Forms

Forms to be used in E-Permitting Portal for the National Pollution Discharge Elimination System (NPDES) Program 

 

(1)  CWB Individual NPDES Form – Application to request Individual NPDES Permit coverage (read the instructions, then click on the “Submit online form” button in the E-Permitting portal to begin the application process).

Forms to be completed and uploaded as specified in the CWB Individual NPDES Form:

(a) Form B – Discharges of storm water associated with industrial activities. NPDES permit coverage is required for discharges of storm water runoff associated with industrial activity(ies), as categorized in 40 CFR 122.26(b)(14)(i) through 122.26(b)(14)(ix) and 122.26(b)(14)(xi).

(b) Form C – Discharges of storm water associated with construction activities. NPDES permit coverage is required for activities that disturb one (1) acre or more of total land area. NPDES permit coverage is also required for activities that disturb less than one (1) acre of total land area that are part of a larger common plan of development or sale if the larger common plan will ultimately disturb one (1) acre or more of total land area [40 CFR 122.26(b)(15)].

(c) Form D – Discharges of treated effluent from leaking underground storage tank remedial activities. NPDES permit coverage is required for the release or discharge of treated ground water to State waters from the cleanup (or remedial action) of underground storage tanks that have leaked petroleum hydrocarbons.

(d) Form E – Discharges of once through cooling water less than (1) million gallons per day. NPDES permit coverage is required for discharges to State waters of once through cooling water with a total flow of less than one (1) million gallons per day.  “Once through cooling water” means water passed through the main cooling condensers one or two times for the purpose of removing waste heat.

(e) Form F – Discharges of hydrotesting waters. NPDES permit coverage is required for the release or discharge of hydrotesting waters to State waters. “Hydrotesting Waters” means water used to test the integrity of a tank or pipeline, pipeline disinfection, and/or pipeline flushing.

(f) Form G – Discharges of construction activity dewatering.  NPDES permit coverage is required for discharges to State waters of construction activity dewatering effluent. “Dewatering Effluent” is any type of water (e.g. ground water, storm water, stream water, ocean water, etc.) pumped from a construction area.

(g) Form H – Discharges of treated process wastewater associated with petroleum bulk stations and terminals. NPDES permit coverage is required for discharges to State waters of treated process wastewater effluent from petroleum bulk stations and terminals. Treated process wastewater effluent includes tank water draws, product displacement process wastewater, wash down and fire hydrant system test waters, service station tank draws, recovered groundwater, and contaminated storm water runoff from the product storage and handling areas.

(h) Form I -Discharges of treated process wastewater associated with well drilling activities. NPDES permit coverage is required for discharges to State waters of treated process wastewater associated with well drilling activities. Treated process wastewater includes well drilling slurries, lubricating fluids wastewaters, and well purge wastewaters.

(i) Form K – Discharges of storm water and certain non-storm water discharges from small Municipal Separate Storm Sewer Systems (MS4s). NPDES permit coverage is required for storm water and certain non-storm water discharges to State waters from small MS4s.

(j) Form L – Discharges of circulation water from decorative ponds or tanks. NPDES permit coverage is required for discharges to State waters of circulation water from decorative ponds or tanks containing fish or other aquatic species.

(k) Form M – Point source discharges from the application of pesticides. NPDES permit coverage is required for the application of pesticides to State waters.

(l) Form 2A – Pollutant discharges from a publically owned treatment works to a State water.

(m) Form 2B – Pollutant discharges from a concentrated animal feeding operation (CAFO) or aquaic animal production facility to a State water.

(n) Form 2C – Discharges of wastewater to a State water from an existing facility, other than described in Form 2A and 2B.

(o) Form 2D – Discharges of process wastewater to a State water from a new, proposed facility, other than described in Form 2A and 2B.  Process wastewater is water that comes into direct contact with or results from the production or use of raw materials, intermediate product, finished product, byproduct, waste product, or wastewater.

