permit coverage) been granted for the discharge that IS listed on
the NOI yeslit noD If Yes pennit number (YlAG 2 S 00 l q b) Is the facility covered by an individual NPDES permit for other discharges yesO no[iJ
Ifyes Pennit Number ------ shyPage 1 of6
file dot ~
Search
Places
La~ers
Pnmary Orubase r Sonfe~ and labelgt 0 Places
~ bull PhotOlt
rl Roads 30 Buildigs
IY1A61S6a I ct~ID r1t26T AVENUlf ih-1amp10 ma o2zq fofi- amputrua)tJ ~~
HVAC~7CALMGH Institute Of Health Professionals PIJ7loG 51-sTEJI liAG2a0019
36 First AvenueCharlestown Navy Yard Bostotl MA Dnacm byRJUilono JAroAJlYaa ao15
Side walk First Avenue Seat1rltel Pump Containment Room 8 below Grade
Dry Dock
2
TERRY IUXG 1VAY
146ft to bldamp
Parking Space
I ICatch Basin
Mechanical Room
MGHIHP Recucle BoC2m
5tLTiou B $ 2
-------------------
NCCW GP Appendix 5
c) Is there a pending NPDES application on file with EPA for this discharge yesO nolk-Ifyes date of submittal and pennit number ifavailab le - --- --shy
7 Attach a topographic ma~iodicating the location of the facility and the outfall(s) to the receiving water Map attached 0
B Discharge Information (attach additional sheets as needed)
1 Name of receiving water into which discharge will occur 3oo[() t Ia fl i3 OR Freshwater 0 Marine Water rtV State Water Quality Classification Class __ Type ofReceiving Water Body (eg stream river lake reservoir estuary etc) OCQA rV
2 Attach a line drawing or flow schematic showing water flow through the facility including sources of intake water operations contributing to flow treatment units outfalls and receiving water(s) Line drawing or flow diagram attached [1)
3 Describe the discharge activities for which the ownerapplicant is seeking coverage (eg building cooling process line cooling etc) o1 d M( CeoiN( 4 Nu mber ofOutfalls I Latitude and Longitude to the nearest second for each OutfaJJ See EPAs siting tool at httpwwwepagovtrireportingsiting tooL Attach additional pages ifnecessary
Latitude _ ~U11121Lmiddot~S~~ ~ Longitude 1~03tSltt 1 Outfall _ 4-=--=z~=- ~ ~~N w Outfall Latitude Longitude_ _ __________
Outfall Latitude ------------ Longirude_ _ _ __________ __
5 For each Outfall provide the fo llowing discharge information
Outfall I _ im MGDa) Max - um Daily Flow 8 l90 ~ Average Monthly Flow laquo~SOOOOO MGD
NOTE EPA will use the flow eported bere as the facilitys permitted effiuent flow limit b) Maximum Daily Temperature 80 degF Average Monthly Temperature 10 c ) Maximum Monthly pH S 5 su Minimum Monthly pH 6 S su d) Outfall s discharge is continuous 0 intennittent ~ seasonal 0
Outfall __ a) Maximum Daily Flow MGD Average Monthly Flow _______ MGD
NOTE EPA will use the flow reported here as the facilitys permitted effluent flow limit b) Maximum Daily Temperature op Average Monthly Temperature _______degF c) Maximum Monthly pH su Minimum Monthly pH su d) OutfaJ Is discharge is continuous 0 intennittent 0 seasonal 0
Outfall __ a) Maximum Daily Flow MGD Average Monthly Flow _____ __MGD
NOTE EPA will use the flow reported here as the facilitys permitted effiuent flow limit b) Maximum Dai ly Temperature degF Average Monthly Temperature _____degF c) Maximum Monthly pH su M inimum Monthly pH su d) Outfall s discharge is continuous 0 intermittent 0 seasonal D
Page 2 of6
NCCW GP Appendix 5
6 Is the source ofthe NCCW potable water yesD nof5l Ifyes EPA will caJculate a Total Residual Chlorine effluent limit for your facility
7 Provide the reported or calculated seven day-ten year low flow (7Q10) ofthe receiving water _ ___ MGD Attach any calculation sheets used to support stream flow andor di lution calc ulations
8 For facilities that discharge to Massachusetts surface waters a) Submit the completed engineering calculation of the surface water temperature rise as shown in Attachment B of
the GeneraJ Permit Calculation attached D
b) Does the d ischarge occur in an Area ofCritical Environmental Concern (ACEC) yesD no(i
Ifyes provide the name ofACEC - --- --- ----------- --- - shyNote See Part 34 and Appendix 1 of the General Permit for more information on ACEC
C C hemical Additives
1 Are any non-toxic neutralization andor dechlorination chemicals used in the discharge(s) yesD noM
2 Ifyes attach a listing ofeach chemical used Include the chemical name and manufacturer maximum and average daily quantity used on a monthly basis as well as the maximum and average daily expected concentrations (mg1) in the discharge and the vendors reported aquatic toxicity (NOAEL andor LC50 in percent for typically acceptable aquatic organism)
3 Was the listing submitted with the facilitys 2008 NCCWGP NOI yesD no~
D NCCW Source Water Information
I State the source ~CW (eg municipal water supply private well surface water w ithdrawal etc) Source ~ Name of Source Water JogtToJ H-MV3Ct2
2 Is the source water registeredpermitted under MA Water Management Act or NHDES User Registration Rule (ENV WQ 2202) yesD no~ Ifyes registration number ________
3 Ifthe source water is groundwater (non-municipal we ll water) see Appendix 9 ofthe General Permit and submit etlluent (and receiving water hardness) test results as required in Part 54 of the General Permit
Test results attached D
4 Does the facility use both a primary and backup source ofNCCW yesO nogIfyes attach information that identifies and explains the primary and backup sources ofNCCW and how often the backup supply was used in the oast three years
E Best Technology Available for Cooling Water Intake Structures (CWISs)
If the faci lity s discharge is covered by this General Permit and the faci lity wi thdraws non-contact cooling water from a surface water you are subject to the BTA requirements at Part 42 ofthe General Pennit
l Are you s ubject to the BTA requirements ofthe General Permit yes( no D a) Ifno explain and skip to F b) Ifyes was the facility-specific BTA description submitted with the facilitys 2008 NCCW GP NOI
yes~ noD c) Ifyes does that description accurately describe the facility current operations and practices yesY noD
Page 3 of6
US Fish and Wildlife Service
Trust Resources List
This resource list Is to be used for planning purposes only - it is not an official species list
Endangered Species Act species list information for your project is available online and listed below for the foUowing FWS Field Offices
New England Ecological Services Field Office 70 COMMERCIAL STREET SUITE 300 CONCORD NH 3301 (603 223-2541 htmwwwfwsgovnewenglaod
Project Name 36 first avenue
S fCTj0tV F
QLlpoundSl1cw 3shy012312015 Information Planning and Conservation System (IPAC) Page I of7
Version 14
NCCW GP Appendix 5
2 lfthe facility is subject to the General Permits BTA requirements and is requesting coverage under the NCCWGP for the first time or ifyou answered No to question Elc above attach the facility-specific BTA description as required in art 42 of the General Pennit For additional information and guidance see Section N of the Fact Sheet
Include in your description a) Measures to meet the General Pennit Part 43a general BTA requirements includinll documentation that describes
the facilitys monitoring program for impinged fish andor invertebrate or the required alternative monitoring plan frequency andor protocol
b) A characterization of the source water bodys aquatic life habitat in the vicinity ofeach CWIS during the seasons when the CWIS may be in use
c) The attributes ofthe current CWIS d) The design measures of the CWIS e) The operation measures of the CWIS f) The historical occurrence of impinged fish for the past five years g) Ifapplicable a demonstration that the facilitys intake rate is commensurate with a closed-cycle recirculation system h) Other components to reduce impingement andor entrainment ofaquatic l ife
3 Provide the following information for each CWIS to support your attached facility-specific BTA description a) The design capacity of the ofthe CWIS AfJJ MGD b) Maximum monthly average intake of the CWIS during the previous five years Vftg MGD C) The month in which this flow reported in 3b occurred -~IY~J41C1-------d) The maximum through-screen design intake velocity feetsecond (fps) NA
4 For facilities where the CWIS is located on a freshwater river or stream provide the following information a) The source waters annual mean flow in MGD as available from USGS or other appropriate source
YIi MGD 1A b) The design intake flow as a ofthe source waters annual mean flow ~
Attach calculations ifequal to or less than 5 ofannual mean flow c) The source waters 7Q10 11M MGD 1f d) The design intake flow as a per~ent ofthe source waters 7Q10 ~
5 Provide a map showing the location ofeach cooling water intake structure NCCW Outfall(s) and CWIS features reterred to in the BTA description Map attached D IV~ F Endangered Species Act Eligibility Information
Using the instructions in Appendix 2 of the NCCW GP which ofthe following criteria apply to your facility USFW~
Criteria A it B D C u
1 Ifyou selected USFWS criteria B has consultation with the US Fish and Wildlife Service been completed yesD noD
2 lfconsultation with US Fish amp Wildlife Service andor NOAA Fisheries Service was completed was a written concurrence finding that the discharge is not likely to adversely affect listed species or critical habitat received
yesD noU
3 Attach documentation ofESA eligibility for USFWS as required at Part 34 and Appendix 2 ofthe General Permit Documentation attached~
Page 4 of6
NCCW GP Appendix 5
