HomeMy WebLinkAboutIowa Department of Natural Resources-05/29/2012NOTICE OF DISCONTINUATION
OF A STORM WATER DISCHARGE
COVERED UNDER IOWA NPDES GENERAL PERMIT NO. 2
FOR CONSTRUCTION ACTIVITIES
Naive of the owner or facility to which the stonn water discharge general permit coverage was issued.
City of Waterloo
Coiurty: Black Hawk
List the complete permit authorization number for the discharge. This number is provided on the bottom of the
authorization sheet.
1A _ 17342 ___ 17109
List the date the construction site reached final stabilization as defined on the back of this form.
7-01-10
The following certification must he signed in accordance with the signatory requirements of the general permit (see
back side).
I certify under penalty of law that disturbed soils at the identified facility have been finally stabilized and temporary
erosion and sediment control measures have been removed or will be removed at an appropriate time. I understand
that by submitting this Notice of Discontinuation, I am no longer authorized to discharge storm water associated
with industrial activity for construction activities by Iowa Department of Natural Resources NPDES General Permit
No. 2 and that discharging pollutants from storm water associated with industrial activity to waters of the United
States is unlawful under the Clean Water Act where the discharge is not authorized by an NPDES permit.
I fiurther certify under penalty of law that this document and all attaclunents were prepared under in_y direction or
supervision in accordance with a system designed to assure that qualified personnel 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 inibnnation, the information submitted is, to the best of my knowledge and
belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fine and imprisonment for known violations.
54- t C� • �1�-I-r5,,
- Name (print)
Return to:
Signature
Title
Stonn Water Coordinator
Department of Natural Resources
502 E. 9th Street
Des Moines, IA 50319-0034
542-8115 (over)
Final Stabilization means that all soil disturbing activities at the site have been completed and that a
unifonn perennial vegetative cover for the area has been established or equivalent stabilization measures
have been employed. All building must be completed before the project is considered finally stabilized.
SIGNATORY REQUIREMENTS All Notices of Intent, storm water pollution prevention plans, reports,
certifications or information either submitted to the Department or the operator of a large or
medium municipal separate storm sewer system, or that this permit requires be maintained by the
permittee, shall be signed in accordance with rule 567--64.3(8) of the Iowa Administrative Code as
follows:
643(8) Identity of signatories of operation permit applications. The person who signs the application for
an operation permit shall be:
a. Corporations. In the case of corporations, a principal executive officer of at least the level of vice-
president.
b. Partnerships. In the case of a partnership, a general partner.
c. Sole proprietorships. In the case of a sole proprietorship, the proprietor.
d. Public facilities. In the case of a municipal, state, or other public facility, by either the principal
executive officer, or the ranking elected official.
e. Storm water discharge associated with construction activity. In the case of a storm water discharge
associated with industrial activity from construction as identified in 40 CFR 122 26(b)(14)(x),
either the owner of the site or the general contractor.
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
City of Waterloo plans to submit a Notice of Intent to the
(applicant name)
Iowa Department of Natural Resources to be covered under the NPDES General Permit
General Permit No. 2 "Storm Water
Discharge Associated with Industrial
Activity for Construction Activities
(select the appropriate general permit - Na 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 Road Construction
located in
(description of industrial activity)
NE 1/4 Section 8 Township 89 Range 13, Black
Hawk County
(1/4 section, section, township, range, county)
Storm water will be discharged from one point source(s) and will be discharged to
(number)
the following streams: Cedar River
(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.
05/2011 cmz DNR Form 542-1415