Form WPS250 "Renewal Form for a Type 2 General Aquifer Protection Permit" - Arizona

What Is Form WPS250?

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

Form Details:

  • Released on October 1, 2019;
  • The latest edition provided by the Arizona Department of Environmental Quality;
  • 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 WPS250 by clicking the link below or browse more documents and templates provided by the Arizona Department of Environmental Quality.

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Download Form WPS250 "Renewal Form for a Type 2 General Aquifer Protection Permit" - Arizona

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INSTRUCTIONS FOR RENEWING A TYPE 2
GENERAL AQUIFER
PROTECTION PERMIT
I
NSTRUCTIONS
This form allows a permittee to renew a Type 2 general permit. The renewal period for coverage under a Type 2 general permit begins
on the date the Department receives the Notice of Intent to Discharge (NOI). The permittee shall submit this application for renewal at
least 30 days before the permit date of expiration. Type 2 general permits need to be renewed in accordance with Arizona
Administrative Code R18-9-A303 or they will expire. The renewal period for each Type 2 general permit is as follows:
General
Description
Renewal Period
Permit Type
in Years
2.01
Drywells that Drain Areas Where Hazardous Substances are Used, Stored, Loaded or Treated
5
2.02
Intermediate Stockpiles at Mining Sites
7
2.03
Hydrologic Tracer Studies
2
2.04
Drywells that Drain Areas Where Motor Fuels are Used, Stored or Loaded
5
2.05
Capacity, Management, Operation, and Maintenance of a Sewage Collection System
5
2.06
Fish Hatchery Discharge to a Perennial Surface Water
5
F
EES
The renewal fee is $500.00 Standard / $1,000.00 Complex per Type 2 general permit. Only the Type 2.02 general permit will require
the $1,000 complex fee. All other Type 2 permits will require the standard fee. An additional $50 is required if the permittee listed in
the original Notice of Intent is different than the one listed on the Notice of Intent to Discharge or most recent renewal/transfer form.
SITES WITH MULTIPLE PERMITS
Sites with multiple permits must submit multiple renewal forms with the applicable fee. If a site contains more than one facility
covered by the same Type 2 general Permit and each facility is substantially similar in design, construction, and operation, the first
facility is paid at the full applicable fee $500.00 and each additional facility is half the applicable fee $250.00. For example, if a site
has three Type 2 general permits and needs to be renewed, the permittee would need to submit three Renewal Forms and a fee of
$1,000.00 Standard or $2,000.00 Complex.
WHAT HAPPENS IF MY PERMIT HAS EXPIRED
If your permit has expired, you will need to resubmit the Type 2 NOl and the NOI Supplement as a new application with the
associated fees.
HOW LONG DOES IT TAKE
As soon as you submit the renewal application you are covered by this general permit. ADEQ will send you a notice confirming
receipt of your renewal form.
Mail Form & Fees to: ADEQ Water Permits Section
LTF Clerk
1110 W. Washington
Phoenix, AZ 85007
F
WPS 250 (R
. O
2019)
Page 1 of 3
ORM
EV
CTOBER
1110 W
W
, P
, AZ 85007
EST
ASHINGTON
HOENIX
.
.
WWW
AZDEQ
GOV
INSTRUCTIONS FOR RENEWING A TYPE 2
GENERAL AQUIFER
PROTECTION PERMIT
I
NSTRUCTIONS
This form allows a permittee to renew a Type 2 general permit. The renewal period for coverage under a Type 2 general permit begins
on the date the Department receives the Notice of Intent to Discharge (NOI). The permittee shall submit this application for renewal at
least 30 days before the permit date of expiration. Type 2 general permits need to be renewed in accordance with Arizona
Administrative Code R18-9-A303 or they will expire. The renewal period for each Type 2 general permit is as follows:
General
Description
Renewal Period
Permit Type
in Years
2.01
Drywells that Drain Areas Where Hazardous Substances are Used, Stored, Loaded or Treated
5
2.02
Intermediate Stockpiles at Mining Sites
7
2.03
Hydrologic Tracer Studies
2
2.04
Drywells that Drain Areas Where Motor Fuels are Used, Stored or Loaded
5
2.05
Capacity, Management, Operation, and Maintenance of a Sewage Collection System
5
2.06
Fish Hatchery Discharge to a Perennial Surface Water
5
F
EES
The renewal fee is $500.00 Standard / $1,000.00 Complex per Type 2 general permit. Only the Type 2.02 general permit will require
the $1,000 complex fee. All other Type 2 permits will require the standard fee. An additional $50 is required if the permittee listed in
the original Notice of Intent is different than the one listed on the Notice of Intent to Discharge or most recent renewal/transfer form.
