Blank Notice of Intent to File Suit - PDF

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					                                                                                               To file a complete Notice of Intent you must provide the following items:
                        "HOW TO FILE A COMPLETE                                                1.   The completed Form 542-1415 entitled "Notice of Intent for NPDES Coverage
                             NOTICE OF INTENT"                                                      Under General Permit",
                                        For                                                    2.   Proof of Public notification from the two newspapers in the area with the
                                                                                                    highest circulation and,
                          NPDES General Permit No.1
                          for "Storm Water Discharge                                           3.   Permit fee.
                       Associated With Industrial Activity"                                    Each of these items is discussed in detail below and on the back side of this page.
                          NPDES General Permit No.2                                            Mail the completed application form 542-1415 with the two proofs of public notice
                                                                                               and permit fee to the following address. Do not send the Pollution Prevention Plan
                          for " Storm Water Discharge                                          with your Notice of Intent. Do not send the application form, fee payment or proofs
                       Associated with Industrial Activity                                     of public notice separately. Send all of them together.
                           for Construction Activities"
                                                                                                                         Storm Water Coordinator
                          NPDES General Permit No.3
                                                                                                                    Department of Natural Resources
                  for “Storm Water Discharge Associated with
                      Industrial Activity for Asphalt Plants,                                                                  502 E. 9th Street
                  Concrete Batch Plants, Rock Crushing Plants                                                          Des Moines, Iowa 50319-0034
                  and Construction Sand and Gravel Facilities”
                                                                                               1. Proof of Public Notification
                                                                                               Iowa law requires dischargers to make public notice for seeking coverage under a
                                                                                               general permit. The public notice must be published at least one day at your own
                                                                                               expense in two different newspapers with the largest circulation in the area where
In accordance with the Clean Water Act, all industrial facilities that discharge storm water
                                                                                               the discharge is located.
meeting the definition of storm water associated with industrial activity must apply for
coverage under a National Pollutant Discharge Elimination System (NPDES) permit.               The wording to use in the public notice is specified as a rule of the IDNR and is
                                                                                               included as a separate page for your convenience. This wording contains the
These instructions are provided to assist activities that need to notify the Iowa Department
                                                                                               minimum information that must be provided in the public notice. You must
of Natural Resources (IDNR) of their storm water discharge to be covered under Iowa's
                                                                                               complete the blank portions with the specified information. You may add more
NPDES General Permit No. 1, General Permit No. 2 or General Permit No. 3.
                                                                                               information to the notice if you wish.
The instructions are the same for all general permits. When a discharger provides a
                                                                                               To determine which newspapers have the largest circulation, ask your local
complete Notice of Intent to the IDNR, its storm water discharges will be subject to the
                                                                                               newspaper or call the Iowa Newspaper Association (INA) at (515) 244-2145 for
terms and conditions of the appropriate general permit unless notified by the IDNR.
                                                                                               circulation information. The INA is located at 319 E. Fifth Street, Des Moines,
A pollution prevention plan is required for all storm water permits. The plan must be          Iowa 50309.
completed before submittal of the Notice of Intent. The plan should be kept on-site at the
                                                                                               When your Notice of Intent is sent to the IDNR, you must enclose a clipping of
facility or construction site that generates the storm water discharge. Do not send the
                                                                                               each public notice with the names of the newspaper and date published, or an
pollution prevention plan with the Notice of Intent.
                                                                                               affidavit from each newspaper with the clippings attached to demonstrate your
                                                                                               public notification requirement.