4 P lease indicate ifyour facility directly intakes water for non-contact cooling from any of the following waterbodies 0 Merrimack River
Connecticut River 0 Piscataqua River 0 Taunton River
EPA will consult with the National Marine Fisheries Service on cooling water intakes covered under this penn it in areas (in the above waterbodies) of the endangered Shortnose Sturgeon and Atlantic Sturgeon
G National Historic Properties Act Eligibility
1 Are any historic properties listed or eligible for listing on the National Register ofHistoric Places located on the facility site or in proximity to the discharge yes[ no~
2 Have any State or Tribal Historic Preservation Officers been consulted in t his determination yesO nolB If yes attach the results of the consultation(s)
3 Wh~b of the three National Historic Preservation Act scenarios listed in Appendix 3 Section C have you met IEl 02 03
H Supplemental Infonnation
Please provide any supplemental information including antidegradation review information applicable to new middotOr increased discharges Attach any analytical data used to support the application Attach any certification(s) required by the General Permit
Page 5 of6
NCCW GP Appendix 5
I Signature Requirements
The NOI must be signed by the operator in accordance with the signatory requirements of40 CFR sect 12222 (see below) including the following certification
l certify under penalty of law that ( 1) no biocides or other chemical additives except for those used for pH adjustment andor dechlorination are used in the noncontact cooling water (NCCW) system (2) the discharge consists solely ofNCCW (to reduce temperature) and authorized pH adjustment andor dechlorination chemicals (3) the discharge does not come in contact with any raw materials intermediate product water product (other than heat) or finished product ( 4) if the discharge ofnon contact cooling water subseq uently mixes with other wastewater (ie stormwater) prior to discharging to the receiving water any monitoring provided under this permit wi ll be only for noncontact cooling water (5) where applicable the facility has complied with the requirements ofthis permit specific to the Endangered Species Act and National Historic Preservation Act and (6) this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted
Based on my inquiry of the person o r persons who manage the system or those persons directly responsible for gathering the information I certify that the information submitted is to the best of my knowledge and belief true accurate and complete I certify that I am aware that there are signiftcam
penalties fi submitting false information including the possibility offine and imprisonment for knowinpound
Date ILJtjdaJJ-
Federal regulations require this application to be signed as follows L For a corporation by a principal executive officer ofat least the level ofvice president 2 For a partnership or sole proprietorship by a genera l partner or the proprietor respectively or 3 For a municipality State Federal or other public facility by either a principal executive officer or ranking elected
official
Page 6 of6
file dot ~
Search
Places
La~ers
Pnmary Orubase r Sonfe~ and labelgt 0 Places
~ bull PhotOlt
rl Roads 30 Buildigs
IY1A61S6a I ct~ID r1t26T AVENUlf ih-1amp10 ma o2zq fofi- amputrua)tJ ~~
HVAC~7CALMGH Institute Of Health Professionals PIJ7loG 51-sTEJI liAG2a0019
36 First AvenueCharlestown Navy Yard Bostotl MA Dnacm byRJUilono JAroAJlYaa ao15
Side walk First Avenue Seat1rltel Pump Containment Room 8 below Grade
Dry Dock
2
TERRY IUXG 1VAY
146ft to bldamp
Parking Space
I ICatch Basin
Mechanical Room
MGHIHP Recucle BoC2m
5tLTiou B $ 2
-------------------
NCCW GP Appendix 5
c) Is there a pending NPDES application on file with EPA for this discharge yesO nolk-Ifyes date of submittal and pennit number ifavailab le - --- --shy
7 Attach a topographic ma~iodicating the location of the facility and the outfall(s) to the receiving water Map attached 0
B Discharge Information (attach additional sheets as needed)
1 Name of receiving water into which discharge will occur 3oo[() t Ia fl i3 OR Freshwater 0 Marine Water rtV State Water Quality Classification Class __ Type ofReceiving Water Body (eg stream river lake reservoir estuary etc) OCQA rV
2 Attach a line drawing or flow schematic showing water flow through the facility including sources of intake water operations contributing to flow treatment units outfalls and receiving water(s) Line drawing or flow diagram attached [1)
3 Describe the discharge activities for which the ownerapplicant is seeking coverage (eg building cooling process line cooling etc) o1 d M( CeoiN( 4 Nu mber ofOutfalls I Latitude and Longitude to the nearest second for each OutfaJJ See EPAs siting tool at httpwwwepagovtrireportingsiting tooL Attach additional pages ifnecessary
Latitude _ ~U11121Lmiddot~S~~ ~ Longitude 1~03tSltt 1 Outfall _ 4-=--=z~=- ~ ~~N w Outfall Latitude Longitude_ _ __________
Outfall Latitude ------------ Longirude_ _ _ __________ __
5 For each Outfall provide the fo llowing discharge information
Outfall I _ im MGDa) Max - um Daily Flow 8 l90 ~ Average Monthly Flow laquo~SOOOOO MGD
NOTE EPA will use the flow eported bere as the facilitys permitted effiuent flow limit b) Maximum Daily Temperature 80 degF Average Monthly Temperature 10 c ) Maximum Monthly pH S 5 su Minimum Monthly pH 6 S su d) Outfall s discharge is continuous 0 intennittent ~ seasonal 0
Outfall __ a) Maximum Daily Flow MGD Average Monthly Flow _______ MGD
NOTE EPA will use the flow reported here as the facilitys permitted effluent flow limit b) Maximum Daily Temperature op Average Monthly Temperature _______degF c) Maximum Monthly pH su Minimum Monthly pH su d) OutfaJ Is discharge is continuous 0 intennittent 0 seasonal 0
Outfall __ a) Maximum Daily Flow MGD Average Monthly Flow _____ __MGD
NOTE EPA will use the flow reported here as the facilitys permitted effiuent flow limit b) Maximum Dai ly Temperature degF Average Monthly Temperature _____degF c) Maximum Monthly pH su M inimum Monthly pH su d) Outfall s discharge is continuous 0 intermittent 0 seasonal D
Page 2 of6
NCCW GP Appendix 5
6 Is the source ofthe NCCW potable water yesD nof5l Ifyes EPA will caJculate a Total Residual Chlorine effluent limit for your facility
7 Provide the reported or calculated seven day-ten year low flow (7Q10) ofthe receiving water _ ___ MGD Attach any calculation sheets used to support stream flow andor di lution calc ulations
8 For facilities that discharge to Massachusetts surface waters a) Submit the completed engineering calculation of the surface water temperature rise as shown in Attachment B of
the GeneraJ Permit Calculation attached D
b) Does the d ischarge occur in an Area ofCritical Environmental Concern (ACEC) yesD no(i
Ifyes provide the name ofACEC - --- --- ----------- --- - shyNote See Part 34 and Appendix 1 of the General Permit for more information on ACEC
C C hemical Additives
1 Are any non-toxic neutralization andor dechlorination chemicals used in the discharge(s) yesD noM
2 Ifyes attach a listing ofeach chemical used Include the chemical name and manufacturer maximum and average daily quantity used on a monthly basis as well as the maximum and average daily expected concentrations (mg1) in the discharge and the vendors reported aquatic toxicity (NOAEL andor LC50 in percent for typically acceptable aquatic organism)
3 Was the listing submitted with the facilitys 2008 NCCWGP NOI yesD no~
D NCCW Source Water Information
I State the source ~CW (eg municipal water supply private well surface water w ithdrawal etc) Source ~ Name of Source Water JogtToJ H-MV3Ct2
2 Is the source water registeredpermitted under MA Water Management Act or NHDES User Registration Rule (ENV WQ 2202) yesD no~ Ifyes registration number ________
3 Ifthe source water is groundwater (non-municipal we ll water) see Appendix 9 ofthe General Permit and submit etlluent (and receiving water hardness) test results as required in Part 54 of the General Permit
Test results attached D
4 Does the facility use both a primary and backup source ofNCCW yesO nogIfyes attach information that identifies and explains the primary and backup sources ofNCCW and how often the backup supply was used in the oast three years
E Best Technology Available for Cooling Water Intake Structures (CWISs)
If the faci lity s discharge is covered by this General Permit and the faci lity wi thdraws non-contact cooling water from a surface water you are subject to the BTA requirements at Part 42 ofthe General Pennit
l Are you s ubject to the BTA requirements ofthe General Permit yes( no D a) Ifno explain and skip to F b) Ifyes was the facility-specific BTA description submitted with the facilitys 2008 NCCW GP NOI
yes~ noD c) Ifyes does that description accurately describe the facility current operations and practices yesY noD
Page 3 of6
US Fish and Wildlife Service
Trust Resources List
This resource list Is to be used for planning purposes only - it is not an official species list
Endangered Species Act species list information for your project is available online and listed below for the foUowing FWS Field Offices
New England Ecological Services Field Office 70 COMMERCIAL STREET SUITE 300 CONCORD NH 3301 (603 223-2541 htmwwwfwsgovnewenglaod
Project Name 36 first avenue
S fCTj0tV F
QLlpoundSl1cw 3shy012312015 Information Planning and Conservation System (IPAC) Page I of7
Version 14
NCCW GP Appendix 5
