HomeMy WebLinkAboutIowa Department of Natural Resources-1/23/2012IOWA DEPARTMENT OF NATURAL RESOURCES
ENVIRONMENTAL PROTECTION DIVISION
NOTICE OF INTENT FOR NPDES COVERAGE UNDER GENERAL PERMIT
No. 1 FOR "STORM WATER DISCHARGES ASSOCIATED WITH INDUSTRIAL
ACTIVITY"
or
No. 2 FOR "STORM WATER DISCHARGES ASSOCIATED WITH INDUSTRIAL
ACTIVITY FOR CONSTRUCTION ACTIVITIES"
or
No. 3 FOR "STORM WATER DISCHARGE ASSOCIATED WITH INDUSTRIAL
ACTIVITY FOR ASPHALT PLANTS, CONCRETE BATCH PLANTS, ROCK CRUSHING
PLANTS, AND CONSTRUCTION SAND AND GRAVEL FACILITIES."
PERMIT INFORMATION
Has this storm water discharge been previously permitted? 0 Yes El No
If yes, please list authorization number
Under what General Permit are you applying for coverage?
General Permit No. 1 0 General Permit No. 2 0 General Permit No. 3 ❑.
IDNR CASHIER'S USE ONLY
0253-542-SW08-0581
PERMIT FEE OPTIONS
For coverage under the NPDES General Permit the following fees apply:
❑ Annual Permit Fee $175 (per year) Maximum coverage is one year.
MI 3 -year Permit Fee $350 Maximum coverage is three years.
❑ 4 -year Permit Fee $525 Maximum coverage is four years.
❑ 5 -year Permit Fee $700 Maximum coverage is five years.
Checks should be made payable to: Iowa Department of Natural Resources.
FACILITY OR PROJECT INFORMATION
Enter the name and full address/location (not mailing address) of the facility or project for which permit coverage is requested
NAME:
STREET ADDRESS OF SITE:
WEST SHAULIS ROAD / ANSBOROUGH AVENUE
WEST SHAULIS ROAD FROM ANSBOROUGH AVENUE TO
HIGHWAY 21, AND ANSBOROUGH AVENUE FROM
SHAULIS ROAD TO HIGHWAY 20
CITY:
COUNTY:
STATE:
ZIP CODE:
Waterloo
Black Hawk
Iowa
50703
CONTACT INFORMATION Give name, mailing address and telephone number of a contact person (Attach additional
information on separate pages as needed). This will be the address to which all correspondence will be sent and to which all
questions regarding your application and compliance with the permit will be directed.
NAME:
Jeff Bales
ADDRESS:
715 Mulberry St.
CITY:
Waterloo
STATE:
Iowa
ZIP CODE:
50703
TELEPHONE
(319)291-4312
Check the appropriate box to indicate the legal status of the operator of the facility.
0 Federal 0 State 0 Public 0 Private 0 Other (specify)
SIC CODE (General Permit No. 1 & 3 Applicants Only)
SIC code refers to Standard Industrial Classification code number used to classify establishments by type of economic activity.
Be sure to complete both sides of this form.
542-1415 (Rev. 7/08)
FACILITY LOCATION OR LOCATION OF CONSTRUCTION SITE
Give the location b_ 1/4 section, section, township, range, (e.g., NW, 7, T78N, R3W).
1/4 SECTION
SECTION
TOWNSHIP
RANGE
SW, SE
9
T73N
R15W
SW
10
T73N
R15W
OWNER INFORMATION Enter the name and full address of the owner of the facility.
MAIL TO:
- STORM WATER COORDINATOR
IOWA DEPARTMENT OF
NATURAL RESOURCES
502 E. 9m STREET
DES MOINES, IA 50319-0034
NAME: City of Waterloo
ADDRESS: 715 Mulberry St.
CITY:
Waterloo
STATE:
Iowa
ZIP CODE:
50703
TELEPHONE:
(319)291-4312
OUTFALL INFORMATION
Discharge start date, i.e., when did/will the site begin operation or 10/1/92, whichever is later: 4/1/12
Is any storm water monitoring information available describing the concentration of pollutants in storm water discharges? 0 Yes D No
NOTE: Do not attach any storm water monitoring information with the application.