                                                                                                                                              Iowa Department of Natural Resources
                                                                                                                                                                         JUNE 2008
2. Form 542-1415                          Facility Location or Location of            Provide the name(s) of the receiving       The Notice of Intent will be returned
                                          Construction Site                           water(s) to the first uniquely named       and no permit issued if information on
In filling out the form, type or print                                                river. Explain to where the storm          the form is incomplete.
legibly and complete both sides of the    Give the location by ¼ section (e.g.,
                                          NW), section number, township               water runoff will drain (e.g., unnamed
form.                                                                                 waterway to road ditch to unnamed
                                          number (e.g., T78N) and range
Permit Information and Fee Options                                                    tributary to Mud Creek to Skunk            3. Fees
                                          number (e.g., R4W). The location
                                          information can be obtained from            River).
Give permit information on the                                                                                                   There is a permit fee for each general
general permit for which you are          United States Geological Survey             Compliance conditions                      permit. The fee schedule is the same
applying and select a fee option.         topographic maps, by calling 1-(888)        Check the compliance conditions that       for General Permit No. 1, No. 2 and
                                          ASK-USGS.                                   apply. A pollution prevention plan is      No. 3.
Facility or Project Information
                                          Owner Information                           required for all storm water permits.      The applicant has the option of paying
Enter the official or legal name of the                                               For General Permit No. 3 (if no soil
                                          Enter the name, mailing address and                                                    an annual permit fee or a multi-year
facility or site. Enter the complete                                                  disturbing activities will take place)
                                          telephone number of the owner of the                                                   permit fee.
street address. If no street address                                                  and General Permit No. 1, the question
exists,    provide      a    geographic   facility.
                                                                                      regarding state or local sediment and
description (e.g., Intersection of 5th    Outfall Information                         erosion control plans does not apply.      annual permit fee         $175
Street and 2nd Avenue or, at a            Provide an estimated start date the         If you check no to any of the              3-year permit fee         $350
minimum, the name of the street or        discharge did or is to commence, the        applicable compliance conditions,
road nearest the site), city, county,                                                                                            4-year permit fee         $525
                                          name(s) of the receiving water(s), and      your application will not be approved.
state and zip code. Do not use a P.O.     check compliance conditions. All                                                       5-year permit fee         $700
box number. This is the address of the                                                General Permits No. 2 and No. 3
                                          applicable compliance conditions
facility or construction site not the     listed must be met for the Notice of        For construction sites that need a
address of the owner or contact.          Intent to be considered complete.           storm water discharge permit, in
For General Permits No. 1 and No. 3,                                                  addition to the information required       IMPORTANT - The storm water
                                          The discharge start date is the date
provide a four-digit SIC code that best                                               above, include a brief description of      permit authorization will not be
                                          storm water discharge from industrial
represents the principal products or                                                  the project, estimated timetable for       issued unless the two proofs of public
                                          activity or construction activity (from
activities provided by the facility.                                                  major activities and an estimate of the    notice and permit fee accompany the
                                          a construction site that disturbs one
                                                                                      number of acres of the site on which       completed Notice of Intent.
Contact Information                       acre or more or is part of a larger
                                                                                      soil will be disturbed.
Provide the legal name of a contact       common plan of development that
                                          disturbs one acre or more) began or         For General Permit No. 3, identify if
person, firm, public organization or                                                                                             If you need assistance contact the IDNR
                                          will begin to leave the property. If the    the facility is a portable plant.          at (515) 281-6782 or (515) 281-7017.
any other entity that owns or operates
the facility or site. The name of the     discharge start date is before 10/1/92,     Certification
operator or contact may or may not be     the correct date to place in the blank is
                                                                                      The completed form must be signed
the same as the name of the facility.     10/1/92. This is the date the State of
                                                                                      by a qualified official. A qualified
The operator is the legal entity that     Iowa implemented the storm water
                                                                                      official is any of the following: owner,
controls the facility’s operation.        permit requirements.
                                                                                      principal executive officer of at least
Provide a mailing address (P.O. box       If an industrial facility was not           the level of vice-president, general
numbers may be used). Include the         initially required to obtain a storm        partner, general contractor (for
city, state, zip code and telephone       water permit but changed operations         construction sites), principal executive
number for a contact person. All          so that later a storm water permit was      officer or ranking elected official (for
correspondence relating to the storm      or will be required, the discharge start    publicly owned facilities).
water permit, including the storm         date is the date that the change was
water permit authorization, will be       made that necessitated the need for a
sent to this address.                     storm water permit.
                                                                                                                                  Iowa Department of Natural Resources
                                                                                                                                                             JUNE 2008

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