Form ECY020-87 "Notice of Termination Form" - Washington

What Is Form ECY020-87?

This is a legal form that was released by the Washington State Department of Ecology - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2020;
  • The latest edition provided by the Washington State Department of Ecology;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form ECY020-87 by clicking the link below or browse more documents and templates provided by the Washington State Department of Ecology.

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Download Form ECY020-87 "Notice of Termination Form" - Washington

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Notice of Termination Form
Permit # WAR
Construction Stormwater General Permit
Use this form to request termination of permit coverage.
I. Operator/Permittee
Name:
Company:
Mailing Address:
City:
State:
Zip + 4:
Business Phone:
Ext.
Cell Phone:
E-mail:
II. Site Location/Address
Site name:
Street address (or location description):
City (or nearest city):
County:
Zip:
III. Construction Activity The site is eligible for termination by one of the following methods:
Construction was never started.
The entire site has undergone final stabilization and all temporary BMPs are removed. (Permit Condition S10.A.1. See
instructions for definition.)
Permit coverage on all portions of the site that have not undergone final stabilization are being, or have been,
transferred (Permit Condition G9), and the Permittee no longer has operational control of the construction activity.
We provided the new owner Transfer of Coverage form on (date):
Please provide new owner contact info:
All portions of the site that have not undergone final stabilization have been sold and the Permittee no longer has
operational control of the construction activity. We will not be submitting Transfer of Permit coverage paperwork.
(Optional) Please provide new owner contact info:
IV. Certification of Signature Please read the certification statement carefully before signing.
“I certify under penalty of law, that this document and all attachments were prepared under my direction or
supervision in accordance with a system designed to assure that qualified personnel 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 information, the information submitted is, to the best of my
knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
submitting false information, including the possibility of fine and imprisonment for knowing violations.”
Permittee printed name
Title
)
Date
Permittee signature (Permittee on record or a VP level officer
ECY 020-87 (Rev.2/20)
Notice of Termination Form
Permit # WAR
Construction Stormwater General Permit
Use this form to request termination of permit coverage.
I. Operator/Permittee
Name:
Company:
Mailing Address:
City:
State:
Zip + 4:
Business Phone:
Ext.
Cell Phone:
E-mail:
II. Site Location/Address
Site name:
Street address (or location description):
City (or nearest city):
County:
Zip:
III. Construction Activity The site is eligible for termination by one of the following methods:
Construction was never started.
The entire site has undergone final stabilization and all temporary BMPs are removed. (Permit Condition S10.A.1. See
instructions for definition.)
Permit coverage on all portions of the site that have not undergone final stabilization are being, or have been,
transferred (Permit Condition G9), and the Permittee no longer has operational control of the construction activity.
We provided the new owner Transfer of Coverage form on (date):
Please provide new owner contact info:
All portions of the site that have not undergone final stabilization have been sold and the Permittee no longer has
operational control of the construction activity. We will not be submitting Transfer of Permit coverage paperwork.
(Optional) Please provide new owner contact info:
IV. Certification of Signature Please read the certification statement carefully before signing.
“I certify under penalty of law, that this document and all attachments were prepared under my direction or
supervision in accordance with a system designed to assure that qualified personnel 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 information, the information submitted is, to the best of my
knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
submitting false information, including the possibility of fine and imprisonment for knowing violations.”
Permittee printed name
Title
)
Date
Permittee signature (Permittee on record or a VP level officer
ECY 020-87 (Rev.2/20)
ECY 020-87 (Rev.2/20)
Instructions for Notice of Termination Form
The permit fees will continue until Ecology terminates the permit coverage. Continue complying with
permit conditions until notified that coverage has been terminated.
I. Operator/ Permittee
Give the name, address, and telephone number of the permittee on record. Ecology
sends the final fee invoice to the permittee.
II. Site Location/Address
Enter the street address or location description, including the city or nearest city and
county for the construction site. Construction sites that do not have a street address
must also provide a legal description in the space provided, or as an attachment.
III. Construction Activity
Indicate:
The construction project has not started and there are no other sources of
construction stormwater.
That all stormwater discharges associated with construction activity are
eliminated and final stabilization of all exposed soils is completed. Final
stabilization means established permanent vegetative cover, or equivalent
permanent stabilization measures which prevent erosion. You are certifying that:
Soils are no longer being disturbed.
All permanent vegetative cover is fully established and growing.
All exposed soils are permanently stabilized to prevent erosion.
All temporary sediment and erosion control BMPs such as catch basin filters
and silt fencing, etc. are removed.
All Low Impact Development (LID) Bioretention and Rain Garden facilities
are fully functional and free of sediment accumulated during construction.
All stormwater discharges associated with construction activity are
eliminated.
That the permit has been transferred to another responsible party(ies) for
management. (Provide the information required on the Transfer of Coverage
form.)
That all portions of the site that have not undergone final stabilization have
been sold.
Use this option for residential construction where the permittee has completed
temporary stabilization and the homeowners have taken possession of the
residences.
IV. Certification of Signature
Read this statement carefully. The permittee, or vice president level or above in the
permittee’s company, must print their name for clarity, then sign and date the
document on the lines provided.
ECY 020-87 (Rev.2/20)
Please sign and return this original document to the following address and retain a copy for your records:
Department of Ecology
Permit Fee Unit
PO Box 47600
Olympia, WA 98504-7696
Note: Your site remains under permit and subject to all permit conditions until your termination is effective. Continue to
comply with permit conditions until the earlier of the following two dates:
1) The date you receive written notification from Ecology that termination is effective.
st
2) The 31
day following Ecology receives a complete NOT form.
Questions?
Contact the Permit Fee Unit at (800) 633-6193, Option 2 or wqfee_unit@ecy.wa.gov.
To request ADA accommodation including materials in a format for the visually impaired, call the Water Quality Program at
360-407-6600. Persons with impaired hearing may call Washington Relay Service at 711. Persons with a speech disability may
call 877-833-6341.
ECY 020-87 (Rev.2/20)
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