Batch Discharge Permit Application

Contact Information

* Name

* Phone

* Email

Discharge Information

* Describe the processes for generating wastewater

* List known or suspected contaminants in wastewater

* Volume to be discharged (in m3)

* Proposed maximum flow rate (in gpm)

* Proposed discharge date(s)

* Proposed discharge time(s)

* Describe proposed discharge point (including address)

* Discharge is to be made to a manhole: Private
Niagara Region
Municipal

Manhole proof of approval from the municipality

* Was the wastewater generated from municipality-metered drinking water? Yes
No

* Water account number

* Does this wastewater contain any other known contaminants not regulated under the Niagara Region Sewer Use By-law No. 27-2014? Yes
No

Description of contaminants

Lab Results

Laboratory analysis

Laboratory analysis must include but not limited to:

• Oil and grease (or TPH)
• Total suspended solids
• pH
• Chemical oxygen demand / biochemical oxygen demand
• TP and TKN

Contact Environmental Enforcement Officer for guidance prior to having the analysis performed.

Applicant represents that the submitted analytical results are representative of the wastewater to be discharged.

Environmental Compliance

Environmental compliance or certificate of approval

If you cannot provide proof of approval, provide reasoning for why the required documentation has not been enclosed with the application

Billing Information

Provide the information below as it appears on your credit card.

* Company

Industrial user number

* First Name

* Last Name

* Address

* City

* State or Province Provinces... Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Northwest Territories Nunavut Yukon States... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

* Postal / Zip Code
xxx xxx / xxxxx

* Country Select one... Canada United States

* Phone
xxx-xxx-xxxx

* Email
Receipts will be sent to this email

Mailing Information

Mailing information is the same as billing information

Terms and Conditions

* I, the undersigned hereby declare that, to the best of my knowledge, the information contained herein and the information submitted in support of this request is complete and accurate in every way for the purpose of obtaining approval under Section 13 of the Niagara Region Sewer Use By-law No. 27-2014 (as amended).

Personal Information and Privacy

Any personal information or personal health information submitted in writing will be collected, used and disclosed by members of Regional Council and Regional staff in accordance with the Municipal Freedom of Information and Protection of Privacy Act or the Personal Health Information Protection Act, where applicable.

Freedom of Information

Any information you share will be used only for the intended purpose for which it was provided. If you have any questions, email foi@niagararegion.ca or call 905-980-6000 ext. 3779.