"Notice of Intent (Noi) to Obtain Coverage Under the Swd General Permit for Temporary Discharge Activities and a Temporary Water Rights Use Permit" - South Dakota

Notice of Intent (Noi) to Obtain Coverage Under the Swd General Permit for Temporary Discharge Activities and a Temporary Water Rights Use Permit is a legal document that was released by the South Dakota Department of Environment & Natural Resources - a government authority operating within South Dakota.

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  • Released on January 12, 2018;
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DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
NOTICE OF INTENT (NOI)
to Obtain Coverage Under the SWD General Permit for
Temporary Discharge Activities and a Temporary Water Rights Use Permit
Original to:
SD Department of Environment and Natural Resources
Surface Water Quality Program
523 East Capitol Avenue
Pierre, South Dakota 57501
Telephone: 1-800-SDSTORM
ALL QUESTIONS MUST BE ANSWERED COMPLETELY FOR THIS FORM TO BE VALID
I.
Primary Contact Information:
Owner
Operator
Contractor
Contact Person:
Company Name:
Mailing Address:
City:
County:
State:
Zip Code:
Phone Number:
Email Address:
II.
Other Contact Information:
Owner
Operator
Contractor
Contact Person:
Company Name:
Mailing Address:
City:
County:
State:
Zip Code:
Phone Number:
Email Address:
III.
Project Information:
Project/Facility Name:
On-Site Contact Person:
Phone Number:
Physical Project Address or Description of Construction Site Location:
City:
County:
State:
Zip Code:
Latitude:
Longitude:
Source (GPS, Google, etc.):
Quarter(s):
Section(s):
Township(s):
Range(s):
Is this project/facility located on Tribal Lands?
Yes
No
IV.
Project Activities:
Please describe the activities which require the applicant to obtain a discharge permit:
FOR DENR USE ONLY
Permit Number:
Limit Classifications:
Date Approved:
Approved by:
Notice of Intent – Temporary Discharge Permit
Revised January 12, 2018
Page 1 of 2
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
NOTICE OF INTENT (NOI)
to Obtain Coverage Under the SWD General Permit for
Temporary Discharge Activities and a Temporary Water Rights Use Permit
Original to:
SD Department of Environment and Natural Resources
Surface Water Quality Program
523 East Capitol Avenue
Pierre, South Dakota 57501
Telephone: 1-800-SDSTORM
ALL QUESTIONS MUST BE ANSWERED COMPLETELY FOR THIS FORM TO BE VALID
I.
Primary Contact Information:
Owner
Operator
Contractor
Contact Person:
Company Name:
Mailing Address:
City:
County:
State:
Zip Code:
Phone Number:
Email Address:
II.
Other Contact Information:
Owner
Operator
Contractor
Contact Person:
Company Name:
Mailing Address:
City:
County:
State:
Zip Code:
Phone Number:
Email Address:
III.
Project Information:
Project/Facility Name:
On-Site Contact Person:
Phone Number:
Physical Project Address or Description of Construction Site Location:
City:
County:
State:
Zip Code:
Latitude:
Longitude:
Source (GPS, Google, etc.):
Quarter(s):
Section(s):
Township(s):
Range(s):
Is this project/facility located on Tribal Lands?
Yes
No
IV.
Project Activities:
Please describe the activities which require the applicant to obtain a discharge permit:
FOR DENR USE ONLY
Permit Number:
Limit Classifications:
Date Approved:
Approved by:
Notice of Intent – Temporary Discharge Permit
Revised January 12, 2018
Page 1 of 2
V.
Discharge Information:
Estimate the following information:
A. Date water withdrawal will commence:
B. Date water withdrawal will cease:
C. Total volume of withdrawal (in gallons):
D. Date water discharge will commence:
E. Date water discharge will cease:
F. Total volume of discharge (in gallons):
G. Average flow rate of discharge (in gpm):
Source of water being withdrawn/discharged:
Name of receiving waters:
Treatment processes employed, if any:
Describe the discharge and type of wastewater from each discharge location (including overflows, bypasses or discharges from
holding ponds, trenches, excavations, vessels, pipelines, etc.) Attach additional sheets if necessary.
A. Discharge 1:
B. Discharge 2:
C. Discharge 3:
NOTE: Please place points of withdrawal and discharge on a topographic map, or other map if a topographic map is
unavailable. This map should extend to one (1) square mile beyond the property boundaries of the facility and each of its
discharge facilities, and those wells, springs, and other surface water bodies, drinking water wells, and surface water intake
structures listed in public records, or otherwise known to the applicant in the map area.
VI.
Stormwater Pollution Prevention Plan (SWPPP):
Is there any reason to believe the discharge may contain any pollutants other than those limited in the permit (i.e. TSS, pH,
BTEX, Benzene, & TPH)?
