HomeMy WebLinkAboutIowa Department of Natural Resources-1/19/2016No. 1 FOR "STORM
No. 2 FOR "STORM
ACTIVITIES"
No. 3 FOR "STORM
CONCRETE BATCH
IOWA DEPARTMENT OF NATURAL RESOURCES
ENVIRONMENTAL PROTECTION DIVISION
NOTICE OF INTENT FOR NPDES COVERAGE UNDER
GENERAL PERMIT
Iran
CASHIER'S USE ONLY
0253-542-SW08-0581
Name
WATER DISCHARGES ASSOCIATED WITH INDUSTRIAL ACTIVITY"
or
WATER DISCHARGES ASSOCIATED WITH INDUSTRIAL ACTIVITY FOR CONSTRUCTION
or
WATER DISCHARGE ASSOCIATED WITH INDUSTRIAL ACTIVITY FOR ASPHALT PLANTS,
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
General Permit No. 3 0
PERMIT FEE OPTIONS
For coverage under the NPDES General Permit the following fees apply:
0 Annual Permit Fee $175 (per year) Maximum coverage is one year.
® 3 -year Permit Fee $350 Maximum coverage is three years.
0 4 -year Permit Fee $525 Maximum coverage is four years.
0 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 addressof the facility or project for which permit coverage is requested.
NAME: F.Y. 2015 Fitzway Drive and Galactic Drive
Extensions
CITY:
Waterloo
COUNTY:
Black Hawk
STREET ADDRESS OF SITE:
Galactic and Fitzway Drives
STATE:
IA
ZIP CODE:
50701
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
City of Waterloo
CITY:
Waterloo
STATE:
IA
ADDRESS:
715 Mulberry Street
ZIP CODE:
50703
Check the appropriate box to indicate the legal status of the operator of the facility.
0 Federal 0 State ® Public ❑ Private 0 Other (specify)
TELEPHONE
(319) 291-4312
SIC CODE (General Permit No. 1 & 3Applicants Only)
SIC code refers to Standard Industrial Classification code number used to classify establishments by type of economic activity.
11/2014 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 % section, section, township, range, (e.g., NW, 7, T78N, R3W).
1/4 SECTION
SECTION
TOWNSHIP
RANGE
NE
8
88
13
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 9TH ST
DES MOINES IA 50319-0034
NAME:
City of Waterloo
ADDRESS:
715 Mulberry Street
CITY:
Waterloo
STATE:
IA
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: March 2016
Is any storm water monitoring information available describing the concentration of pollutants in storm water discharges?
❑Yes ®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):
Sunnyside Creek to Black Hawk Creek 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)
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
® ❑
®
0
GENERAL PERMIT NO. 2 AND GENERAL PERMIT NO. 3 APPLICANTS COMPLETE THIS SECTION.
Description of Project (describe in one sentence what is being constructed):
Grading, utilities, and roadway construction
For General Permit No. 3 - Is this facility to be moved this year? 0 Yes 0 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:
March 2016 — February 2017
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) ,
TITLE AND COMPANY NAME OF SIGNATORY:
Or
1 DATE:
11/2014 cmc
Be sure to complete both sides of this form
DNR Form 542-1415
Instructions - To complete the public notice, fill in the blanks with the required
information or select the appropriate response.
PUBLIC NOTICE OF STORM WATER DISCHARGE
The 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
No.2 "Storm Water Discharge Associated with Industrial Activity for Construction
Activities.
The storm water discharge will be from grading, utilities, and roadway construction
(description of industrial activity)
Located in NE 1/4 of Section 8, Township 88 North, Range 13 West, in Black Hawk
County.
(I/9 section, township, range, county)
Storm water will be discharged from 1_ point source(s) and will be discharged to
(number)
the following streams: Sunnyside Creek to Black Hawk Creek to the Cedar River
(stream name(s))
Comments may be submitted to the Storm Water Discharge Coordinator, IOWA
DEPARTMENT OF NATURAL RESOURCES, Environmental Protection Division,
Henry A. Wallace Building, 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.
CITY OF WATERLOO
Council Communication
Resolution approving Notice of Intent for NPDES coverage under general permit to the Iowa De
of Natural Resources for FY 2016 Fitzway and Galactic Drive Extensions, Contract No. 896 and
authorize Mayor to execute said document.
City Council Meeting: 1/19/2016
Prepared: 1/11/2016
SUBJECT:
Submitted by:
Recommended Action:
Expenditure Required:
Resolution approving Notice of Intent for NPDES coverage under /
general permit to the Iowa Department of Natural Resources for FY)/
2016 Fitzway and Galactic Drive Extensions, Contract No. 896 and
authorize Mayor to execute said document.
Submitted By: Jeff Bales, Associate Engineer
Recommend approval. These documents have been reviewed by this
office and recommends approval by the City Council.
$350.00 (3 -year permit)