Receiving water(s) to the first uniquely named waterway in Iowa, (e.g., road ditch to unnamed tributary to Mud Creek to South Skunk
River): road ditch to unnamed tributary to Prescotts Creek to Sink Creek to Cedar River.
Compliance With The Following Conditions:
Has the Storm Water Pollution Prevention Plan been developed prior to the submittal of this Notice of Intent and
does the plan meet the requirements of the applicable General Permit? (do not submit the SWPPP with the
application)
Will the Storm Water Pollution Prevention Plan comply with approved State (Section 161A.64, Code of Iowa) or
local sediment and erosion plans? (for General Permit 2 only)
Have two public notices been published for at least one day, one each in the two newspapers with the largest
circulation in the area where the discharge is located, and are the proofs of notice attached? (new applications only)
Yes No
GENERAL PERMIT NO. 2 AND GENERAL PERMIT NO. 3 APPLICANTS COMPLETE THIS SECTION.
Description of Project (describe in one sentence what is being constructed):PCC Roadway and Bike Trail Construction/Reconstruction
For General Permit No. 3 - Is this facility to be moved this year?
❑ Yes ❑ No
Number of Acres of Disturbed Soil: 38.5
(Construction Activities Only)
Estimated Timetable For Activities / Projects, i.e., approximately when did/will the project begin and end: 04/01/12 - 12/31/12
CERTIFICATION — ALL APPLICATIONS MUST BE SIGNED
Only the following individuals may sign the certification: owner of site, principal executive officer of at least the level of vice-
president of the company owning the site, a general partner of the company owning the site, principal executive officer or ranking
elected official of the public entity owning the site, any of the above of the general contracting company for construction sites.
I certify under penalty of law that this document was prepared under my direction or supervision in accordance with a system
designed to assure that qualified people properly gathered and evaluated the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the information, this information is to
the best of my knowledge and belief, true, accurate, and complete. I further certify that the terms and conditions of the general
permit will be met. I am aware that there are significant penalties for submitting false information, including the possibility of fine
and imprisonment for knowing violations.
NAME: (print or type)/ rr (r
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111or
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,.,-/SIGNATURE:
DATE:
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instructions - To complete the public notice, fill in the blanks with the required information or select the
appropriate response and send to the newspapers.
The public notice must be published at least one day each in two newspapers at your own
expense.
PUBLIC NOTICE OF STORM WATER DISCHARGE
plans to submit a Notice of Intent to the
(applicant name)
Iowa Department of Natural Resources to be covered under the NPDES General Permit
(select the appropriate general permit - No. 1 "Storm Water Discharge Associated with Industrial Activity',
General Permit No. 2 "Storm Water Discharge Associated with Industrial Activity for Construction
Activities, or General Permit No. 3 "Storm Water Discharge Associated With Industrial Activity From
Asphalt Plants, Concrete Batch Plants, Rock Crushing Plants, And Construction Sand And Gravel
Facilities')
The storm water discharge will be from
located in
(description of industrial activity)
(1/4 section, section, township, range, county)
Storm water will be discharged from point source(s) and will be discharged to
(number)
the following streams:
(stream name(s))
Comments may be submitted to the Storm Water Discharge Coordinator, Iowa Department of
Natural Resources, Environmental Protection Division, 502 E. 9th Street, Des Moines, IA
50319-0034. The public may review the Notice of Intent from 8 a.m. to 4:30 p.m., Monday
through Friday, at the above address after it has been received by the department.
PUBLIC NOTICE OF STORM WATER DISCHARGE
The City of Waterloo, Iowa plans to submit a Notice of Intent to the Iowa Department of
Natural Resources to be covered under the NPDES General Permit No. 2 "Storm Water
Discharge Associated with Industrial Activity for Construction Activities."
The storm water discharge will be from the grading and construction/reconstruction of
West Shaulis Road from Ansborou .h Avenue to Highway 21 including recreational trail,
and Ansborough Avenue from West Shaulis Road to Highway 20 located in the SW 'A
and SE 'A of Section 9 the SW 'A of Section 17, T73N-R15W, Dallas County. Storm
water will be discharged from 6 point sources and will be discharged to the Cedar River
via Prescotts Creek and Sink Creek.