(p) Form 2E – Discharges of nonprocess wastewater which is not regulated by effluent limitation guidelines or new source performance standards. This form is intended primarily for use by dischargers (new or existing) of sanitary wastes and noncontact cooling water. It may not be used for discharges of storm water runoff or by educational, medical, or commercial chemical laboratories, or by publicly owned treatment works.

(q) Form 2S – Sewage sludge (biosolids) for new and existing treatment works treating domestic sewage.

(r) ZOM Form – Zone of Mixing (ZOM).


(2) CWB NOI Form – Notice of Intent (NOI) application to request coverage under NPDES General Permit (read instructions, then click on the “Submit online form” button in the E-Permitting portal to begin the application process).

       Forms to be completed and uploaded as specified in the CWB NOI Form:

  • Transmittal Requirements and Certification Statement for E-Permitting Noitce of Intent (NOI) Submissions (required for all submissions) Note: You must download  this form in the “Certify & Submit” step during your portal submission to continue to the next step in the e-permitting application.
  • Tax Map Key (TMK) Spreadsheet (required in Section 5 of CWB NOI Form)
  • Discharge Specific Attachments – To request coverage under NPDES General Permit in HAR 11-55, Appendices B through I, K, and L.  Select the form for the discharge/activity that you are requesting NPDES General Permit coverage (required in Section 9 of CWB NOI Form).  Note: only one (1) discharge/activity per CWB NOI Form is allowed.  If you have two (2) or more discharges/activities, then you would have to submit two (2) or more CWB NOI Forms, or you may combine multiple discharges/activities under one (1) Individual NPDES Permit application.

(a) NOI Form B – Discharges of storm water associated with industrial activities. NPDES permit coverage is required for discharges of storm water runoff associated with industrial activity(ies), as categorized in 40 CFR 122.26(b)(14)(i) through 122.26(b)(14)(ix) and 122.26(b)(14)(xi).

(b) NOI Form C – Discharges of storm water associated with construction activities. NPDES permit coverage is required for activities that disturb one (1) acre or more of total land area. NPDES permit coverage is also required for activities that disturb less than one (1) acre of total land area that are part of a larger common plan of development or sale if the larger common plan will ultimately disturb one (1) acre or more of total land area [40 CFR 122.26(b)(15)].  Land disturbance includes, but is not limited to clearing, grubbing, grading, excavation, demolition (even if leaving foundation), uprooting of vegetation, equipment staging on grassed areas or bare ground, equipment staging on a paved roadway (only if area blocked off from public usage), storage areas, and roadway work that touches the base course. Note: Areas which are cleared, graded, and/or excavated for the sole purpose of growing crops are considered to be agricultural and are therefore not included in the disturbed area quantity. This exemption does not extend to the construction of buildings and roads of agricultural or agriculture-related operations that disturb one (1) acre or more.

(c) NOI Form D – Discharges of treated effluent from leaking underground storage tank remedial activities. NPDES permit coverage is required for the release or discharge of treated ground water to State waters from the cleanup (or remedial action) of underground storage tanks that have leaked petroleum hydrocarbons.

(d) NOI Form E – Discharges of once through cooling water less than (1) million gallons per day. NPDES permit coverage is required for discharges to State waters of once through cooling water with a total flow of less than one (1) million gallons per day. “once through cooling water” means water passed through the main cooling condensers one or two times for the purpose of removing waste heat.

(e) NOI Form F – Discharges of hydrotesting waters. NPDES permit coverage is required for the release or discharge of hydrotesting waters to State waters. “Hydrotesting Waters” means water used to test the integrity of a tank or pipeline, pipeline disinfection, and/or pipeline flushing.

(f) NOI Form G – Discharges of construction activity dewatering. NPDES permit coverage is required for discharges to State waters of construction activity dewatering effluent. “Dewatering Effluent” is any type of water (e.g. ground water, storm water, stream water, ocean water, etc.) pumped from a construction area.

