HomeMy WebLinkAboutIowa Department of Natural Resources-2/21/2011IOWA 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 t] 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 0
IDNR CASHIER'S USE ONLY
0253-542-SW08-0581
PERMIT FEE OPTIONS
For coverage under the NPDES General Permit the following fees apply:
O Annual Permit Fee $175 (per year) Maximum coverage is one year.
❑ 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: Midport Boulevard Extension Phase III
STREET ADDRESS
1100' West of W
OF SITE: North Side of Airline Hwy. Approx.
er Rd. and Airline H . Intersection.
CITY: Waterloo
COUNTY: Black Hawk County
STATE: Iowa
ZIP CODE: 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 Street
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
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OWNER INFORMATION Enter the name and full address of the owner of the facility.
ADDRESS: City Hall, 715 Mulberry Street
MAIL TO:
STORM WATER COORDINATOR
IOWA DEPARTMENT OF
NATURAL RESOURCES
502 E. 9'B STREET
DES MOINES, IA 50319-0034
NAME: City of Waterloo, Iowa
CITY: Waterloo
STATE: Iowa
ZIP CODE: 50703
TELEPHONE:
( 319) 291- 4301
OUTFALL INFORMATION
Discharge start date, i.e., when did/will the site begin operation or 10/1/92, whichever is later: April 2011
Is any storm water monitoring information available describing the concentration of pollutants in storm water discharges? 0 Yes El 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): Storm Sewer Piping and roadway drainage ditches along Midport Boulevard to Airline Highway ditches to an unnamed drainageway
ultimately to the 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
X
X
X
GENERAL PERMIT NO. 2 AND GENERAL PERMIT NO. 3 APPLICANTS COMPLETE THIS SECTION.
Description of Project (describe in one sentence what is being constructed): Construction of approximately 900 feet of new grading and
paving along with associated roadway storm sewer and ditching.
For General Permit No. 3 - Is this facility to be moved this year?
❑ Yes ❑ No
Number of Acres of Disturbed Soil: 3_0
(Construction Activities Only)
Estimated Timetable For Activities / Projects, i.e., approximately when did/will the project begin and end:
Start: April 1s`, 2011 End: December 31st, 2011
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) Ernest G. Clark
TITLE: Mayor, City of Waterloo
DATE:
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