ADEM Form 26 "Notice of Intent - Npdes General Permit Number Alg850000" - Alabama

What Is ADEM Form 26?

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

Form Details:

  • Released on April 1, 2020;
  • The latest edition provided by the Alabama Department of Environmental Management;
  • Easy to use and ready to print;
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  • Fill out the form in our online filing application.

Download a printable version of ADEM Form 26 by clicking the link below or browse more documents and templates provided by the Alabama Department of Environmental Management.

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Download ADEM Form 26 "Notice of Intent - Npdes General Permit Number Alg850000" - Alabama

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A
D
E
M
(ADEM)
LABAMA
EPARTMENT OF
NVIRONMENTAL
ANAGEMENT
N
I
– NPDES G
P
N
ALG850000
OTICE OF
NTENT
ENERAL
ERMIT
UMBER
Instructions: This form should be used to submit a Notice of Intent for coverage under NPDES General Permit Number ALG850000, which is the general permit
authorizing discharges from the mining and processing (wet or dry) of construction sand and gravel, chert, dirt, and/or red clay, and areas associated with these activities.
Please complete all questions. Respond with “N/A” as appropriate. Incomplete or incorrect answers, or missing signatures will delay processing. If space is insufficient,
continue on an attached sheet(s) as necessary. Attach other information as needed. Commencement of activities for which permit coverage is requested as detailed in this
notice of intent are not authorized until permit coverage has been issued by the department. Please type or print legibly in blue or black ink. Mail completed form to:
FOR OFFICE USE ONLY
ADEM-Water Division
Stormwater Management Branch
NPDES PERMIT NUMBER
PO Box 301463
Montgomery, Alabama 36130-1463
RECEIPT NUMBER
DISCHARGES NOT COVERED BY GENERAL PERMIT ALG850000
If the facility will have any of the following discharges, please contact the Mining and Natural Resources Section of ADEM before proceeding:
A. Discharges to a waterbody designated as Outstanding National Resource Water (ONRW), Outstanding Alabama Water (OAW), or Treasured Alabama Lake
(TAL);
B. Discharges to a waterbody that is included on Alabama’s current §303(d) list for a pollutant of concern;
C. Discharges to a waterbody included in an EPA approved or EPA established Total Maximum Daily Load (TMDL) for a pollutant of concern if the discharges are
not consistent with the EPA approved or EPA established TMDL
PURPOSE OF THIS NOTICE OF INTENT
Initial NOI for New Facility
Initial NOI for Existing Facility (Previous NPDES Permit AL
)
Modification of General Permit No. ALG
Reissuance of General Permit No. ALG
Transfer of General Permit No. ALG_____________
Other
I.
PERMITTEE INFORMATION
Permittee Name
Responsible Official Phone Number
Responsible Official and Title
Responsible Official E-Mail Address
Responsible Official (RO) Street/Physical Address
City, State, and Zip Code
Responsible Official (RO) Mailing Address
City, State, and Zip Code
II.
FACILITY INFORMATION
Facility/Site Name
Facility/Site Contact and Title
Facility/Site Street Address or Location Description
City, State, and Zip Code
Facility Front Gate Latitude and Longitude
Facility/Site Contact Phone Number
Facility/Site Contact Email Address
County(s)
Township(s), Range(s), Section(s)
Detailed Directions to Site
ADEM Form 26 m4 04/2020
Page 1 of 7
A
D
E
M
(ADEM)
LABAMA
EPARTMENT OF
NVIRONMENTAL
ANAGEMENT
N
I
– NPDES G
P
N
ALG850000
OTICE OF
NTENT
ENERAL
ERMIT
UMBER
Instructions: This form should be used to submit a Notice of Intent for coverage under NPDES General Permit Number ALG850000, which is the general permit
authorizing discharges from the mining and processing (wet or dry) of construction sand and gravel, chert, dirt, and/or red clay, and areas associated with these activities.
Please complete all questions. Respond with “N/A” as appropriate. Incomplete or incorrect answers, or missing signatures will delay processing. If space is insufficient,
