DS14 Halifax Water Pollution Prevention Abbreviated Discharger Information Report - Form 1 You must have JavaScript enabled to use this form. Required fields are marked with an asterisk (*) The completion of this form, and providing satisfactory responses to any concerns resulting from this submission, satisfies Section 73.(1) of Halifax Water Regulations to allow Discharge from an ICI premises in Halifax Water’s Wastewater and Stormwater Systems. Halifax Water requires you to file an updated copy of this form if you make any changes that will affect the quality of your Wastewater under Section 73.(2). Location Information Permit/Application Number This field is required. Business Name This field is required. Business Address Information Please provide information specific to the property that the information below applies to. Unit / Suite Street Name and Type This field is required. City This field is required. Province This field is required. - Select -British ColumbiaAlbertaManitobaSaskatchewanOntarioQuebecNew BrunswickNewfoundland and LabradorNova ScotiaPrince Edward IslandNorthwest TerritoriesNunavutYukon Postal Code This field is required. Telephone This field is required. Name This field is required. Is the mailing address the same as the business address? Yes No Please enter your mailing address Unit / Suite Street Name and Type City Province - Select -British ColumbiaAlbertaYukonSaskatchewanNorthwest TerritoriesManitobaNunavutOntarioQuebecNew BrunswickNova ScotiaPrince Edward IslandNewfoundland and Labrador Postal Code Business Activities Please provide a brief description of the business or intended use of the property: This field is required. Excluding Domestic Waste (washroom, residential waste) are there additional sources of Wastewater? This field is required. - Select -YesNo If yes, please describe below: Do you prepare or serve food on site? This field is required. - Select -YesNo Does the property have a Grease Interceptor (grease trap, etc.)? This field is required. - Select -YesNo If your property does have a Grease Interceptor, please send the specification sheet and model number information in an email to p2@halifaxwater.ca. Be sure to reference the submission ID number in the subject line of your email. (You will receive your submission ID for this business in an email following the submission of this form.) Is the Grease Interceptor (grease trap, etc.) CSA certified? - Select -YesNo Halifax Water requires that all grease interceptors be CSA certified. Do you have an area where vehicles are serviced, repaired, or maintained? This field is required. - Select -YesNo Does the property have an Oil Interceptor (oil/water separator, etc.)? This field is required. - Select -YesNo If your property does have an Oil Interceptor, please send the specification sheet and model number information in an email to p2@halifaxwater.ca. Be sure to reference the submission ID number in the subject line of your email. (You will receive your submission ID for this business in an email following the submission of this form.) Do you have an area where sediment may enter the Wastewater System (indoor parking area, wash bay, etc.)? This field is required. - Select -YesNo Does the property have a Wastewater Sediment Interceptor (Sediment pit, etc.)? This field is required. - Select -YesNo If your property does have an Wastewater Sediment Interceptor, please send the specification sheet and model number information in an email to p2@halifaxwater.ca. Be sure to reference the submission ID number in the subject line of your email. (You will receive your submission ID for this business in an email following the submission of this form.) Do you have an area where sediment or contamination may enter the Stormwater System (outdoor parking area, fuel station, etc.)? This field is required. - Select -YesNo Does the property have a Stormwater treatment unit (Stormceptor, CDS unit, etc.)? This field is required. - Select -YesNo If your property does have an Stormwater treatment unit, please send the specification sheet and model number information in an email to p2@halifaxwater.ca. Be sure to reference the submission ID number in the subject line of your email. (You will receive your submission ID for this business in an email following the submission of this form.) Do you manufacture anything on site? This field is required. - Select -YesNo If yes, please describe below: Do you have any other pretreatment on site? This field is required. - Select -YesNo If yes, please indicate type(s) of pretreatment below: Filtration Flow Equalization Biological Treatment pH Adjustment Silver Recovery Unit Plaster Trap Holding Tank Sludge Pit Other Treatment If another treatment method is used, please describe below: Please send maintenance records and waste disposal records for all applicable pretreatment systems/methods listed above in an email to p2@halifaxwater.ca. Be sure to reference the submission ID number in the subject line of your email. (You will receive your submission ID for this business in an email following the submission of this form.) Do you store any bulk cleaners or chemicals on site? This field is required. - Select -YesNo List all stored bulk cleaners and chemicals on site: Are there floor drains in the area the chemicals are stored? This field is required. - Select -YesNo Do you have any environmental, water reduction, or Best Management Practices in place? This field is required. - Select -YesNo If yes, please list what you have: Please upload the following information/documents (if applicable). If you are unable to upload document please include them in an email to p2@halifaxwater.ca. Internal proposed mechanical/plumbing drawings Specification Sheets for all Interceptors Fixture sizes in any kitchens Number of hose bibs and flow rates in the vicinity of any Oil Interceptors A copy of your spill prevention plan Be sure to reference the submission ID number in the subject line of your email. (You will receive your submission ID for this business in an email following the submission of this form.) Document Upload Maximum 7 files.5 MB limit.Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods. Please be prepared to provide the following documentation on request: Existing data on monitoring, flow metering, or sampling of any Wastewater Discharges Record drawing of property showing buildings, Pretreatment Facility or Interceptors, property boundaries, effluent lines, and connections to Wastewater, Combined, and/or Stormwater Systems Locations of existing Wastewater and/or Stormwater Monitoring Access Points A copy of your SDS Binder Flow diagrams of site flows/processes Pump run times and size of pumps (include any relevant operational data) Contact Information Name This field is required. Title This field is required. Email This field is required. Telephone Number This field is required. I verify that all information provided is accurate and complete. Yes This field is required. CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Leave this field blank