Comments may be submitted to the Storm Water Discharge Coordinator, Iowa
Department of Natural Resources, Environmental Protection Division, 502 E. 9th Street,
Des Moines, IA 50319-0034. The public may review the Notice of Intent from 8 a.m. to
4:30 p.m., Monday through Friday, at the above address after it has been received by the
department.
STATE OF IOWA,
Black Hawk County
I do solemnly swear that the annexed copy of
1374430
INSIDER- ANSBOROUGH AVE STORM WATER
notice was published in the WATERLOO/CEDAR FALLS
a daily newspaper printed in WATERLOO,
Black Hawk County, Iowa, for 1 issues
commencing on 01/31/2012, in the issues of
01/31/2012
of said newspaper, and that the annexed rate of
advertising is the regular legal rate of said
newspaper, and that the following is a correct
bill for publishing said notice.
Printer's Bill $14.26
Signed
Subscribed and sworn to before me this
,.. day of
Received of
the sum, of
C:Ofd"amissiC'; s` N°I . ate: G
(4 i4} 0 EXPTES
Dollars
in full for publication of the above invoice.
Notary Seal:
COURIER
PUBLIC NOTICE OF STORM WATER
DISCHARGE
The City of Waterloo, Iowa plans to
submit a Notice of. Intent to the Iowa
Department of Natural Resources to
be covered under the NPDES General
Permit No. 2 "Storm Water Discharge
,Associated with Industrial Activity for
Construction Activities.°
The storm water discharge willbe from
the grading and construction/recon-
struction of West Shaulis Road from
Ansborough Avenue to Highway 21
including recreational trail, and Ansbor-
ough Avenue from West Shaulis Road
to Highway 20 located in the SW 14 and
SE '4 of Section 9 the SW 14 of Section
17, T73N-RI5W, Dallas County. Storm
water will be discharged from 6 point
sources and will be discharged to the
Cedar River via Prescotts Creek and
Sink Creek.
Comments may be submitted to the
Storrn Water Discharge Coordinator,
Iowa Department of Natural Resources,
Environmental Protection Division, 502
E. 9t11 Street, Des Moines, IA 50319-
0034. The public may review the No-
tice of Intent from 9 a.m. to 4:30 p.m.,
Monday through Friday, at the above
address after it has been received by
the department.
STATE OF IOWA, }
Black Hawk County, SS
PUBLIC NOTICE OF
STORM WATER DISCHARGE
The City of Waterloo, Iowa plans to sub-
mit a Notice of Intent to the Iowa Depart-
ment of Natural Resources to be covered
under the NPDES General Permit No. 2
"Storm Water Discharge Associated with
Industrial Activity for Construction
Activities."
The storm water discharge will be from
thegradingandconstruc-
tion/reconstruction of West Shaulis Road
from Ansborough Avenue to Highway 21
including recreational trail, and Ansbor-
ough Avenue from West Shaulis Road to
Highway 20 located in the SW 'A andSE
''A of Section 9 the SW 'Ai of Section 17,
T73N-RISW, Dallas County. Storm wa-
ter will be discharged from 6 point sourc-
es and will be discharged to the Cedar
River via Prescotts Creek and Sink
Creek.
Comments may be submitted to the
Storm Water Discharge Coordinator,
Iowa Department of Natural Resources,
Environmental Protection Division, 502
E. 9th Street, Des Moines, IA 50319-
0034. The public may review the Notice
of Intent from 8 a.m. to 4:30 p.m., Mon-
day through Friday, at the above address
after it has been received by the
department.
I do solemnly swear that the annexed copy of legal
City of Waterloo
Storm Water Discharge
West Shaulis Road
Notice was published in the Courier, a daily
publication printed in Waterloo, Black Hawk County,
Iowa, 1 time commencing on the 2nd day of
February, 2012 in the name of said newspaper, and
that the annexed legal rate of advertised is the regular
rate of said newspaper, and that the following is a
correct bill for publishing said notice.
Printer's Bill $14. 6
Signed
Subscribed and sworn to before me this 7
Day of
A.D., 20 la
11 ji ii.ti'�'li-;S _ ; rn 3
V o a ti 9
is Citi EXPiE f S
Received of
Notary Public
the sum of
Dollars.
In full for publication of the above notice.