(g) NOI Form H – Discharges of treated process wastewater associated with petroleum bulk stations and terminals. NPDES permit coverage is required for discharges to State waters of treated process wastewater effluent from petroleum bulk stations and terminals. Treated process wastewater effluent includes tank water draws, product displacement process wastewater, wash down and fire hydrant system test waters, service station tank draws, recovered groundwater, and contaminated storm water runoff from the product storage and handling areas.

(h) NOI Form I – Discharges of treated process wastewater associated with well drilling activities. NPDES permit coverage is required for discharges to State waters of treated process wastewater associated with well drilling activities. Treated process wastewater includes well drilling slurries, lubricating fluids wastewaters, and well purge wastewaters.

(i) NOI Form K – Discharges of storm water and certain non-storm water discharges from small Municipal Separate Storm Sewer Systems (MS4s). NPDES permit coverage is required for storm water and certain non-storm water discharges to State waters from small MS4s.

(j) NOI Form L – Discharges of circulation water from decorative ponds or tanks. NPDES permit coverage is required for discharges to State waters of circulation water from decorative ponds or tanks containing fish or other aquatic species.


(3) CWB NOI Form M – Notice of Intent (NOI) application to request coverage under NPDES General Permit authorizing Point Source Discharges from the Application of Pesticides (read instructions, then click on the “Submit online form” button in the E-Permitting portal to begin the application process).

       Form to be completed and uploaded as specified in the CWB NOI Form M:


(4) CWB “No Exposure” Certification Form – Form to request a Conditional “No Exposure” Exclusion from NPDES storm water associated with industrial activity permitting (read instructions, then click on the “Submit online form” button in the E-Permitting portal to proceed with the application process).

Form to be completed and uploaded as specified in the CWB “No Exposure” Certification Form:

See Industrial Storm Water SIC Codes for a list of applicable industrial activities.  As reference, EPA Guidance Manual for Conditional Exclusion from Storm Water Permitting Based on “No Exposure” of Industrial Activities to Storm Water is provided for your information, however, please note that the CWB is delegated NPDES Permitting authority and the entire document is for reference only (Note: do not submit forms in this Guidance Manual).


(5) Forms Used to Report NPDES Individual and General Permit Compliance Data

CWB Compliance Submittal Form for Individual NPDES Permits and NGPCs – Form to submit all NPDES Permit and NGPC compliance information, including Discharge Monitoring Reports (DMRs) (read instructions, then click on “Submit online form” button in the E-Permitting portal to proceed with Compliance Submittal).  Please reference your issued NPDES Permit and/or NGPC for your required compliance submittals.

Forms to be completed and uploaded as specified in the CWB Compliance Submittal Form for Individual NPDES Permits and NGPCs:



Forms to be used in E-permitting portal for the Section 401 Water Quality Certification (WQC) Program.

(1) Section 401 WQC Form – Application to request a Section 401 WQC.

(2) Vessel General Permit (VGP) DOH Notification Form – Form for the Owner or Operator of a vessel seeking coverage under the 2013 VGP (read instructions, then click on the “Submit online form” button in the E-Permitting portal to begin the application process).

Form to be completed and uploaded as specified in the VGP DOH Notification Form:



Other Forms

(1) Form Used to Request Funding


(2) Request to Access a Government Record Form

The WPC Viewer provides public access to Clean Water Branch NPDES permit and Section 401 WQC information, including facility/project, inspection, and enforcement information. Please search the WPC Viewer.  If you cannot locate the desired documents, then print, complete, and either fax (808 586-4352) or email (CleanWaterBranch@doh.hawaii.gov) the Request to Access a Government Record form to the Clean Water Branch.  Other related forms include the Notice to Requester form and Acknowledgment to Requester form.  Please obtain the compliance reports from EPA’s Environmental Compliance History Online (ECHO).