HomeMy WebLinkAboutIowa Department of Natural Resources-10/14/2013NOTICE OF DISCONTINUATION
OF A STORM WATER DISCHARGE
COVERED UNDER IOWA NPDES GENERAL PERMIT NO. 2
FOR CONSTRUCTION ACTIVITIES
Name of the owner or facility to which the storm water discharge general permit coverage was issued.
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County:
List the complete permit authorization number for the discharge. This number is provided on the bottom of the
authorization sheet.
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List the date the construction site reached final stabilization as defined on the back of this form.
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The following certification must be 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 further certify under penalty of law that this document and all attachments were prepared under my 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 information, 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.
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Signature /0 / %o / 3 Date
Return to:
Storm 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
uniform 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:
64.3(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.