continue on an attached sheet(s) as necessary. Attach other information as needed. Commencement of activities for which permit coverage is requested as detailed in this
notice of intent are not authorized until permit coverage has been issued by the department. Please type or print legibly in blue or black ink. Mail completed form to:
FOR OFFICE USE ONLY
ADEM-Water Division
Stormwater Management Branch
NPDES PERMIT NUMBER
PO Box 301463
Montgomery, Alabama 36130-1463
RECEIPT NUMBER
DISCHARGES NOT COVERED BY GENERAL PERMIT ALG850000
If the facility will have any of the following discharges, please contact the Mining and Natural Resources Section of ADEM before proceeding:
A. Discharges to a waterbody designated as Outstanding National Resource Water (ONRW), Outstanding Alabama Water (OAW), or Treasured Alabama Lake
(TAL);
B. Discharges to a waterbody that is included on Alabama’s current §303(d) list for a pollutant of concern;
C. Discharges to a waterbody included in an EPA approved or EPA established Total Maximum Daily Load (TMDL) for a pollutant of concern if the discharges are
not consistent with the EPA approved or EPA established TMDL
PURPOSE OF THIS NOTICE OF INTENT
Initial NOI for New Facility
Initial NOI for Existing Facility (Previous NPDES Permit AL
)
Modification of General Permit No. ALG
Reissuance of General Permit No. ALG
Transfer of General Permit No. ALG_____________
Other
I.
PERMITTEE INFORMATION
Permittee Name
Responsible Official Phone Number
Responsible Official and Title
Responsible Official E-Mail Address
Responsible Official (RO) Street/Physical Address
City, State, and Zip Code
Responsible Official (RO) Mailing Address
City, State, and Zip Code
II.
FACILITY INFORMATION
Facility/Site Name
Facility/Site Contact and Title
Facility/Site Street Address or Location Description
City, State, and Zip Code
Facility Front Gate Latitude and Longitude
Facility/Site Contact Phone Number
Facility/Site Contact Email Address
County(s)
Township(s), Range(s), Section(s)
Detailed Directions to Site
ADEM Form 26 m4 04/2020
Page 1 of 7
III. LEGAL STRUCTURE OF APPLICANT
A. Indicate the legal structure of the “Permittee” listed in Part I:
Corporation
Association
Individual
Single Proprietorship
Partnership
LLP
LLC
Government Agency:
Other:
B.
If not an individual, single proprietorship, or government agency, is the “Permittee” listed in Part I. properly registered and in good
standing with the Alabama Secretary of State’s Office? (If the answer is “No,” attach a letter of explanation.)
Yes
No
C.
Parent Corporation and Subsidiary Corporations of Applicant, if any:
D. Land Owner(s):
E.
Mining Sub-contractor(s)/Operator(s), if known:
IV. COMPLIANCE HISTORY
A. Has the applicant ever had any of the following:
Yes No
(1) An Alabama NPDES, SID, or UIC permit suspended or terminated?
(2) An Alabama license to mine suspended or revoked?
(3) An Alabama or federal mining permit suspended or terminated?
Yes No
(4) A reclamation bond, or similar security deposited in lieu of a bond, or portion thereof, forfeited?
(5) A bond or similar security deposited in lieu of a bond, or portion thereof, the purpose of which was to secure compliance
with any requirement of the Alabama Water Improvement Commission or Alabama Department of Environmental
Management, forfeited?
(If the response to any item of Part IV.A. is “Yes,” attach a letter of explanation.)
B.
Identify every Warning Letter, Notice of Violation (NOV), Administrative Action, or litigation issued to the applicant, parent corporation,
subsidiary, general partner, LLP partner, or LLC member and filed by ADEM or EPA during the three year (36 months) period preceding the date
on which this form is signed. Indicate the date of issuance, briefly describe alleged violations, list actions (if any) to abate alleged violations, and
indicate date of final resolution:
V. OTHER PERMITS/AUTHORIZATIONS
A. List any other NPDES or other environmental permits (including permit numbers), authorizations, or certifications that have been applied for or
