Clean Water Act (CWA)
The Clean Water Act (CWA) is intended to protect the quality of the nation's surface water resources, including both physical and biological aspects. It gives EPA the authority to regulate the discharge of pollutants.
This section discusses three topics covered by CWA regulations that are of particular relevance for healthcare facilities:
A typical healthcare facility has a wide variety of wastewater sources, such as:
- lavatories, sinks, and showers
- laboratories
- photo processing labs
- washing machines and dish washers
- boilers
- maintenance shops
The facility will fall under one of two sets of regulations, depending on where the water goes next. Facilities that discharge their wastewater to a municipal sewer system are referred to as indirect dischargers, while those that discharge directly to streams or rivers are considered direct dischargers.
Indirect dischargers
The vast majority of healthcare facilities are indirect discharges. Such facilities are subject to regulations by their local sewer authority, which are in turn regulated by the CWA (Title 40 CFR Part 403--General Pretreatment Regulations). Typically, indirect discharges must obtain a permit (called an industrial user permit), and are required to comply with the specific rules stated in the permit. CWA regulations expressly prohibit any indirect discharger from releasing any of the following into the sewer:
- fire or explosion hazards
- corrosive discharges (pH < 5.0)
- solid or viscous pollutants; heat (in amounts that cause the treatment plant influent to exceed 104oF)
- pollutants that cause toxic gases, fumes, or vapors
- any other pollutant (including oil and grease from a cafeteria) that will interfere with or pass through the municipal treatment plant
Beyond that, the local sewer authority will establish rules and limits for the facility that take into account local conditions, and the requirements of the authority's own permit.
Some hospitals, primarily larger ones located in smaller communities, may be designated by their sewer authority as a significant industrial user. This designation is usually associated with manufacturing facilities (40 CFR 403.3), but a sewer authority can apply the designation if a facility) has a "reasonable potential for adversely affecting” the operation of the sewage treatment plant. A hospital designated as a significant industrial user must sample and analyze their wastewater and submit reports to the sewer authority twice a year (40 CFR 403.12).
In addition to the specific rules discussed above, the CWA provides municipalities with regulatory flexibility so that they can meet their specific needs. Many municipalities have chosen to establish local rules that apply specifically to medical waste discharges. Examples range from blanket prohibitions on "all medical waste" to more specific prohibitions regarding items such as recognizable body parts or radioactive compounds.
Direct dischargers
For hospitals that are direct dischargers, EPA has established national discharge standards, which are numerical limitations for certain specific pollutants. These standards are much more difficult to meet than the limitations for indirect dischargers, which is understandable, given that the wastewater from direct discharge hospitals flows directly into a stream or river, without having been treated or monitored by a municipal system. To meet the direct discharge limitations, a hospital would have to obtain a permit from their state environmental agency or EPA (depending on the status of the state agency) and install a complex wastewater treatment plant. According to the EPA Office of Water, about 34 hospitals in the U.S. have elected to be direct dischargers.
Healthcare facilities generate stormwater from building and parking lot areas or from aboveground or underground oil or fuel storage tank areas. Hospitals with construction activities of one acre or larger need stormwater permits. Refer to CICA Center for stormwater permit information related to construction activities.
Public healthcare facilities in urban areas may discharge to municipal separate storm sewer systems (MS4s) and must also comply with applicable stormwater regulations. The term MS4 does not solely refer to municipally owned storm sewer systems, but rather is a term with a much broader application that can include, in addition to local jurisdictions, state departments of transportation, universities, local sewer districts, hospitals, military bases, and prisons. A MS4 also is not always just a system of underground pipes - it can include roads with drainage systems, gutters, and ditches. Hospitals in urbanized areas should consult with their state NPDES authority to evaluate whether a permit authorization is required.
If a hospital uses or stores oil it may be subject to the Spill Prevention Control Countermeasure (SPCC) rule. Hospitals that have a total aboveground oil storage capacity exceeding 1,320 gallons or an underground storage capacity exceeding 42,000 gallons are subject to spill prevention control and countermeasure (SPCC) plan requirements (see guidance documents under More Resources). Healthcare facilities meeting these criteria must prepare and implement a SPCC plan to prevent any discharge of oil into navigable waters.
Aboveground or Underground Oil Storage Containers
EPA's Oil Program web site, provides information about EPA's program for preventing, preparing for, and responding to oil spills that occur in and around inland waters of the United States. If a hospital uses or stores oil it may be subject to the Spill Prevention Control and Countermeasure (SPCC) rule. Hospitals with an above ground oil storage capacity of greater than 1,320 gallons, or total completely buried oil storage capacity greater than 42,000 gallons must prepare and implement a SPCC plan to prevent any discharge of oil into or upon navigable waters of the United States or adjoining shorelines.
The Spill Prevention, Control, and Countermeasure (SPCC) rule was originally promulgated on December 11, 1973 and was revised on July 17, 2002. In December 2006, EPA issued an amendment to address a number of issues raised by its 2002 rule, including those pertaining to facilities with smaller oil storage capacities. On December 5, 2008, EPA amended the SPCC rule again to provide clarity, tailor requirements to particular industry sectors, and streamline certain requirements while maintaining protection of human health and the environment (73 FR 74236). On November 5, 2009, EPA promulgated revisions to the December 2008 amendments (11/5/2009 Revisions). An EPA fact sheet identifies the latest changes. This rule is effective January 14, 2010. On June 19, 2009, EPA published in the Federal Register a SPCC compliance date extension for all facilities until November 10, 2010. Facilities must amend or prepare, and implement SPCC Plans by the compliance date in accordance with revisions to the SPCC rule promulgated since 2002.
In the amendments, EPA streamlined and tailored the SPCC requirements for a subset of qualified facilities. The owner or operator of a qualified facility has the option to self-certify his SPCC Plan and comply with other streamlined requirements. This final rule designates a subset of qualified facilities (“Tier I qualified facilities”) as those that meet the current qualified facilities eligibility criteria and that have no oil storage containers with an individual aboveground storage capacity greater than 5,000 U.S. gallons. A Tier I qualified facility has the option to complete a self-certified SPCC Plan template instead of a full SPCC Plan. By completing the SPCC Plan template, an owner or operator of a Tier I qualified facility will certify that the facility complies with a set of streamlined SPCC rule requirements. All other qualified facilities are designated “Tier II qualified facilities.”
Who is subject to the SPCC rule?
The SPCC rule applies to owners or operators of non-transportation-related facilities that:
- Drill, produce, store, process, refine, transfer, distribute, use, or consume oil or oil products; and
- Could reasonably be expected to discharge oil to U.S. navigable waters or adjoining shorelines.
Facilities are subject to the rule if they meet at least one of the following capacity thresholds:
- Aboveground oil storage capacity greater than 1,320 U.S. gallons, [Containers with a storage capacity less than 55 U.S. gallons of oil.], or
- Completely buried oil storage capacity greater than 42,000 U.S. gallons.
CWA common areas for inspections
Typical records a state or EPA inspector may ask to review during a CWA inspection include:
- Industrial user (IU) permit for discharges to the local municipality (indirect discharge)
- Wastewater monitoring data or other forms of records required by the IU permit
- Spill Prevention, Control, and Countermeasure (SPCC) Plan
- Construction stormwater permits (Phase I or Phase II) for any construction activity greater than 1 acre
- Phase II stormwater permits under the NPDES program for public hospitals
- NPDES general permit for discharging directly to a water body (direct discharge)
More Resources
EPA's oil spill program web site.
Title 40 CFR Part 403--General Pretreatment Regulations For Existing And New Sources Of Pollution.
40 CFR 122.26 Stormwater Discharges