2 lfthe facility is subject to the General Permits BTA requirements and is requesting coverage under the NCCWGP for the first time or ifyou answered No to question Elc above attach the facility-specific BTA description as required in art 42 of the General Pennit For additional information and guidance see Section N of the Fact Sheet
Include in your description a) Measures to meet the General Pennit Part 43a general BTA requirements includinll documentation that describes
the facilitys monitoring program for impinged fish andor invertebrate or the required alternative monitoring plan frequency andor protocol
b) A characterization of the source water bodys aquatic life habitat in the vicinity ofeach CWIS during the seasons when the CWIS may be in use
c) The attributes ofthe current CWIS d) The design measures of the CWIS e) The operation measures of the CWIS f) The historical occurrence of impinged fish for the past five years g) Ifapplicable a demonstration that the facilitys intake rate is commensurate with a closed-cycle recirculation system h) Other components to reduce impingement andor entrainment ofaquatic l ife
3 Provide the following information for each CWIS to support your attached facility-specific BTA description a) The design capacity of the ofthe CWIS AfJJ MGD b) Maximum monthly average intake of the CWIS during the previous five years Vftg MGD C) The month in which this flow reported in 3b occurred -~IY~J41C1-------d) The maximum through-screen design intake velocity feetsecond (fps) NA
4 For facilities where the CWIS is located on a freshwater river or stream provide the following information a) The source waters annual mean flow in MGD as available from USGS or other appropriate source
YIi MGD 1A b) The design intake flow as a ofthe source waters annual mean flow ~
Attach calculations ifequal to or less than 5 ofannual mean flow c) The source waters 7Q10 11M MGD 1f d) The design intake flow as a per~ent ofthe source waters 7Q10 ~
5 Provide a map showing the location ofeach cooling water intake structure NCCW Outfall(s) and CWIS features reterred to in the BTA description Map attached D IV~ F Endangered Species Act Eligibility Information
Using the instructions in Appendix 2 of the NCCW GP which ofthe following criteria apply to your facility USFW~
Criteria A it B D C u
1 Ifyou selected USFWS criteria B has consultation with the US Fish and Wildlife Service been completed yesD noD
2 lfconsultation with US Fish amp Wildlife Service andor NOAA Fisheries Service was completed was a written concurrence finding that the discharge is not likely to adversely affect listed species or critical habitat received
yesD noU
3 Attach documentation ofESA eligibility for USFWS as required at Part 34 and Appendix 2 ofthe General Permit Documentation attached~
Page 4 of6
NCCW GP Appendix 5
4 P lease indicate ifyour facility directly intakes water for non-contact cooling from any of the following waterbodies 0 Merrimack River
Connecticut River 0 Piscataqua River 0 Taunton River
EPA will consult with the National Marine Fisheries Service on cooling water intakes covered under this penn it in areas (in the above waterbodies) of the endangered Shortnose Sturgeon and Atlantic Sturgeon
G National Historic Properties Act Eligibility
1 Are any historic properties listed or eligible for listing on the National Register ofHistoric Places located on the facility site or in proximity to the discharge yes[ no~
2 Have any State or Tribal Historic Preservation Officers been consulted in t his determination yesO nolB If yes attach the results of the consultation(s)
3 Wh~b of the three National Historic Preservation Act scenarios listed in Appendix 3 Section C have you met IEl 02 03
H Supplemental Infonnation
Please provide any supplemental information including antidegradation review information applicable to new middotOr increased discharges Attach any analytical data used to support the application Attach any certification(s) required by the General Permit
Page 5 of6
NCCW GP Appendix 5
I Signature Requirements
The NOI must be signed by the operator in accordance with the signatory requirements of40 CFR sect 12222 (see below) including the following certification
l certify under penalty of law that ( 1) no biocides or other chemical additives except for those used for pH adjustment andor dechlorination are used in the noncontact cooling water (NCCW) system (2) the discharge consists solely ofNCCW (to reduce temperature) and authorized pH adjustment andor dechlorination chemicals (3) the discharge does not come in contact with any raw materials intermediate product water product (other than heat) or finished product ( 4) if the discharge ofnon contact cooling water subseq uently mixes with other wastewater (ie stormwater) prior to discharging to the receiving water any monitoring provided under this permit wi ll be only for noncontact cooling water (5) where applicable the facility has complied with the requirements ofthis permit specific to the Endangered Species Act and National Historic Preservation Act and (6) this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted
Based on my inquiry of the person o r persons who manage the system or those persons directly responsible for gathering the information I certify that the information submitted is to the best of my knowledge and belief true accurate and complete I certify that I am aware that there are signiftcam
penalties fi submitting false information including the possibility offine and imprisonment for knowinpound
Date ILJtjdaJJ-
Federal regulations require this application to be signed as follows L For a corporation by a principal executive officer ofat least the level ofvice president 2 For a partnership or sole proprietorship by a genera l partner or the proprietor respectively or 3 For a municipality State Federal or other public facility by either a principal executive officer or ranking elected
official
Page 6 of6
HVAC~7CALMGH Institute Of Health Professionals PIJ7loG 51-sTEJI liAG2a0019
36 First AvenueCharlestown Navy Yard Bostotl MA Dnacm byRJUilono JAroAJlYaa ao15
Side walk First Avenue Seat1rltel Pump Containment Room 8 below Grade
Dry Dock
2
TERRY IUXG 1VAY
146ft to bldamp
Parking Space
I ICatch Basin
Mechanical Room
MGHIHP Recucle BoC2m
5tLTiou B $ 2
-------------------
NCCW GP Appendix 5
c) Is there a pending NPDES application on file with EPA for this discharge yesO nolk-Ifyes date of submittal and pennit number ifavailab le - --- --shy
7 Attach a topographic ma~iodicating the location of the facility and the outfall(s) to the receiving water Map attached 0
B Discharge Information (attach additional sheets as needed)
1 Name of receiving water into which discharge will occur 3oo[() t Ia fl i3 OR Freshwater 0 Marine Water rtV State Water Quality Classification Class __ Type ofReceiving Water Body (eg stream river lake reservoir estuary etc) OCQA rV
2 Attach a line drawing or flow schematic showing water flow through the facility including sources of intake water operations contributing to flow treatment units outfalls and receiving water(s) Line drawing or flow diagram attached [1)
3 Describe the discharge activities for which the ownerapplicant is seeking coverage (eg building cooling process line cooling etc) o1 d M( CeoiN( 4 Nu mber ofOutfalls I Latitude and Longitude to the nearest second for each OutfaJJ See EPAs siting tool at httpwwwepagovtrireportingsiting tooL Attach additional pages ifnecessary
Latitude _ ~U11121Lmiddot~S~~ ~ Longitude 1~03tSltt 1 Outfall _ 4-=--=z~=- ~ ~~N w Outfall Latitude Longitude_ _ __________
Outfall Latitude ------------ Longirude_ _ _ __________ __
5 For each Outfall provide the fo llowing discharge information
Outfall I _ im MGDa) Max - um Daily Flow 8 l90 ~ Average Monthly Flow laquo~SOOOOO MGD
NOTE EPA will use the flow eported bere as the facilitys permitted effiuent flow limit b) Maximum Daily Temperature 80 degF Average Monthly Temperature 10 c ) Maximum Monthly pH S 5 su Minimum Monthly pH 6 S su d) Outfall s discharge is continuous 0 intennittent ~ seasonal 0
Outfall __ a) Maximum Daily Flow MGD Average Monthly Flow _______ MGD
NOTE EPA will use the flow reported here as the facilitys permitted effluent flow limit b) Maximum Daily Temperature op Average Monthly Temperature _______degF c) Maximum Monthly pH su Minimum Monthly pH su d) OutfaJ Is discharge is continuous 0 intennittent 0 seasonal 0
Outfall __ a) Maximum Daily Flow MGD Average Monthly Flow _____ __MGD
NOTE EPA will use the flow reported here as the facilitys permitted effiuent flow limit b) Maximum Dai ly Temperature degF Average Monthly Temperature _____degF c) Maximum Monthly pH su M inimum Monthly pH su d) Outfall s discharge is continuous 0 intermittent 0 seasonal D
Page 2 of6
NCCW GP Appendix 5
6 Is the source ofthe NCCW potable water yesD nof5l Ifyes EPA will caJculate a Total Residual Chlorine effluent limit for your facility
7 Provide the reported or calculated seven day-ten year low flow (7Q10) ofthe receiving water _ ___ MGD Attach any calculation sheets used to support stream flow andor di lution calc ulations
8 For facilities that discharge to Massachusetts surface waters a) Submit the completed engineering calculation of the surface water temperature rise as shown in Attachment B of
the GeneraJ Permit Calculation attached D
b) Does the d ischarge occur in an Area ofCritical Environmental Concern (ACEC) yesD no(i
