Form ECY070-36 "Sand and Gravel Permit Portable Beginning of Operations Notice" - Washington

What Is Form ECY070-36?

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 January 1, 2018;
  • 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 fillable version of Form ECY070-36 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 ECY070-36 "Sand and Gravel Permit Portable Beginning of Operations Notice" - Washington

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Sand and Gravel General Permit
Portable Beginning of Operation Notice Form
Ecology must receive this notification form at least 10 days before you begin operating at a new
location.
Submitting this notification does not guarantee that you may begin operations on the proposed start date. Ecology
reserves the right to require additional information or the placement of best management practices before you begin
operations if this form is incomplete or environmental sensitivity is not sufficiently addressed.
Please print in ink or type all sections of this application. All fields are required unless otherwise marked.
Permit Number
1.
– Provide your permit number.
Permit Number:
2. Permittee Contact Information
3. Site Contact
– Ecology may contact this person
regarding site inspections
Organization Name – Provide the legal name of the
Site Contact First & Last Name:
business or company (Permittee) that is applying for permit
coverage:
Legal Responsible Party – Provide the first and last name
of the person who has the legal authority to represent the
Organization Name:
permittee and commit to the terms and conditions of the
permit:
E-mail:
Business Phone:
E-mail (Optional):
Business Phone:
Mailing Address:
Mailing Address:
City:
State:
Zip + 4:
City:
State:
Zip + 4:
Cell Phone (Optional):
Fax (Optional):
Cell Phone (Optional):
Fax (Optional):
4. Site Owner
Site Owner First & Last Name:
Organization Name (Optional):
Mailing Address:
City:
State:
Zip + 4:
Business Phone:
Cell Phone (Optional):
E-mail (Optional):
5. Site Management Plan
Is your Site Management Plan (including the Site Map, Stormwater Pollution Prevention Plan, Monitoring Plan, Spill
Control Plan, and Erosion and Sediment Control Plan) created, up to date, and complete for this specific site?
Yes
No
ECY 070-36 (Rev.01/18)
Sand and Gravel General Permit
Portable Beginning of Operation Notice Form
Ecology must receive this notification form at least 10 days before you begin operating at a new
location.
Submitting this notification does not guarantee that you may begin operations on the proposed start date. Ecology
reserves the right to require additional information or the placement of best management practices before you begin
operations if this form is incomplete or environmental sensitivity is not sufficiently addressed.
Please print in ink or type all sections of this application. All fields are required unless otherwise marked.
Permit Number
1.
– Provide your permit number.
Permit Number:
2. Permittee Contact Information
3. Site Contact
– Ecology may contact this person
regarding site inspections
Organization Name – Provide the legal name of the
Site Contact First & Last Name:
business or company (Permittee) that is applying for permit
coverage:
Legal Responsible Party – Provide the first and last name
of the person who has the legal authority to represent the
Organization Name:
permittee and commit to the terms and conditions of the
permit:
E-mail:
Business Phone:
E-mail (Optional):
Business Phone:
Mailing Address:
Mailing Address:
City:
State:
Zip + 4:
City:
State:
Zip + 4:
Cell Phone (Optional):
Fax (Optional):
Cell Phone (Optional):
Fax (Optional):
4. Site Owner
Site Owner First & Last Name:
Organization Name (Optional):
Mailing Address:
City:
State:
Zip + 4:
Business Phone:
Cell Phone (Optional):
E-mail (Optional):
5. Site Management Plan
Is your Site Management Plan (including the Site Map, Stormwater Pollution Prevention Plan, Monitoring Plan, Spill
Control Plan, and Erosion and Sediment Control Plan) created, up to date, and complete for this specific site?
Yes
No
ECY 070-36 (Rev.01/18)
7. Site Information
Site Name:
Street Address:
City:
Zip + 4:
Record Site Location at front door or site entrance – Provide latitude and longitude, expressed in decimal degrees to
six decimal places, at front door or site entrance.
° N
° W
Latitude:
Longitude:
Acreage that will be occupied by the portable operation include materials and stockpiles:
Proposed Begin Date for Portable Operations at the Site:
Proposed End Date for Portable Operation, or Date for Site Restoration (whichever is later):
8. Site Map -
Attach a copy of the site map from your Site Management Plan. See Attachment 2 for an example
site map. Your site map should be to scale and preferably 11” x 17” in size.
9. Site Restoration
Describe the site condition before setting up the portable operation (e.g. vegetated, unimproved, cleared and
leveled, paved):
Describe how the site will be changed to set up the portable operation (e.g. cleared and leveled, access road
developed, concrete footings added):
Describe what actions will be taken to restore the site when the portable operation is moved out (e.g. area
seeded, concrete footings removed):
Will the portable operate at an active construction site?
No
Yes
Who will be responsible for site restoration?
We will (portable owner / operator)
Construction Contractor
Site Owner
Other (provide explanation):
_____________________________________________________________
ECY 070-36 (Rev.01/18)
10. Ground Water Protection Designations
Is the site within a Critical Aquifer Recharge Area?
Yes
No
Is the site within a designated Wellhead Protection Area?
Yes
No
Is the site within a Sole Source Aquifer?
Yes
No
11. NAICS / Ecology Code Information
– Indicate what activities take place at the site by checking the
appropriate boxes. (See Appendix A of the Sand & Gravel General Permit for code descriptions.)
Asphalt Batch Plant (NAICS 324121)
Rock Crusher for crushing:
Bag House
Gravel (NAICS 212321)
Wet Scrubber
Limestone (NAICS 212312)
Other Stone (NAICS 212319)
