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Home My WebLink AboutNOTICE OF INTENT - RESOLUTION 2008-630 IOWA DEPARTMENT OF NATURAL RESOURCES IDNR CASHIER'S USE ONLY 0253-542-SW08-0581 ENVIRONMENTAL PROTECTION DIVISION NOTICE OF INTENT FOR NPDES COVERAGE UNDER GENERAL PERMIT No. 1 FOR"STORM WATER DISCHARGES ASSOCIATED WITH INDUSTRIAL 1 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 0 No If yes, please list authorization number IA-13 85 9—13 6 48 Under what General Permit are you applying for coverage? General Permit No. 1 ❑ General Permit No. 2 El General Permit No. 3 ❑ PERMIT FEE OPTIONS For coverage under the NPDES General Permit the following fees apply: a 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: Waterloo — US 63 - Westfield STREET ADDRESS OF SITE: Ave. Connection, City Contract No. 730 Westfield Avenue CITY: COUNTY: STATE: ZIP CODE: Waterloo Black Hawk Iowa 5070 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: ADDRESS: City of Waterloo ,Jeff Bales . 7i'5-14tlhprry STrpp CITY: STATE: ZIP CODE: TELEPHONE Waterloo IA 50703 (319) 291-4312 Check the appropriate box to indicate the legal status of the operator of the facility. ❑ Federal ❑ State 51 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. Be sure to complete both sides of this form. 542-1415(Rev.6/08) FACILITY LOCATION OR LOCATION OF CONSTRUCTION SITE Give the location by 1/4 section,section,township,range,(e.g.,NW,7,T78N,R3W). 1/4 SECTION SECTION TOWNSHIP RANGE MAIL TO: SW 23 89N 13W STORM WATER COORDINATOR IOWA DEPARTMENT OF NW 2 6 8 9N 13W NATURAL RESOURCES 502 E.9TH STREET DES MOINES,IA 50319-0034 OWNER INFORMATION Enter the name and full address of the owner of the facility. NAME: ADDRESS: City of Waterloo 715 Mulberry Street CITY: STATE: ZIP CODE: TELEPHONE: Waterloo IA 50703 (319) 291-4312 OUTFALL INFORMATION Discharge start date,i.e.,when did/will the site begin operation or 10/1/92,whichever is later: 8/1/2007 Is any storm water monitoring information available describing the concentration of pollutants in storm water discharges? CI 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): storm sewer to Black Hawk Creek to Cedar River Compliance With The Following Conditions: Yes No 1. Has the Storm Water Pollution Prevention Plan been developed prior to the submittal of this Notice of Intent? (do not submit the SWPPP with the application) X 2. 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) X 3. Have two public notices been published for at least one day,one each in the two newspapers with the largest N/A N/A circulation in the area where the discharge is located and are the proofs of notice attached?(new applications only) GENERAL PERMIT NO.2 AND GENERAL PERMIT NO.3 APPLICANTS COMPLETE THIS SECTION. Description of Project(describe in one sentence what is being constructed): Relocation of approx. 83 0 ; of Westfield Ave. , a 3—lane roadway and construction of a new connection between Westfield Ave. and US 63/US 218 or Generai Permit No.3-Is this facility to be moved this year? Number of Acres of Disturbed Soil: 3• 6 ❑ Yes ❑ No (Construction Activities Only) Estimated Timetable For Activities/Projects,i.e.,approximately when did/will the project begin and end: 8/1/2007 to 8/1/2009 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(please print) TITLE: Tim. H.ur1ey Mayor SIGNATURE: DATE: )4J. *At off -07 542-1415(Rev.6/08)