Ifyes provide the name ofACEC - --- --- ----------- --- - shyNote See Part 34 and Appendix 1 of the General Permit for more information on ACEC
C C hemical Additives
1 Are any non-toxic neutralization andor dechlorination chemicals used in the discharge(s) yesD noM
2 Ifyes attach a listing ofeach chemical used Include the chemical name and manufacturer maximum and average daily quantity used on a monthly basis as well as the maximum and average daily expected concentrations (mg1) in the discharge and the vendors reported aquatic toxicity (NOAEL andor LC50 in percent for typically acceptable aquatic organism)
3 Was the listing submitted with the facilitys 2008 NCCWGP NOI yesD no~
D NCCW Source Water Information
I State the source ~CW (eg municipal water supply private well surface water w ithdrawal etc) Source ~ Name of Source Water JogtToJ H-MV3Ct2
2 Is the source water registeredpermitted under MA Water Management Act or NHDES User Registration Rule (ENV WQ 2202) yesD no~ Ifyes registration number ________
3 Ifthe source water is groundwater (non-municipal we ll water) see Appendix 9 ofthe General Permit and submit etlluent (and receiving water hardness) test results as required in Part 54 of the General Permit
Test results attached D
4 Does the facility use both a primary and backup source ofNCCW yesO nogIfyes attach information that identifies and explains the primary and backup sources ofNCCW and how often the backup supply was used in the oast three years
E Best Technology Available for Cooling Water Intake Structures (CWISs)
If the faci lity s discharge is covered by this General Permit and the faci lity wi thdraws non-contact cooling water from a surface water you are subject to the BTA requirements at Part 42 ofthe General Pennit
l Are you s ubject to the BTA requirements ofthe General Permit yes( no D a) Ifno explain and skip to F b) Ifyes was the facility-specific BTA description submitted with the facilitys 2008 NCCW GP NOI
yes~ noD c) Ifyes does that description accurately describe the facility current operations and practices yesY noD
Page 3 of6
US Fish and Wildlife Service
Trust Resources List
This resource list Is to be used for planning purposes only - it is not an official species list
Endangered Species Act species list information for your project is available online and listed below for the foUowing FWS Field Offices
New England Ecological Services Field Office 70 COMMERCIAL STREET SUITE 300 CONCORD NH 3301 (603 223-2541 htmwwwfwsgovnewenglaod
Project Name 36 first avenue
S fCTj0tV F
QLlpoundSl1cw 3shy012312015 Information Planning and Conservation System (IPAC) Page I of7
Version 14
NCCW GP Appendix 5
2 lfthe facility is subject to the General Permits BTA requirements and is requesting coverage under the NCCWGP for the first time or ifyou answered No to question Elc above attach the facility-specific BTA description as required in art 42 of the General Pennit For additional information and guidance see Section N of the Fact Sheet
Include in your description a) Measures to meet the General Pennit Part 43a general BTA requirements includinll documentation that describes
the facilitys monitoring program for impinged fish andor invertebrate or the required alternative monitoring plan frequency andor protocol
b) A characterization of the source water bodys aquatic life habitat in the vicinity ofeach CWIS during the seasons when the CWIS may be in use
c) The attributes ofthe current CWIS d) The design measures of the CWIS e) The operation measures of the CWIS f) The historical occurrence of impinged fish for the past five years g) Ifapplicable a demonstration that the facilitys intake rate is commensurate with a closed-cycle recirculation system h) Other components to reduce impingement andor entrainment ofaquatic l ife
3 Provide the following information for each CWIS to support your attached facility-specific BTA description a) The design capacity of the ofthe CWIS AfJJ MGD b) Maximum monthly average intake of the CWIS during the previous five years Vftg MGD C) The month in which this flow reported in 3b occurred -~IY~J41C1-------d) The maximum through-screen design intake velocity feetsecond (fps) NA
4 For facilities where the CWIS is located on a freshwater river or stream provide the following information a) The source waters annual mean flow in MGD as available from USGS or other appropriate source
YIi MGD 1A b) The design intake flow as a ofthe source waters annual mean flow ~
Attach calculations ifequal to or less than 5 ofannual mean flow c) The source waters 7Q10 11M MGD 1f d) The design intake flow as a per~ent ofthe source waters 7Q10 ~
5 Provide a map showing the location ofeach cooling water intake structure NCCW Outfall(s) and CWIS features reterred to in the BTA description Map attached D IV~ F Endangered Species Act Eligibility Information
Using the instructions in Appendix 2 of the NCCW GP which ofthe following criteria apply to your facility USFW~
Criteria A it B D C u
1 Ifyou selected USFWS criteria B has consultation with the US Fish and Wildlife Service been completed yesD noD
2 lfconsultation with US Fish amp Wildlife Service andor NOAA Fisheries Service was completed was a written concurrence finding that the discharge is not likely to adversely affect listed species or critical habitat received
yesD noU
3 Attach documentation ofESA eligibility for USFWS as required at Part 34 and Appendix 2 ofthe General Permit Documentation attached~
Page 4 of6
NCCW GP Appendix 5
4 P lease indicate ifyour facility directly intakes water for non-contact cooling from any of the following waterbodies 0 Merrimack River
Connecticut River 0 Piscataqua River 0 Taunton River
EPA will consult with the National Marine Fisheries Service on cooling water intakes covered under this penn it in areas (in the above waterbodies) of the endangered Shortnose Sturgeon and Atlantic Sturgeon
G National Historic Properties Act Eligibility
1 Are any historic properties listed or eligible for listing on the National Register ofHistoric Places located on the facility site or in proximity to the discharge yes[ no~
2 Have any State or Tribal Historic Preservation Officers been consulted in t his determination yesO nolB If yes attach the results of the consultation(s)
3 Wh~b of the three National Historic Preservation Act scenarios listed in Appendix 3 Section C have you met IEl 02 03
H Supplemental Infonnation
Please provide any supplemental information including antidegradation review information applicable to new middotOr increased discharges Attach any analytical data used to support the application Attach any certification(s) required by the General Permit
Page 5 of6
NCCW GP Appendix 5
I Signature Requirements
The NOI must be signed by the operator in accordance with the signatory requirements of40 CFR sect 12222 (see below) including the following certification
l certify under penalty of law that ( 1) no biocides or other chemical additives except for those used for pH adjustment andor dechlorination are used in the noncontact cooling water (NCCW) system (2) the discharge consists solely ofNCCW (to reduce temperature) and authorized pH adjustment andor dechlorination chemicals (3) the discharge does not come in contact with any raw materials intermediate product water product (other than heat) or finished product ( 4) if the discharge ofnon contact cooling water subseq uently mixes with other wastewater (ie stormwater) prior to discharging to the receiving water any monitoring provided under this permit wi ll be only for noncontact cooling water (5) where applicable the facility has complied with the requirements ofthis permit specific to the Endangered Species Act and National Historic Preservation Act and (6) this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted
Based on my inquiry of the person o r persons who manage the system or those persons directly responsible for gathering the information I certify that the information submitted is to the best of my knowledge and belief true accurate and complete I certify that I am aware that there are signiftcam
penalties fi submitting false information including the possibility offine and imprisonment for knowinpound
Date ILJtjdaJJ-
Federal regulations require this application to be signed as follows L For a corporation by a principal executive officer ofat least the level ofvice president 2 For a partnership or sole proprietorship by a genera l partner or the proprietor respectively or 3 For a municipality State Federal or other public facility by either a principal executive officer or ranking elected
official
Page 6 of6
-------------------
NCCW GP Appendix 5
c) Is there a pending NPDES application on file with EPA for this discharge yesO nolk-Ifyes date of submittal and pennit number ifavailab le - --- --shy
7 Attach a topographic ma~iodicating the location of the facility and the outfall(s) to the receiving water Map attached 0
B Discharge Information (attach additional sheets as needed)
1 Name of receiving water into which discharge will occur 3oo[() t Ia fl i3 OR Freshwater 0 Marine Water rtV State Water Quality Classification Class __ Type ofReceiving Water Body (eg stream river lake reservoir estuary etc) OCQA rV
2 Attach a line drawing or flow schematic showing water flow through the facility including sources of intake water operations contributing to flow treatment units outfalls and receiving water(s) Line drawing or flow diagram attached [1)