Yes
No
Has the SWPPP been developed in lieu of sampling for TSS or TRC?
Yes
No
Describe the best management practices being used in lieu of, or along with, sampling:
VII.
Hydrostatic Testing:
A. Type of vessel being tested:
B. Material vessel is constructed from:
C. Check the appropriate box:
Vessel has been previously used
Vessel is virgin material
VIII.
Other Information:
Please list other information you feel should be brought to the attention of the SDDENR regarding coverage under this
general permit. Attach additional sheets if necessary.
Notice of Intent – Temporary Discharge Permit
Revised January 12, 2018
Page 2 of 2
STATE OF SOUTH DAKOTA
BEFORE THE SECRETARY OF
THE DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
IN THE MATTER OF THE
)
APPLICATION OF
)
)
CERTIFICATION OF
_______________________________________________ )
)
APPLICANT
STATE OF _____________________________________ )
)
COUNTY OF ___________________________________ )
I, ____________________________________, the applicant in the above matter after being duly
sworn upon oath hereby certify the following information in regard to this application:
I have read and understand South Dakota Codified Law Section 1-40-27 which provides:
"The secretary may reject an application for any permit filed pursuant to Titles 34A or 45,
including any application by any concentrated swine feeding operation for authorization to
operate under a general permit, upon making a specific finding that:
(1) The applicant is unsuited or unqualified to perform the obligations of a permit holder
based upon a finding that the applicant, any officer, director, partner, or resident general
manager of the facility for which application has been made:
(a) Has intentionally misrepresented a material fact in applying for a permit;
(b) Has been convicted of a felony or other crime involving moral turpitude;
(c) Has habitually and intentionally violated environmental laws of any state or the
United States which have caused significant and material environmental damage;
(d) Has had any permit revoked under the environmental laws of any state or the United
States; or
(e) Has otherwise demonstrated through clear and convincing evidence of previous
actions that the applicant lacks the necessary good character and competency to reliably
carry out the obligations imposed by law upon the permit holder; or
(2) The application substantially duplicates an application by the same applicant denied
within the past five years which denial has not been reversed by a court of competent
jurisdiction. Nothing in this subdivision may be construed to prohibit an applicant from
submitting a new application for a permit previously denied, if the new application
represents a good faith attempt by the applicant to correct the deficiencies that served as the
basis for the denial in the original application.
All applications filed pursuant to Titles 34A and 45 shall include a certification, sworn to
under oath and signed by the applicant, that he is not disqualified by reason of this section from
obtaining a permit. In the absence of evidence to the contrary, that certification shall constitute a
prima facie showing of the suitability and qualification of the applicant. If at any point in the
application review, recommendation or hearing process, the secretary finds the applicant has
intentionally made any material misrepresentation of fact in regard to this certification,
Page 1 of 2
consideration of the application may be suspended and the application may be rejected as
provided for under this section.
Applications rejected pursuant to this section constitute final agency action upon that
application and may be appealed to circuit court as provided for under chapter 1-26.”
I certify pursuant to 1-40-27, that as an applicant, officer, director, partner, or resident general
manager of the activity or facility for which the application has been made that I; a) have not
intentionally misrepresented a material fact in applying for a permit; b) have not been convicted
of a felony or other crime of moral turpitude; c) have not habitually and intentionally violated
environmental laws of any state or the United States which have caused significant and material
environmental damage; (d) have not had any permit revoked under the environmental laws of
any state or the United States; or e) have not otherwise demonstrated through clear and
convincing evidence of previous actions that I lack the necessary good character and competency
to reliably carry out the obligations imposed by law upon me. I also certify that this application
does not substantially duplicate an application by the same applicant denied within the past five
years which denial has not been reversed by a court of competent jurisdiction. Further;
“I declare and affirm under the penalties of perjury that this claim (petition, application,
information) has been examined by me, and to the best of my knowledge and belief, is in all
things true and correct.”
Dated this ______ day of ___________________________ , 20____ .
_______________________________________________________
Applicant (print)
_______________________________________________________
Applicant (signature)
Subscribed and sworn before me this _____ day of ___________________________ , 20_____ .
_______________________________________________________
Notary Public (signature)
My commission expires: ___________________________________
(SEAL)
PLEASE ATTACH ANY ADDITIONAL INFORMATION NECESSARY TO DISCLOSE
ALL FACTS AND DOCUMENTS PERTAINING TO
SDCL 1-40-27 (1) (a) THROUGH (e).
ALL VIOLATIONS MUST BE DISCLOSED, BUT WILL NOT
AUTOMATICALLY RESULT IN THE REJECTION OF AN APPLICATION
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