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www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats wq-strm4-49e • 6/7/13 Page 1 of 3 Alum or Ferric Chloride Phosphorus Treatment System Form Attachment to 2013 MS4 SWPPP Application for Reauthorization for the NPDES/SDS Small MS4 General Permit MNR040000 Stormwater Pollution Prevention Program (SWPPP) Document Doc Type: Permit Application Instructions: Only complete this form if your Municipal Separate Storm Sewer System (MS4) uses an alum or ferric chloride phosphorus treatment system for stormwater. Refer to Part III.F. of National Pollutant Discharge Elimination System (NPDES)/State Disposal System (SDS) Small MS4 General Permit MNR040000 with an effective date of August 1, 2013, for alum or ferric chloride phosphorus treatment system requirements. In-lake phosphorus treatment activities are not authorized under this application attachment to the 2013 MS4 SWPPP Application for Reauthorization (SWPPP Document). Submittal: This form must be submitted electronically via e-mail to the Minnesota Pollution Control Agency (MPCA) at ms4permitprogram.pca@state.mn.us from the person that is duly authorized to certify this form. Submit this form along with the 2013 MS4 SWPPP Application for Reauthorization (SWPPP Document). Title your form appropriately, such as: MS4NameHere_TreatmentSystem.doc. Questions: Contact Claudia Hochstein at 651-757-2881 or claudia.hochstein@state.mn.us, Dan Miller at 651-757-2246 or daniel.miller@state.mn.us, or call toll-free at 800-657-3864. General Information 1. Provide the geographic coordinates of the alum or ferric chloride phosphorus treatment system, in decimal degrees. (Approximate centroid of treatment system within five-foot accuracy): Latitude: 45.03872 Longitude: -93.22336 2. Provide the name or the position title of the individual(s) who is responsible for the operation of the treatment system: Jay Hartman, Public Works Director 3. If the system is constructed at the time the 2013 MS4 SWPPP Application for Reauthorization (SWPPP Document) is submitted to the MPCA, provide the following information: a. Dates of operation: May through September b. Chemical(s) used for treatment: Alum c. Gallons of water treated: estimated to be: 19,872,000 gallons d. Gallons of alum or ferric chloride treatment used: estimated to be: 2,884 gallons e. Calculated pounds of phosphorus removed: estimated to be: 21 lbs f. Any performance issue(s) and the corrective action(s), including the date(s) when corrective action(s) was taken: This system will be constructed March of 2014 and be operational during the summer of 2014. Alum or Ferric Chloride Phosphorus Treatment System Permit Requirements Answer yes or no below to indicate if your alum or ferric chloride phosphorus treatment system meets the following requirements in the Permit (Part III.F.1.): 4. Minimum requirements of an Alum or Ferric Chloride Phosphorus Treatment System: a. Limitations 1) Is your treatment system only used for the treatment of phosphorus in stormwater (non- stormwater discharges shall not be treated by this system)? *If no, contact MPCA MS4 Permit Program staff for appropriate next steps. Yes No Attachment 2