3 Describe the discharge activities for which the ownerapplicant is seeking coverage (eg building cooling process line cooling etc) o1 d M( CeoiN( 4 Nu mber ofOutfalls I Latitude and Longitude to the nearest second for each OutfaJJ See EPAs siting tool at httpwwwepagovtrireportingsiting tooL Attach additional pages ifnecessary
Latitude _ ~U11121Lmiddot~S~~ ~ Longitude 1~03tSltt 1 Outfall _ 4-=--=z~=- ~ ~~N w Outfall Latitude Longitude_ _ __________
Outfall Latitude ------------ Longirude_ _ _ __________ __
5 For each Outfall provide the fo llowing discharge information
Outfall I _ im MGDa) Max - um Daily Flow 8 l90 ~ Average Monthly Flow laquo~SOOOOO MGD
NOTE EPA will use the flow eported bere as the facilitys permitted effiuent flow limit b) Maximum Daily Temperature 80 degF Average Monthly Temperature 10 c ) Maximum Monthly pH S 5 su Minimum Monthly pH 6 S su d) Outfall s discharge is continuous 0 intennittent ~ seasonal 0
Outfall __ a) Maximum Daily Flow MGD Average Monthly Flow _______ MGD
NOTE EPA will use the flow reported here as the facilitys permitted effluent flow limit b) Maximum Daily Temperature op Average Monthly Temperature _______degF c) Maximum Monthly pH su Minimum Monthly pH su d) OutfaJ Is discharge is continuous 0 intennittent 0 seasonal 0
Outfall __ a) Maximum Daily Flow MGD Average Monthly Flow _____ __MGD
NOTE EPA will use the flow reported here as the facilitys permitted effiuent flow limit b) Maximum Dai ly Temperature degF Average Monthly Temperature _____degF c) Maximum Monthly pH su M inimum Monthly pH su d) Outfall s discharge is continuous 0 intermittent 0 seasonal D
Page 2 of6
NCCW GP Appendix 5
6 Is the source ofthe NCCW potable water yesD nof5l Ifyes EPA will caJculate a Total Residual Chlorine effluent limit for your facility
7 Provide the reported or calculated seven day-ten year low flow (7Q10) ofthe receiving water _ ___ MGD Attach any calculation sheets used to support stream flow andor di lution calc ulations
8 For facilities that discharge to Massachusetts surface waters a) Submit the completed engineering calculation of the surface water temperature rise as shown in Attachment B of
the GeneraJ Permit Calculation attached D
b) Does the d ischarge occur in an Area ofCritical Environmental Concern (ACEC) yesD no(i
Ifyes provide the name ofACEC - --- --- ----------- --- - shyNote See Part 34 and Appendix 1 of the General Permit for more information on ACEC
C C hemical Additives
1 Are any non-toxic neutralization andor dechlorination chemicals used in the discharge(s) yesD noM
2 Ifyes attach a listing ofeach chemical used Include the chemical name and manufacturer maximum and average daily quantity used on a monthly basis as well as the maximum and average daily expected concentrations (mg1) in the discharge and the vendors reported aquatic toxicity (NOAEL andor LC50 in percent for typically acceptable aquatic organism)
3 Was the listing submitted with the facilitys 2008 NCCWGP NOI yesD no~
D NCCW Source Water Information
I State the source ~CW (eg municipal water supply private well surface water w ithdrawal etc) Source ~ Name of Source Water JogtToJ H-MV3Ct2
2 Is the source water registeredpermitted under MA Water Management Act or NHDES User Registration Rule (ENV WQ 2202) yesD no~ Ifyes registration number ________
3 Ifthe source water is groundwater (non-municipal we ll water) see Appendix 9 ofthe General Permit and submit etlluent (and receiving water hardness) test results as required in Part 54 of the General Permit
Test results attached D
4 Does the facility use both a primary and backup source ofNCCW yesO nogIfyes attach information that identifies and explains the primary and backup sources ofNCCW and how often the backup supply was used in the oast three years
E Best Technology Available for Cooling Water Intake Structures (CWISs)
If the faci lity s discharge is covered by this General Permit and the faci lity wi thdraws non-contact cooling water from a surface water you are subject to the BTA requirements at Part 42 ofthe General Pennit
l Are you s ubject to the BTA requirements ofthe General Permit yes( no D a) Ifno explain and skip to F b) Ifyes was the facility-specific BTA description submitted with the facilitys 2008 NCCW GP NOI
yes~ noD c) Ifyes does that description accurately describe the facility current operations and practices yesY noD
Page 3 of6
US Fish and Wildlife Service
Trust Resources List
This resource list Is to be used for planning purposes only - it is not an official species list
Endangered Species Act species list information for your project is available online and listed below for the foUowing FWS Field Offices
New England Ecological Services Field Office 70 COMMERCIAL STREET SUITE 300 CONCORD NH 3301 (603 223-2541 htmwwwfwsgovnewenglaod
Project Name 36 first avenue
S fCTj0tV F
QLlpoundSl1cw 3shy012312015 Information Planning and Conservation System (IPAC) Page I of7
Version 14
NCCW GP Appendix 5
2 lfthe facility is subject to the General Permits BTA requirements and is requesting coverage under the NCCWGP for the first time or ifyou answered No to question Elc above attach the facility-specific BTA description as required in art 42 of the General Pennit For additional information and guidance see Section N of the Fact Sheet
Include in your description a) Measures to meet the General Pennit Part 43a general BTA requirements includinll documentation that describes
the facilitys monitoring program for impinged fish andor invertebrate or the required alternative monitoring plan frequency andor protocol
b) A characterization of the source water bodys aquatic life habitat in the vicinity ofeach CWIS during the seasons when the CWIS may be in use
c) The attributes ofthe current CWIS d) The design measures of the CWIS e) The operation measures of the CWIS f) The historical occurrence of impinged fish for the past five years g) Ifapplicable a demonstration that the facilitys intake rate is commensurate with a closed-cycle recirculation system h) Other components to reduce impingement andor entrainment ofaquatic l ife
3 Provide the following information for each CWIS to support your attached facility-specific BTA description a) The design capacity of the ofthe CWIS AfJJ MGD b) Maximum monthly average intake of the CWIS during the previous five years Vftg MGD C) The month in which this flow reported in 3b occurred -~IY~J41C1-------d) The maximum through-screen design intake velocity feetsecond (fps) NA
4 For facilities where the CWIS is located on a freshwater river or stream provide the following information a) The source waters annual mean flow in MGD as available from USGS or other appropriate source
YIi MGD 1A b) The design intake flow as a ofthe source waters annual mean flow ~
Attach calculations ifequal to or less than 5 ofannual mean flow c) The source waters 7Q10 11M MGD 1f d) The design intake flow as a per~ent ofthe source waters 7Q10 ~
5 Provide a map showing the location ofeach cooling water intake structure NCCW Outfall(s) and CWIS features reterred to in the BTA description Map attached D IV~ F Endangered Species Act Eligibility Information
Using the instructions in Appendix 2 of the NCCW GP which ofthe following criteria apply to your facility USFW~
Criteria A it B D C u
1 Ifyou selected USFWS criteria B has consultation with the US Fish and Wildlife Service been completed yesD noD
2 lfconsultation with US Fish amp Wildlife Service andor NOAA Fisheries Service was completed was a written concurrence finding that the discharge is not likely to adversely affect listed species or critical habitat received
yesD noU
3 Attach documentation ofESA eligibility for USFWS as required at Part 34 and Appendix 2 ofthe General Permit Documentation attached~
Page 4 of6
NCCW GP Appendix 5
4 P lease indicate ifyour facility directly intakes water for non-contact cooling from any of the following waterbodies 0 Merrimack River
Connecticut River 0 Piscataqua River 0 Taunton River
EPA will consult with the National Marine Fisheries Service on cooling water intakes covered under this penn it in areas (in the above waterbodies) of the endangered Shortnose Sturgeon and Atlantic Sturgeon
G National Historic Properties Act Eligibility
1 Are any historic properties listed or eligible for listing on the National Register ofHistoric Places located on the facility site or in proximity to the discharge yes[ no~
2 Have any State or Tribal Historic Preservation Officers been consulted in t his determination yesO nolB If yes attach the results of the consultation(s)
3 Wh~b of the three National Historic Preservation Act scenarios listed in Appendix 3 Section C have you met IEl 02 03
H Supplemental Infonnation
Please provide any supplemental information including antidegradation review information applicable to new middotOr increased discharges Attach any analytical data used to support the application Attach any certification(s) required by the General Permit
Page 5 of6
NCCW GP Appendix 5
I Signature Requirements
The NOI must be signed by the operator in accordance with the signatory requirements of40 CFR sect 12222 (see below) including the following certification