SITES WITH MULTIPLE PERMITS
Sites with multiple permits must submit multiple renewal forms with the applicable fee. If a site contains more than one facility
covered by the same Type 2 general Permit and each facility is substantially similar in design, construction, and operation, the first
facility is paid at the full applicable fee $500.00 and each additional facility is half the applicable fee $250.00. For example, if a site
has three Type 2 general permits and needs to be renewed, the permittee would need to submit three Renewal Forms and a fee of
$1,000.00 Standard or $2,000.00 Complex.
WHAT HAPPENS IF MY PERMIT HAS EXPIRED
If your permit has expired, you will need to resubmit the Type 2 NOl and the NOI Supplement as a new application with the
associated fees.
HOW LONG DOES IT TAKE
As soon as you submit the renewal application you are covered by this general permit. ADEQ will send you a notice confirming
receipt of your renewal form.
Mail Form & Fees to: ADEQ Water Permits Section
LTF Clerk
1110 W. Washington
Phoenix, AZ 85007
F
WPS 250 (R
. O
2019)
Page 1 of 3
ORM
EV
CTOBER
1110 W
W
, P
, AZ 85007
EST
ASHINGTON
HOENIX
.
.
WWW
AZDEQ
GOV
RENEWAL FORM FOR A
TYPE 2 GENERAL AQUIFER
PROTECTION PERMIT
1
Indicate which Type 2 you are renewing (check the applicable box))
2.01 Drywells that Drain Areas Where Hazardous Substances are Used, Stored, Loaded or Treated [A.A.C. R18-9-C301]
2.02 Intermediate Stockpiles at Mining Sites [A.A.C. R18-9-C302]
2.03 Hydrologic Tracer Studies [A.A.C. R18-9-C303]
2.04 Drywells that Drain Areas Where Motor Fuels are Used, Stored or Loaded [A.A.C. R18-9-C304]
2.05 Capacity, Management, Operation, and Maintenance of a Sewage Collection System [A.A.C. R18-9-C305]
2.06 Fish Hatchery Discharge to a Perennial Surface Water [A.A.C. R18-9-C306]
Permit Numbers (copy both the Inventory number and LTF number from the Notice of Recording (NOR) for the facility
you want to renew. If there are multiple facilities and LTF numbers on the NOR, use a separate Renewal Form for each
2
facility you want to renew)
3
Discharging Facility Identifying Name and Number for each facility at the site
4
Permittee
Note: An additional $50 is required if the permittee listed below is different than the one listed on the Notice of Intent to
Discharge or most recent renewal/transfer form
Name
Phone
Address
Email:
City
State
Zip
5
Name of owner/operator responsible for ensuring compliance with this permit if different from No. 4 above
Name:
Phone
Position:
Email:
Address:
______________________________________________________________________________________________
City
State
Zip
6.
Provide any information that has changed from the original Notice of Intent to Discharge
F
WPS 250 (R
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RENEWAL FORM FOR A
TYPE 2 GENERAL AQUIFER
PROTECTION PERMIT
7.
Certification of Compliance (to be completed by the Permittee)
I, ______________________, certify that this document and all attachments were prepared under my direction or supervision and
all information is, to the best of my knowledge, true, accurate and complete. I also certify that the facility described in this form is
or will be constructed, designed, and operated in accordance with the provisions of Article 3 of the Aquifer Protection Permit
rules as they pertain to this General Permit. I am aware that there are significant penalties for submitting false information,
including permit revocation as well as the possibility of fine and imprisonment for knowing violations.
Signature
Date
Pursuant to A.R.S. § 41-1030:
(1) ADEQ shall not base a licensing decision, in whole or in part, on a requirement or condition not specifically authorized by
statute or rule. General authority in a statute does not authorize a requirement or condition unless a rule is made pursuant to
it that specifically authorizes the requirement or condition.
(2) Prohibited licensing decisions may be challenged in a private civil action. Relief may be awarded to the prevailing party
against ADEQ, including reasonable attorney fees, damages, and all fees associated with the license application.
(3) ADEQ employees may not intentionally or knowingly violate the requirement for specific licensing authority. Violation is
cause for disciplinary action or dismissal, pursuant to ADEQ’s adopted personnel policy. ADEQ employees are still
afforded the immunity in A.R.S. §§ 12-821.01 and 12-820.02.
F
WPS 250 (R
. J
2019)
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1110 W
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, P
, AZ 85007
EST
ASHINGTON
HOENIX
.
.
WWW
AZDEQ
GOV
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