HomeMy WebLinkAboutDNR Notice of Intent FY17 Wagner Rd Sanitary Sewer-10/17/2016IOWA DEPARTMENT OF NATURAL RESOURCES
ENVIRONMENTAL PROTECTION DIVISION
NOTICE OF INTENT FOR NPDES COVERAGE UNDER GENERAL
PERMIT
CASHIER'S USE ONLY
0253-542-SW08-0581
Authorization #
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 IN No
If yes, please list authorization number
Under what General Permit are you applying for coverage?
General Permit No. 1 9 General Permit No. 2 IN General Perrnit No. 3 9
PERMIT FEE OPTIONS
For coverage under the NPDES General Permit the following fees apply:
❑ Annual Permit Fee $175 (per year) Maximum coverage is one year.
❑ 3 -year Permit Fee $350 Maximum coverage is three years.
❑ 4 -year Perrnit Fee $525 Maximum coverage is four years.
9 5 -year Perrnit Fee $700 Maximum coverage is five years.
Checks should be made payable to: Iowa Department of Natural Resources.
FACILITY 011 PROJECT INFORMATION
Enter the name and full address/location (not mailing address) of the facility or:prbject for which permit coven) fe is requested.
NAME:
F.Y. 2017 Wagner Road Sanitary Sewer Extension & Grading
STREET ADDRESS OF SITE:
3500 & 3600 Blocks of Wagner Road
CITY:
Waterloo
COUNTY:
Black Hawk
STATE:
IA
ZIP CODE:
50703
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:
IDE Engineering, PLC
ADDRESS:
3731 Pheasant Lane, Suite #201
CITY:
Waterloo
STATE:
IA
ZIP CODE:
50701
TELEPHONE
(319) 464-7913
Check the appropriate box to indicate the legal status of the operator of the facility.
9 Federal ❑ State ® Public ❑ Private 9 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.
05/2011 cmx Be sure to complete both sides of this form DNR Form 542-1415
FACILITY LOCATION 011 LOCATION OF CONSTRUCTION SITE
Give the location by 3/4 section, section, township, range; fe.f;., NW, 7, T78N, R3W),
1/4 SECTION
SECTION
TOWNSHIP
RANGE
NW
03
89
13
OWNER INFORMAT ON
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 Stree
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: 11/15/2016
Is any storm water monitoring information available describing the concentration of pollutants in storm water discharges?
El 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):
Overland to No Name 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) El 0
Have two public notices been published for at least one day, one each in the two newspapers with the Ingest
circulation in the area where the discharge is located, and are the proofs of notice attached? (new applications only)
Yes No
E1 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):
Sanitary sewer extension north from existing sewer to approximately 810 feet. Also included is grading of site and associated work.
For General Permit No. 3 - Is this facility to be moved this year? ❑ Yes ® No
Number of Acres of Disturbed Soil; 10.0
(Construction Activities Only.)
Estimated Timetable For Activities / Projects, i.e., approximately when did/will the project begin and end:
Begin construction 11/15/2016 - End construction 06/01/2017
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),
11''t
TITLE AND COMPANY NAME OF SIGNATORY:
\\. A. A (
SIGNATURE:
;42 Lit
DATE:
05/2011 cmz
Be sure to complete both sides of this form
DNR Form 542-1415
Item Coversheet
CITY OF WATERLOO
Council Communication
of 1
Resolution approving Notice of Intent for NPDES coverage under general permit to the Iowa Department of Natural Resources for FY 2017 Wagner
Road Sanitary Sewer Extension & Grading, Contract No. 899, and authorize Mayor to execute said document.
City Council Meeting: 10/17/2016
Prepared: 10/12/2016
REVIEWERS:
Department Reviewer Action Date
Engineering Gentz, Dennis Approved 10/12/2016 - 3:09 PM
Clerk Office Higby, Nancy Approved 10/12/2016 - 3:14 PM
SUBJECT:
Submitted by:
Recommended Action:
Expenditure Required:
Source of Funds:
Resolution approving Notice of Intent for NPDES coverage under general permit to the Iowa
Department of Natural Resources for FY 2017 Wagner Road Sanitary Sewer Extension & Grading,
Contract No. 899, and authorize Mayor to execute said document.
Submitted By: Dennis Gentz, PE, Assistant City Engineer
Recommend approval. These documents have been reviewed by this office and recommends approval
by the City Council.
$350.00 (3 -year permit)
http://waterloo.novusagenda.com/AgendaWeb/CoverSheet.aspx?ItemID=6600 10/12/2016