l certify under penalty of law that ( 1) no biocides or other chemical additives except for those used for pH adjustment andor dechlorination are used in the noncontact cooling water (NCCW) system (2) the discharge consists solely ofNCCW (to reduce temperature) and authorized pH adjustment andor dechlorination chemicals (3) the discharge does not come in contact with any raw materials intermediate product water product (other than heat) or finished product ( 4) if the discharge ofnon contact cooling water subseq uently mixes with other wastewater (ie stormwater) prior to discharging to the receiving water any monitoring provided under this permit wi ll be only for noncontact cooling water (5) where applicable the facility has complied with the requirements ofthis permit specific to the Endangered Species Act and National Historic Preservation Act and (6) this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted
Based on my inquiry of the person o r persons who manage the system or those persons directly responsible for gathering the information I certify that the information submitted is to the best of my knowledge and belief true accurate and complete I certify that I am aware that there are signiftcam
penalties fi submitting false information including the possibility offine and imprisonment for knowinpound
Date ILJtjdaJJ-
Federal regulations require this application to be signed as follows L For a corporation by a principal executive officer ofat least the level ofvice president 2 For a partnership or sole proprietorship by a genera l partner or the proprietor respectively or 3 For a municipality State Federal or other public facility by either a principal executive officer or ranking elected
official
Page 6 of6
NCCW GP Appendix 5
6 Is the source ofthe NCCW potable water yesD nof5l Ifyes EPA will caJculate a Total Residual Chlorine effluent limit for your facility
7 Provide the reported or calculated seven day-ten year low flow (7Q10) ofthe receiving water _ ___ MGD Attach any calculation sheets used to support stream flow andor di lution calc ulations
8 For facilities that discharge to Massachusetts surface waters a) Submit the completed engineering calculation of the surface water temperature rise as shown in Attachment B of
the GeneraJ Permit Calculation attached D
b) Does the d ischarge occur in an Area ofCritical Environmental Concern (ACEC) yesD no(i
Ifyes provide the name ofACEC - --- --- ----------- --- - shyNote See Part 34 and Appendix 1 of the General Permit for more information on ACEC
C C hemical Additives
1 Are any non-toxic neutralization andor dechlorination chemicals used in the discharge(s) yesD noM
2 Ifyes attach a listing ofeach chemical used Include the chemical name and manufacturer maximum and average daily quantity used on a monthly basis as well as the maximum and average daily expected concentrations (mg1) in the discharge and the vendors reported aquatic toxicity (NOAEL andor LC50 in percent for typically acceptable aquatic organism)
3 Was the listing submitted with the facilitys 2008 NCCWGP NOI yesD no~
D NCCW Source Water Information
I State the source ~CW (eg municipal water supply private well surface water w ithdrawal etc) Source ~ Name of Source Water JogtToJ H-MV3Ct2
2 Is the source water registeredpermitted under MA Water Management Act or NHDES User Registration Rule (ENV WQ 2202) yesD no~ Ifyes registration number ________
3 Ifthe source water is groundwater (non-municipal we ll water) see Appendix 9 ofthe General Permit and submit etlluent (and receiving water hardness) test results as required in Part 54 of the General Permit
Test results attached D
4 Does the facility use both a primary and backup source ofNCCW yesO nogIfyes attach information that identifies and explains the primary and backup sources ofNCCW and how often the backup supply was used in the oast three years
E Best Technology Available for Cooling Water Intake Structures (CWISs)
If the faci lity s discharge is covered by this General Permit and the faci lity wi thdraws non-contact cooling water from a surface water you are subject to the BTA requirements at Part 42 ofthe General Pennit
l Are you s ubject to the BTA requirements ofthe General Permit yes( no D a) Ifno explain and skip to F b) Ifyes was the facility-specific BTA description submitted with the facilitys 2008 NCCW GP NOI
yes~ noD c) Ifyes does that description accurately describe the facility current operations and practices yesY noD
Page 3 of6
US Fish and Wildlife Service
Trust Resources List
This resource list Is to be used for planning purposes only - it is not an official species list
Endangered Species Act species list information for your project is available online and listed below for the foUowing FWS Field Offices
New England Ecological Services Field Office 70 COMMERCIAL STREET SUITE 300 CONCORD NH 3301 (603 223-2541 htmwwwfwsgovnewenglaod
Project Name 36 first avenue
S fCTj0tV F
QLlpoundSl1cw 3shy012312015 Information Planning and Conservation System (IPAC) Page I of7
Version 14
NCCW GP Appendix 5
2 lfthe facility is subject to the General Permits BTA requirements and is requesting coverage under the NCCWGP for the first time or ifyou answered No to question Elc above attach the facility-specific BTA description as required in art 42 of the General Pennit For additional information and guidance see Section N of the Fact Sheet
Include in your description a) Measures to meet the General Pennit Part 43a general BTA requirements includinll documentation that describes
the facilitys monitoring program for impinged fish andor invertebrate or the required alternative monitoring plan frequency andor protocol
b) A characterization of the source water bodys aquatic life habitat in the vicinity ofeach CWIS during the seasons when the CWIS may be in use
c) The attributes ofthe current CWIS d) The design measures of the CWIS e) The operation measures of the CWIS f) The historical occurrence of impinged fish for the past five years g) Ifapplicable a demonstration that the facilitys intake rate is commensurate with a closed-cycle recirculation system h) Other components to reduce impingement andor entrainment ofaquatic l ife
3 Provide the following information for each CWIS to support your attached facility-specific BTA description a) The design capacity of the ofthe CWIS AfJJ MGD b) Maximum monthly average intake of the CWIS during the previous five years Vftg MGD C) The month in which this flow reported in 3b occurred -~IY~J41C1-------d) The maximum through-screen design intake velocity feetsecond (fps) NA
4 For facilities where the CWIS is located on a freshwater river or stream provide the following information a) The source waters annual mean flow in MGD as available from USGS or other appropriate source
YIi MGD 1A b) The design intake flow as a ofthe source waters annual mean flow ~
Attach calculations ifequal to or less than 5 ofannual mean flow c) The source waters 7Q10 11M MGD 1f d) The design intake flow as a per~ent ofthe source waters 7Q10 ~
5 Provide a map showing the location ofeach cooling water intake structure NCCW Outfall(s) and CWIS features reterred to in the BTA description Map attached D IV~ F Endangered Species Act Eligibility Information
Using the instructions in Appendix 2 of the NCCW GP which ofthe following criteria apply to your facility USFW~
Criteria A it B D C u
1 Ifyou selected USFWS criteria B has consultation with the US Fish and Wildlife Service been completed yesD noD
2 lfconsultation with US Fish amp Wildlife Service andor NOAA Fisheries Service was completed was a written concurrence finding that the discharge is not likely to adversely affect listed species or critical habitat received
yesD noU
3 Attach documentation ofESA eligibility for USFWS as required at Part 34 and Appendix 2 ofthe General Permit Documentation attached~
Page 4 of6
NCCW GP Appendix 5
4 P lease indicate ifyour facility directly intakes water for non-contact cooling from any of the following waterbodies 0 Merrimack River
Connecticut River 0 Piscataqua River 0 Taunton River
EPA will consult with the National Marine Fisheries Service on cooling water intakes covered under this penn it in areas (in the above waterbodies) of the endangered Shortnose Sturgeon and Atlantic Sturgeon
G National Historic Properties Act Eligibility
1 Are any historic properties listed or eligible for listing on the National Register ofHistoric Places located on the facility site or in proximity to the discharge yes[ no~
2 Have any State or Tribal Historic Preservation Officers been consulted in t his determination yesO nolB If yes attach the results of the consultation(s)
3 Wh~b of the three National Historic Preservation Act scenarios listed in Appendix 3 Section C have you met IEl 02 03
H Supplemental Infonnation
Please provide any supplemental information including antidegradation review information applicable to new middotOr increased discharges Attach any analytical data used to support the application Attach any certification(s) required by the General Permit
Page 5 of6
NCCW GP Appendix 5
I Signature Requirements
The NOI must be signed by the operator in accordance with the signatory requirements of40 CFR sect 12222 (see below) including the following certification
