HomeMy WebLinkAboutIDNR - Notice of Intent FY20 Newel Street Rise Project, Cont No. 991 - 2/10/2020IOWA DEPARTMENT OF NATURAL RESOURCES
ENVIRONMENTAL SERVICES DIVISION
NOTICE OF INTENT FOR NPDES COVERAGE UNDER GENERAL PERMIT
CASHIER'S USE ONLY
0253-542-S W 08-0581
Name
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? ❑ Yes ® No
If yes, please list authorization number
Under what General Permit are you applying for coverage?
General Permit No. 1 ❑ General Permit No. 2 ❑X General Permit No. 3 ❑
PERMIT FEE OPTIONS
For coverage under the NPDES General Permit the following fees apply:
❑X 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: Newell Street Pavement Widening Project
STREET ADDRESS OF SITE: Newell Street
CITY: Waterloo
COUNTY:
Blackhawk
STATE: Iowa
ZIP CODE: 50703
CONTACT INFORMATION
Given 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: Quentin M. Hart
COMPANY NAME (if applicable): Mayor, City of Waterloo
STREET ADDRESS: 715 Mulberry Street
CITY: Waterloo
PHONE: 319-291-4301
STATE: IA ZIP CODE: 50703
E-mail address (if available):
mayor@waterloo-ia.org
Check the appropriate box to indicate the legal status of the operator of the facility.
❑ Federal ❑ State ❑X Public ❑ Private ❑ 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.
04/2017 cmc Be sure to complete both sides of this form
DNR Form 542-1415
FACILITY LOCATION OR LOCATION OF CONSTRUCTION SITE
Give the location by'A section , section, townsh
'/. SECTION
SECTION
TOWNSHIP
RANGE
NW
20
89 N
12 W
OWNER INFORMATION
Enter the name and full address of the owner of the facility.
NAME: City of Waterloo
MAIL TO:
STORM WATER COORDINATOR
IOWA DNR
502 E 9T" ST
DES MOINES IA 50319-0034
STREET ADDRESS: 715 Mulberry Street
CITY: Waterloo
PHONE: 319-291-4301
Owner E-mail address (if available): mayor@waterloo-ia.org
OUTFALL INFORMATION
STATE:
IA
ZIP CODE: 50703
Discharge start date, i.e., when did/will the site begin operation or 10/1/92, whichever is later: April 1, 2020
Is any storm water monitoring information available describing the concentration of pollutants in storm water discharges?
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): Blowers 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)
Has a public notice been published for at least one day, in the newspaper with the largest circulation in the area
where the discharge is located, and is the proof 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):
Newell Street pavement will be reconstructed and widened (west of NE Drive)
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:
initial grading beginning 4/01/20, construction of additional paving over the next year, final stabilization before April 1, 2021
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: (pri or type)
of rt�-(r i {-E a r
SIGNATUR •
TITLE AND COMPANY NAME OF SIGNATORY: ��
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2'%I I /2 #7_&
DATE:
04/2017 cmc Be sure to complete both sides of this form DNR Form 542-1415