issued within the State by ADEM, EPA, Alabama Department of Labor (ADOL), US Army Corp of Engineers (USACE), or other agency, to the
applicant, parent corporation, subsidiary, or LLC member for this facility whether presently effective, expired, suspended, revoked, or
terminated:
B.
List any other NPDES or other ADEM permits (including permit numbers), authorizations, or certifications that have been applied for or issued
within the State by ADEM, EPA, ASMC, ADOL, or USACE, to the applicant, parent corporation, subsidiary, or LLC member for other
facilities whether presently effective, expired, suspended, revoked, or terminated:
VI. PROPOSED SCHEDULE
Anticipated Activity Commencement Date:
Anticipated Activity Completion Date:
ADEM Form 26 m4 04/2020
Page 2 of 7
VII. ACTIVITY DESCRIPTION
List relative percentages of the mineral(s) or mineral product(s) that are proposed to be and/or are currently mined, prepared, processed, handled,
transloaded, or disposed at the facility. If more than one mineral is to be mined, list the relative percentages of each mineral by tonnage for the
life of the mine.
Dirt and/or Chert
Sand and/or Gravel
Red Clay
Other:
Other:
Other:
Area of the permitted site: Total site area in acres:
Total disturbed area in acres:
Primary SIC Code:
NAICS Code:
Description:
Secondary SIC Code(s):
NAICS Code:_______________ Description:
Narrative Description of Activity:
VIII. MINING ACTIVITY TO BE CONDUCTED
Type(s) of activity presently conducted at applicant's existing facility or proposed to be conducted at facility (check all that apply):
Surface mining
Auger mining
Hydraulic mining
Mineral storing
Mineral dry processing (crushing & screening)
Mineral wet preparation
Mineral loading
Construction related temporary borrow pits/areas
Mineral transportation
rail
barge
truck
Grading, clearing, grubbing, etc.
Excavation
Pre-mining logging or land clearing
Waterbody relocation or other alteration
Creek/stream crossings
Onsite construction debris or equipment storage/disposal
Onsite mining debris or equipment storage/disposal
Reclamation of disturbed areas
Chemicals used in process or wastewater treatment (coagulant, biocide, etc.)
Mining a portion of a larger unreclaimed area
Other:
Other:
IX.
FUEL– CHEMICAL HANDLING, STORAGE & SPILL PREVENTION CONTROL & COUNTERMEASURES (SPCC) PLAN
A. Will fuels, chemicals, compounds, or liquid waste be used or stored onsite?
Yes
No
B.
If “Yes,” identify the fuel, chemicals, compounds, or liquid waste and indicate the volume of each:
Volume
Contents
Volume
Contents
Volume
Contents
gallons
gallons
gallons
gallons
gallons
gallons
C.
If “Yes,” a detailed SPCC Plan with acceptable format and content, including diagrams, must be attached to this NOI in accordance with ADEM
Admin. Code R. 335-6-6-.12(r).
X.
TOPOGRAPHIC MAP SUBMITTAL
Attach to this NOI a 7.5 minute series USGS topographic map(s) no larger than 11 by 17 inches (several pages may be necessary), of the area extending
to at least one mile beyond property boundaries. The topographic map(s) must include a caption indicating the name of the topographic map, name of
the applicant, facility name, county, and township, range, & section(s) where the facility is located. The topographic map(s), at a minimum, must show:
(a) An accurate outline of the area to be covered by the Permit
(e)
Proposed and existing discharge points
(b) An outline of the facility
(f)
Perennial, intermittent, and ephemeral streams
(c) All existing and proposed disturbed areas
(g)
Lakes, springs, water wells, wetlands
(d) All known facility roads and surrounding unimproved/improved roads
(h)
Any other pertinent or significant feature
ADEM Form 26 m4 04/2020
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XI.
RECEIVING WATERS
List the requested permit action for each outfall (issue, reissue, delete, move, etc), outfall point number and designation denoting “E” for existing
and “P” for proposed outfalls (ex. 001E or 002P), name of receiving water(s), latitude and longitude of location(s) of each discharge point, distance