l certify under penalty of law that ( 1) no biocides or other chemical additives except for those used for pH adjustment andor dechlorination are used in the noncontact cooling water (NCCW) system (2) the discharge consists solely ofNCCW (to reduce temperature) and authorized pH adjustment andor dechlorination chemicals (3) the discharge does not come in contact with any raw materials intermediate product water product (other than heat) or finished product ( 4) if the discharge ofnon contact cooling water subseq uently mixes with other wastewater (ie stormwater) prior to discharging to the receiving water any monitoring provided under this permit wi ll be only for noncontact cooling water (5) where applicable the facility has complied with the requirements ofthis permit specific to the Endangered Species Act and National Historic Preservation Act and (6) this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted
Based on my inquiry of the person o r persons who manage the system or those persons directly responsible for gathering the information I certify that the information submitted is to the best of my knowledge and belief true accurate and complete I certify that I am aware that there are signiftcam
penalties fi submitting false information including the possibility offine and imprisonment for knowinpound
Date ILJtjdaJJ-
Federal regulations require this application to be signed as follows L For a corporation by a principal executive officer ofat least the level ofvice president 2 For a partnership or sole proprietorship by a genera l partner or the proprietor respectively or 3 For a municipality State Federal or other public facility by either a principal executive officer or ranking elected
official
Page 6 of6
US Fish and Wildlife Service
Trust Resources List
This resource list Is to be used for planning purposes only - it is not an official species list
Endangered Species Act species list information for your project is available online and listed below for the foUowing FWS Field Offices
New England Ecological Services Field Office 70 COMMERCIAL STREET SUITE 300 CONCORD NH 3301 (603 223-2541 htmwwwfwsgovnewenglaod
Project Name 36 first avenue
S fCTj0tV F
QLlpoundSl1cw 3shy012312015 Information Planning and Conservation System (IPAC) Page I of7
Version 14
NCCW GP Appendix 5
2 lfthe facility is subject to the General Permits BTA requirements and is requesting coverage under the NCCWGP for the first time or ifyou answered No to question Elc above attach the facility-specific BTA description as required in art 42 of the General Pennit For additional information and guidance see Section N of the Fact Sheet
Include in your description a) Measures to meet the General Pennit Part 43a general BTA requirements includinll documentation that describes
the facilitys monitoring program for impinged fish andor invertebrate or the required alternative monitoring plan frequency andor protocol
b) A characterization of the source water bodys aquatic life habitat in the vicinity ofeach CWIS during the seasons when the CWIS may be in use
c) The attributes ofthe current CWIS d) The design measures of the CWIS e) The operation measures of the CWIS f) The historical occurrence of impinged fish for the past five years g) Ifapplicable a demonstration that the facilitys intake rate is commensurate with a closed-cycle recirculation system h) Other components to reduce impingement andor entrainment ofaquatic l ife
3 Provide the following information for each CWIS to support your attached facility-specific BTA description a) The design capacity of the ofthe CWIS AfJJ MGD b) Maximum monthly average intake of the CWIS during the previous five years Vftg MGD C) The month in which this flow reported in 3b occurred -~IY~J41C1-------d) The maximum through-screen design intake velocity feetsecond (fps) NA
4 For facilities where the CWIS is located on a freshwater river or stream provide the following information a) The source waters annual mean flow in MGD as available from USGS or other appropriate source
YIi MGD 1A b) The design intake flow as a ofthe source waters annual mean flow ~
Attach calculations ifequal to or less than 5 ofannual mean flow c) The source waters 7Q10 11M MGD 1f d) The design intake flow as a per~ent ofthe source waters 7Q10 ~
5 Provide a map showing the location ofeach cooling water intake structure NCCW Outfall(s) and CWIS features reterred to in the BTA description Map attached D IV~ F Endangered Species Act Eligibility Information
Using the instructions in Appendix 2 of the NCCW GP which ofthe following criteria apply to your facility USFW~
Criteria A it B D C u
1 Ifyou selected USFWS criteria B has consultation with the US Fish and Wildlife Service been completed yesD noD
2 lfconsultation with US Fish amp Wildlife Service andor NOAA Fisheries Service was completed was a written concurrence finding that the discharge is not likely to adversely affect listed species or critical habitat received
yesD noU
3 Attach documentation ofESA eligibility for USFWS as required at Part 34 and Appendix 2 ofthe General Permit Documentation attached~
Page 4 of6
NCCW GP Appendix 5
4 P lease indicate ifyour facility directly intakes water for non-contact cooling from any of the following waterbodies 0 Merrimack River
Connecticut River 0 Piscataqua River 0 Taunton River
EPA will consult with the National Marine Fisheries Service on cooling water intakes covered under this penn it in areas (in the above waterbodies) of the endangered Shortnose Sturgeon and Atlantic Sturgeon
G National Historic Properties Act Eligibility
1 Are any historic properties listed or eligible for listing on the National Register ofHistoric Places located on the facility site or in proximity to the discharge yes[ no~
2 Have any State or Tribal Historic Preservation Officers been consulted in t his determination yesO nolB If yes attach the results of the consultation(s)
3 Wh~b of the three National Historic Preservation Act scenarios listed in Appendix 3 Section C have you met IEl 02 03
H Supplemental Infonnation
Please provide any supplemental information including antidegradation review information applicable to new middotOr increased discharges Attach any analytical data used to support the application Attach any certification(s) required by the General Permit
Page 5 of6
NCCW GP Appendix 5
I Signature Requirements
The NOI must be signed by the operator in accordance with the signatory requirements of40 CFR sect 12222 (see below) including the following certification
l certify under penalty of law that ( 1) no biocides or other chemical additives except for those used for pH adjustment andor dechlorination are used in the noncontact cooling water (NCCW) system (2) the discharge consists solely ofNCCW (to reduce temperature) and authorized pH adjustment andor dechlorination chemicals (3) the discharge does not come in contact with any raw materials intermediate product water product (other than heat) or finished product ( 4) if the discharge ofnon contact cooling water subseq uently mixes with other wastewater (ie stormwater) prior to discharging to the receiving water any monitoring provided under this permit wi ll be only for noncontact cooling water (5) where applicable the facility has complied with the requirements ofthis permit specific to the Endangered Species Act and National Historic Preservation Act and (6) this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted
Based on my inquiry of the person o r persons who manage the system or those persons directly responsible for gathering the information I certify that the information submitted is to the best of my knowledge and belief true accurate and complete I certify that I am aware that there are signiftcam
penalties fi submitting false information including the possibility offine and imprisonment for knowinpound
Date ILJtjdaJJ-
Federal regulations require this application to be signed as follows L For a corporation by a principal executive officer ofat least the level ofvice president 2 For a partnership or sole proprietorship by a genera l partner or the proprietor respectively or 3 For a municipality State Federal or other public facility by either a principal executive officer or ranking elected
official
Page 6 of6
NCCW GP Appendix 5
2 lfthe facility is subject to the General Permits BTA requirements and is requesting coverage under the NCCWGP for the first time or ifyou answered No to question Elc above attach the facility-specific BTA description as required in art 42 of the General Pennit For additional information and guidance see Section N of the Fact Sheet
Include in your description a) Measures to meet the General Pennit Part 43a general BTA requirements includinll documentation that describes
the facilitys monitoring program for impinged fish andor invertebrate or the required alternative monitoring plan frequency andor protocol
b) A characterization of the source water bodys aquatic life habitat in the vicinity ofeach CWIS during the seasons when the CWIS may be in use
c) The attributes ofthe current CWIS d) The design measures of the CWIS e) The operation measures of the CWIS f) The historical occurrence of impinged fish for the past five years g) Ifapplicable a demonstration that the facilitys intake rate is commensurate with a closed-cycle recirculation system h) Other components to reduce impingement andor entrainment ofaquatic l ife
3 Provide the following information for each CWIS to support your attached facility-specific BTA description a) The design capacity of the ofthe CWIS AfJJ MGD b) Maximum monthly average intake of the CWIS during the previous five years Vftg MGD C) The month in which this flow reported in 3b occurred -~IY~J41C1-------d) The maximum through-screen design intake velocity feetsecond (fps) NA