Granite (NAICS 212313)
Concrete Recycle (ECY 002)
Concrete Batch Plant (NAICS 327320)
Asphalt Recycle (ECY 001)
Dry Batch
Wet Batch
Is rock washing part of the operation?
Yes
No
Will Mining or Excavating Occur?
12. Amount of Recycled Concrete (Optional)
No
Yes. Does the site have a Sand and Gravel Permit
Number (e.g. WAG50-0000)?
Approximately, how much concrete will be recycled at
the site in cubic yards per year?
Yes, provide permit number:
_____
No
3
yd
/ year
13. Estimated quantity –
provide the estimated
How much cubic yards of fragmented concrete will be
amount of product that will be produced by your portable
stored onsite at any one time for recycling purposes?
3
at the site, include units (e.g., yd
/ year):
3
yd
/ year
_____
ECY 070-36 (Rev.01/18)
14. Storm Sewer Conveyance System -
If your stormwater, process water, and/or mine dewatering water will flow through a storm drain system or
roadside ditch, provide the name of the operator of the storm sewer system and conveyance system (typically, the operator is the city or county you are located in,
e.g., Kent stormwater drainage system, 145th street ditch). Otherwise leave this blank. Storm Sewer Operator:
15. Discharge to Surface Waterbody -
Skip this section if you discharge to groundwater only.
Fill out the table below for all surface water outfalls related to your site. (Please use an extra sheet of paper if necessary.) Provide the information below for
all the point(s) where your stormwater, process water, and/or mine dewatering water enters (or has the potential to enter) into a surface waterbody. Surface waters
include but are not limited to lakes, rivers, ponds, streams, wetlands, inland waters, salt waters, and all other surface waters and water courses within the jurisdiction
of the state of Washington. See Attachment 3 for an example of how to fill out this section.
Surface Water Outfall Point Identifier: assign a name (up to 4 characters) to identify the outfall point (e.g., S001).
Surface Water Outfall Name: assign a name to identify the outfall point (e.g., Outfall to Duck Creek).
Surface Water Outfall Point Latitude and Longitude: Provide the latitude and longitude, expressed in decimal degrees to six decimal places, of the point where
your stormwater, process water, and/or mine dewatering water enters (or has the potential to enter) into a surface waterbody.
Name of Surface Waterbody: Enter the waterbody name where your stormwater, process water, and/or mine dewatering water enters (or has the potential to enter)
into a surface waterbody; even if the risk of discharge is low or limited to periods of extreme weather.
If the creek or tributary is unnamed, use a format such as “unnamed tributary to Deschutes River.”
If your discharge is to a storm sewer system, enter the name of surface water body that the storm sewer system discharges to.
If the outfall flows into a wetland (which is not a constructed wetland), mark “Wetland”.
Is the Outfall Point a Monitoring Point: Indicate which outfall point(s) from your facility will be sampled to comply with Sections S4.B.1 and S4.B.2 of the permit
monitoring requirements. If it is a monitoring point, mark “Yes”; if it is not, mark “No”.
Type of Discharge: List the discharge type (either process water, mine dewatering water, or stormwater) that apply to the outfall point. Stormwater that mixes with
process water is considered process water.
NAICS Code(s): List all NAICS and Ecology (ECY) codes that apply to the outfall point, see Section 6 for a list of codes.
Surface Water
Surface Water
Surface Water
Name of
Is the Outfall
Outfall Point
Outfall Point
Outfall Point
NAICS / ECY
Type of Discharge (Process
Surface
Surface Water
Point a
Identifier
Latitude
Longitude
Code(s)
Water, Mine Dewatering
Waterbody
Outfall Name
Monitoring
Water, or Stormwater)
(4 characters
(Decimal
(Decimal
Point?
max)
Degrees)
Degrees)
ECY 070-36 (Rev.01/18)
16. Monitoring Point Locations
Fill out the table below for all of the monitoring points (both to surface water and groundwater) on your site. (Please use an extra sheet of paper if
necessary.) Provide the information below for all of the point(s) that you sample to comply with Sections S4.B and S4.C of the permit monitoring requirements. See
Attachment 3 for an example of how to fill out this section.
Monitoring Point Identifier: assign a name (up to 4 characters) to identify the monitoring point (e.g., MP01).
Monitoring Point Name: assign a name to identify the monitoring point (e.g., Stormwater Pond 1).
Monitoring Point Latitude and Longitude: Provide the latitude and longitude, expressed in decimal degrees to six decimal places, of the point where you sample to
comply with Sections S4.B and S4.C of the permit monitoring requirements.
Discharge to Groundwater or Surface Water: Identify if the monitoring point relates to a groundwater or surface water discharge from your site.
Corresponding Surface Water Outfall Identifier: Each monitoring point that discharges to surface water must correspond with a surface water outfall listed in
Section 14. Enter the surface water outfall identifier from Section 14. You can have more than one monitoring point associated with each surface water outfall. If the
monitoring point is related to a groundwater discharge, leave this column blank or enter “N/A”.
Type of Discharge: List the discharge type (either process water, mine dewatering water, or stormwater) that apply to the monitoring point. Stormwater that mixes
with process water is considered process water.
NAICS Code(s): List all NAICS and Ecology (ECY) codes that apply to the outfall point, see Section 6 for a list of codes.
Monitoring
Monitoring
Monitoring
Discharge to
Type of Discharge
Point
Corresponding
Point Identifier
Point Latitude
Monitoring
Groundwater
(Process Water, Mine
NAICS / ECY
Longitude
Surface Water
Point Name
or Surface
Dewatering Water, or
Code(s)
(4 characters
(Decimal
Outfall Identifier
(Decimal
Water?
Stormwater)
max)
Degrees)
Degrees)
ECY 070-36 (Rev.01/18)
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