of receiving water from outfall in feet, and the waterbody use classification. If this NOI is for a modification to an existing permit do not change
the numbering sequence of the permitted outfalls.
Distance to
Outfall
Waterbody Use
Action
Receiving Water(s)
Latitude
Longitude
Rec. Water
E/P
Classification
XII.
DISCHARGE STRUCTURE DESCRIPTION & ORIGIN
List the outfall point number and designation denoting “E” for existing and “P” for proposed outfalls (ex. 001E or 002P), as it appears on the map(s)
required by this NOI, describe each discharge structure (e.g., pipe, spillway, channel, tunnel, conduit, well, discrete fissure, or container), and
identify the method of discharge.
Outfall
Discharge Structure Description
Surface
Groundwater
Wet Prep -Other
Pumped or
E/P
Discharge
Discharge
Production Plant
Controlled
Discharge
XIII. POLLUTION ABATEMENT & PREVENTION (PAP) PLAN
A PAP Plan in accordance with Part III.C of the general permit, and ADEM Admin. Code r. 335-6-9-.03, including Appendices A & B, must be
completed and attached as part of this NOI.
XIV. GENERAL INFORMATION
This NOI and the appropriate fees must be submitted concurrently. The fee for Mineral/Resource Extraction Mining, Storage, Transloading, and/or
Dry Processing facilities and Wet Preparation, Processing, and/or Beneficiation facilities are in Fee Schedule D of ADEM Admin. Code div.335-1.
An additional Greenfield Site fee must be submitted for the initial operation of a new facility or a facility or operation not previously permitted.
ADEM Form 26 m4 04/2020
Page 4 of 7
XV.
POLLUTION ABATEMENT & PREVENTION (PAP) PLAN SUMMARY (must be completed for all outfalls)
Y
N
N/A
Outfall(s):
Runoff from all areas of disturbance is controlled
Drainage from pit area, stockpiles, and spoil areas directed to a sedimentation pond
Drainage from haul roads and other minor disturbed areas treated before discharge
Sedimentation basin at least 0.25 acre/feet for every acre of disturbed drainage
Sedimentation basin cleaned out when sediment accumulation is 60% of design capacity
Trees, boulders, and other obstructions removed from pond during initial construction
Width of top of dam greater than 12'
Side slopes of dam no steeper than 3:1
Cutoff trench at least 8' wide
Side slopes of cutoff trench no less than 1:1
Cutoff trench located along the centerline of the dam
Cutoff trench extends at least 2' into bedrock or impervious soil
Cutoff trench filled with impervious material
Embankments and cutoff trench 95% compaction standard proctor ASTM
Embankment free of roots, tree debris, stones >6" diameter, etc.
Embankment constructed in lifts no greater than 12"
Spillpipe sized to carry peak flow from a one year storm event
Spillpipe will not chemically react with effluent
Subsurface withdrawal used
Anti-seep collars extend radially at least 2' from each joint in spillpipe
Splashpad at the end of the spillpipe
Emergency Spillway sized for peak flow from 25-yr 24-hr event if discharge not into PWS classified stream
Emergency spillway sized for peak flow from 50-yr 24-hr event if discharge is into PWS classified stream
Emergency overflow at least 20' long
Side slopes of emergency spillway no steeper than 2:1
Emergency spillway lined with riprap or concrete
Minimum of 1.5' of freeboard between normal overflow and emergency overflow
Minimum of 1.5' of freeboard between max. design flow of emergency spillway and top of dam
All emergency overflows are sized to handle entire drainage area for ponds in series
Dam stabilized with permanent vegetation
Sustained grade of haul road <10%
Maximum grade of haul road <15% for no more than 300'
Outer slopes of haul road no steeper than 2:1
Outer slopes of haul road vegetated or otherwise stabilized
Detail drawings supplied for all stream crossings
Short-Term Stabilization/Grading and Temporary Vegetative Cover Plans
Long-Term Stabilization/Grading and Permanent Reclamation or Water Quality Remediation Plans
IDENTIFY AND PROVIDE DETAILED EXPLANATION FOR ANY “N” OR “N/A” RESPONSE(s):
ADEM Form 26 m4 04/2020
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