4 For facilities where the CWIS is located on a freshwater river or stream provide the following information a) The source waters annual mean flow in MGD as available from USGS or other appropriate source
YIi MGD 1A b) The design intake flow as a ofthe source waters annual mean flow ~
Attach calculations ifequal to or less than 5 ofannual mean flow c) The source waters 7Q10 11M MGD 1f d) The design intake flow as a per~ent ofthe source waters 7Q10 ~
5 Provide a map showing the location ofeach cooling water intake structure NCCW Outfall(s) and CWIS features reterred to in the BTA description Map attached D IV~ F Endangered Species Act Eligibility Information
Using the instructions in Appendix 2 of the NCCW GP which ofthe following criteria apply to your facility USFW~
Criteria A it B D C u
1 Ifyou selected USFWS criteria B has consultation with the US Fish and Wildlife Service been completed yesD noD
2 lfconsultation with US Fish amp Wildlife Service andor NOAA Fisheries Service was completed was a written concurrence finding that the discharge is not likely to adversely affect listed species or critical habitat received
yesD noU
3 Attach documentation ofESA eligibility for USFWS as required at Part 34 and Appendix 2 ofthe General Permit Documentation attached~
Page 4 of6
NCCW GP Appendix 5
4 P lease indicate ifyour facility directly intakes water for non-contact cooling from any of the following waterbodies 0 Merrimack River
Connecticut River 0 Piscataqua River 0 Taunton River
EPA will consult with the National Marine Fisheries Service on cooling water intakes covered under this penn it in areas (in the above waterbodies) of the endangered Shortnose Sturgeon and Atlantic Sturgeon
G National Historic Properties Act Eligibility
1 Are any historic properties listed or eligible for listing on the National Register ofHistoric Places located on the facility site or in proximity to the discharge yes[ no~
2 Have any State or Tribal Historic Preservation Officers been consulted in t his determination yesO nolB If yes attach the results of the consultation(s)
3 Wh~b of the three National Historic Preservation Act scenarios listed in Appendix 3 Section C have you met IEl 02 03
H Supplemental Infonnation
Please provide any supplemental information including antidegradation review information applicable to new middotOr increased discharges Attach any analytical data used to support the application Attach any certification(s) required by the General Permit
Page 5 of6
NCCW GP Appendix 5
I Signature Requirements
The NOI must be signed by the operator in accordance with the signatory requirements of40 CFR sect 12222 (see below) including the following certification
l certify under penalty of law that ( 1) no biocides or other chemical additives except for those used for pH adjustment andor dechlorination are used in the noncontact cooling water (NCCW) system (2) the discharge consists solely ofNCCW (to reduce temperature) and authorized pH adjustment andor dechlorination chemicals (3) the discharge does not come in contact with any raw materials intermediate product water product (other than heat) or finished product ( 4) if the discharge ofnon contact cooling water subseq uently mixes with other wastewater (ie stormwater) prior to discharging to the receiving water any monitoring provided under this permit wi ll be only for noncontact cooling water (5) where applicable the facility has complied with the requirements ofthis permit specific to the Endangered Species Act and National Historic Preservation Act and (6) this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted
Based on my inquiry of the person o r persons who manage the system or those persons directly responsible for gathering the information I certify that the information submitted is to the best of my knowledge and belief true accurate and complete I certify that I am aware that there are signiftcam
penalties fi submitting false information including the possibility offine and imprisonment for knowinpound
Date ILJtjdaJJ-
Federal regulations require this application to be signed as follows L For a corporation by a principal executive officer ofat least the level ofvice president 2 For a partnership or sole proprietorship by a genera l partner or the proprietor respectively or 3 For a municipality State Federal or other public facility by either a principal executive officer or ranking elected
official
Page 6 of6
NCCW GP Appendix 5
4 P lease indicate ifyour facility directly intakes water for non-contact cooling from any of the following waterbodies 0 Merrimack River
Connecticut River 0 Piscataqua River 0 Taunton River
EPA will consult with the National Marine Fisheries Service on cooling water intakes covered under this penn it in areas (in the above waterbodies) of the endangered Shortnose Sturgeon and Atlantic Sturgeon
G National Historic Properties Act Eligibility
1 Are any historic properties listed or eligible for listing on the National Register ofHistoric Places located on the facility site or in proximity to the discharge yes[ no~
2 Have any State or Tribal Historic Preservation Officers been consulted in t his determination yesO nolB If yes attach the results of the consultation(s)
3 Wh~b of the three National Historic Preservation Act scenarios listed in Appendix 3 Section C have you met IEl 02 03
H Supplemental Infonnation
Please provide any supplemental information including antidegradation review information applicable to new middotOr increased discharges Attach any analytical data used to support the application Attach any certification(s) required by the General Permit
Page 5 of6
NCCW GP Appendix 5
I Signature Requirements
The NOI must be signed by the operator in accordance with the signatory requirements of40 CFR sect 12222 (see below) including the following certification
l certify under penalty of law that ( 1) no biocides or other chemical additives except for those used for pH adjustment andor dechlorination are used in the noncontact cooling water (NCCW) system (2) the discharge consists solely ofNCCW (to reduce temperature) and authorized pH adjustment andor dechlorination chemicals (3) the discharge does not come in contact with any raw materials intermediate product water product (other than heat) or finished product ( 4) if the discharge ofnon contact cooling water subseq uently mixes with other wastewater (ie stormwater) prior to discharging to the receiving water any monitoring provided under this permit wi ll be only for noncontact cooling water (5) where applicable the facility has complied with the requirements ofthis permit specific to the Endangered Species Act and National Historic Preservation Act and (6) this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted
Based on my inquiry of the person o r persons who manage the system or those persons directly responsible for gathering the information I certify that the information submitted is to the best of my knowledge and belief true accurate and complete I certify that I am aware that there are signiftcam
penalties fi submitting false information including the possibility offine and imprisonment for knowinpound
Date ILJtjdaJJ-
Federal regulations require this application to be signed as follows L For a corporation by a principal executive officer ofat least the level ofvice president 2 For a partnership or sole proprietorship by a genera l partner or the proprietor respectively or 3 For a municipality State Federal or other public facility by either a principal executive officer or ranking elected
official
Page 6 of6
NCCW GP Appendix 5
I Signature Requirements
The NOI must be signed by the operator in accordance with the signatory requirements of40 CFR sect 12222 (see below) including the following certification
l certify under penalty of law that ( 1) no biocides or other chemical additives except for those used for pH adjustment andor dechlorination are used in the noncontact cooling water (NCCW) system (2) the discharge consists solely ofNCCW (to reduce temperature) and authorized pH adjustment andor dechlorination chemicals (3) the discharge does not come in contact with any raw materials intermediate product water product (other than heat) or finished product ( 4) if the discharge ofnon contact cooling water subseq uently mixes with other wastewater (ie stormwater) prior to discharging to the receiving water any monitoring provided under this permit wi ll be only for noncontact cooling water (5) where applicable the facility has complied with the requirements ofthis permit specific to the Endangered Species Act and National Historic Preservation Act and (6) this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted
Based on my inquiry of the person o r persons who manage the system or those persons directly responsible for gathering the information I certify that the information submitted is to the best of my knowledge and belief true accurate and complete I certify that I am aware that there are signiftcam
penalties fi submitting false information including the possibility offine and imprisonment for knowinpound
Date ILJtjdaJJ-
Federal regulations require this application to be signed as follows L For a corporation by a principal executive officer ofat least the level ofvice president 2 For a partnership or sole proprietorship by a genera l partner or the proprietor respectively or 3 For a municipality State Federal or other public facility by either a principal executive officer or ranking elected
official
Page 6 of6