APPLICATION WASTEWATER DISCHARGE PERMIT
Attachment 1
INDUSTRIAL SEWER CONNECTION APPLICATION |
Company Name ________________________________________________ |
Address ________________________________________________ |
Authorized Representative (print) ________________________________________________ |
Title ________________________________________________ |
Signature ________________________________________________ |
Telephone ________________________________________________ |
Date ________________________________________________ |
The above-named individual being the duly authorized representative of the above named Company does hereby request a permit to discharge industrial wastewater into the sanitary sewer system/wastewater treatment facility of the Borough of Grove City, Mercer County, Pennsylvania. The Company is engaged in |
_________________________________________________________________________________________ |
type of manufacturing |
________________________________________________________________________________________ |
at the above location. |
In support of this application, the following are attached hereto and made a part hereof: |
1. A plan to the property showing accurately all sewers and drains now existing is attached hereto as Exhibit “A”. |
2. Plans and specifications covering any work proposed to be performed under this permit is attached hereunto as Exhibit “B”. |
3. A complete schedule of all process waters and industrial wastes produced or expected to be produced at said property, including a description of the character of each waste, the daily volume and maximum rates of discharge, representative analyses, and compliance with any applicable Pretreatment Standard or Requirements, is attached hereunto as Exhibit “C”. |
4. The name and address of the person or firm who will perform the work covered by this permit is |
__________________________________________________________________________________ |
In consideration of the granting of this permit, the applicant agrees; |
1. To furnish any additional information relating to the installation or use of the industrial sewer for which this permit is sought as may be requested by the Borough of Grove City. |
2. To accept and abide by all provisions of Ord. 1226 of the Borough of Grove City, and of all other pertinent ordinances or regulations that may be adopted in the future. |
3. To operate and maintain any waste pretreatment facilities, as may he required as a condition of the acceptance into the wastewater treatment system of the industrial wastes involved, in an efficient manner at all times, and at no expense to the Borough of Grove City. |
4. To cooperate at all times with the Borough of Grove City and its representatives in their inspecting, sampling, and study of the industrial wastes, and any facilities provided for pretreatment. |
5. To notify the Borough of Grove City immediately in the event of any accident or other occurrence that occasions contribution to the wastewater treatment system of any wastewater or substances prohibited or not covered by this permit. |
Attachment 2
WASTEWATER DISCHARGE PERMIT |
Permit No. ________________________________________________ |
Company ________________________________________________ |
Address ________________________________________________ |
In accordance with all terms and conditions of the Borough of Grove City and any applicable provisions of State and/or Federal law or regulation, permission is hereby granted to the above-identified Company to discharge wastewater into the sanitary sewer system and wastewater treatment facility of the Borough of Grove City. |
This permit is granted in accordance with the application filed on ______________ 20_____ in the office of the Borough Manager and in conformity with plans, specifications, and other data submitted in support of the application, all of which are filed with and considered as a part of this permit, together with any and all attached named conditions and requirements. |
_______________________________________________________________________________ |
Borough Manager |
Effective this day of ______________ 20_____ |
To Expire _______ day of _________ 20_____ |
(1980 Code, Ch. 20, Appendix A)