"Notice of Intent - Stormwater Discharges Associated With Construction Activity Under State Pollutant Discharge Elimination System (Spdes) General Permit Gp-0-20-001" - New York

Notice of Intent - Stormwater Discharges Associated With Construction Activity Under State Pollutant Discharge Elimination System (Spdes) General Permit Gp-0-20-001 is a legal document that was released by the New York State Department of Environmental Conservation - a government authority operating within New York.

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0644089821
NOTICE OF INTENT
New York State Department of Environmental Conservation
Division of Water
625 Broadway, 4th Floor
NYR
Albany, New York 12233-3505
(for DEC use only)
Stormwater Discharges Associated with Construction Activity Under State
Pollutant Discharge Elimination System (SPDES) General Permit # GP-0-20-001
All sections must be completed unless otherwise noted. Failure to complete all items may
result in this form being returned to you, thereby delaying your coverage under this
General Permit. Applicants must read and understand the conditions of the permit and
prepare a Stormwater Pollution Prevention Plan prior to submitting this NOI. Applicants
are responsible for identifying and obtaining other DEC permits that may be required.
-IMPORTANT-
RETURN THIS FORM TO THE ADDRESS ABOVE
MUST SIGN FORM
OWNER/OPERATOR
Owner/Operator Information
Owner/Operator (Company Name/Private Owner Name/Municipality Name)
Owner/Operator Contact Person Last Name (NOT CONSULTANT)
Owner/Operator Contact Person First Name
Owner/Operator Mailing Address
City
State
Zip
-
Phone (Owner/Operator)
Fax (Owner/Operator)
-
-
-
-
Email (Owner/Operator)
FED TAX ID
-
(not required for individuals)
Page 1 of 14
0644089821
NOTICE OF INTENT
New York State Department of Environmental Conservation
Division of Water
625 Broadway, 4th Floor
NYR
Albany, New York 12233-3505
(for DEC use only)
Stormwater Discharges Associated with Construction Activity Under State
Pollutant Discharge Elimination System (SPDES) General Permit # GP-0-20-001
All sections must be completed unless otherwise noted. Failure to complete all items may
result in this form being returned to you, thereby delaying your coverage under this
General Permit. Applicants must read and understand the conditions of the permit and
prepare a Stormwater Pollution Prevention Plan prior to submitting this NOI. Applicants
are responsible for identifying and obtaining other DEC permits that may be required.
-IMPORTANT-
RETURN THIS FORM TO THE ADDRESS ABOVE
MUST SIGN FORM
OWNER/OPERATOR
Owner/Operator Information
Owner/Operator (Company Name/Private Owner Name/Municipality Name)
Owner/Operator Contact Person Last Name (NOT CONSULTANT)
Owner/Operator Contact Person First Name
Owner/Operator Mailing Address
City
State
Zip
-
Phone (Owner/Operator)
Fax (Owner/Operator)
-
-
-
-
Email (Owner/Operator)
FED TAX ID
-
(not required for individuals)
Page 1 of 14
6401089828
Project Site Information
Project/Site Name
Street Address (NOT P.O. BOX)
Side of Street
North
South
East
West
City/Town/Village (THAT ISSUES BUILDING PERMIT)
State
Zip
County
DEC Region
-
N Y
Name of Nearest Cross Street
Distance to Nearest Cross Street (Feet)
Project In Relation to Cross Street
North
South
East
West
Tax Map Numbers
Tax Map Numbers
Section-Block-Parcel
1. Provide the Geographic Coordinates for the project site. To do this, go to the
NYSDEC Stormwater Interactive Map on the DEC website at:
https://gisservices.dec.ny.gov/gis/stormwater/
Zoom into your Project Location such that you can accurately click on the centroid of
your site. Once you have located the centroid of your project site, go to the bottom
right hand corner of the map for the X, Y coordinates. Enter the coordinates into the
boxes below. For problems with the interactive map use the help function.
X Coordinates (Easting)
Y Coordinates (Northing)
-7
4
Ex. -73.749
Ex. 42.652
2. What is the nature of this construction project?
New Construction
Redevelopment with increase in impervious area
Redevelopment with no increase in impervious area
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4107089829
3. Select the predominant land use for both pre and post development conditions.
SELECT ONLY ONE CHOICE FOR EACH
Pre-Development
Post-Development
Existing Land Use
Future Land Use
FOREST
SINGLE FAMILY HOME
Number of Lots
PASTURE/OPEN LAND
SINGLE FAMILY SUBDIVISION
CULTIVATED LAND
TOWN HOME RESIDENTIAL
SINGLE FAMILY HOME
MULTIFAMILY RESIDENTIAL
SINGLE FAMILY SUBDIVISION
INSTITUTIONAL/SCHOOL
TOWN HOME RESIDENTIAL
INDUSTRIAL
MULTIFAMILY RESIDENTIAL
COMMERCIAL
INSTITUTIONAL/SCHOOL
MUNICIPAL
INDUSTRIAL
ROAD/HIGHWAY
COMMERCIAL
RECREATIONAL/SPORTS FIELD
ROAD/HIGHWAY
BIKE PATH/TRAIL
RECREATIONAL/SPORTS FIELD
LINEAR UTILITY (water, sewer, gas, etc.)
BIKE PATH/TRAIL
PARKING LOT
LINEAR UTILITY
CLEARING/GRADING ONLY
PARKING LOT
DEMOLITION, NO REDEVELOPMENT
OTHER
WELL DRILLING ACTIVITY *(Oil, Gas, etc.)
OTHER
*
Note: for gas well drilling, non-high volume hydraulic fractured wells only
4. In accordance with the larger common plan of development or sale,
enter the total project site area; the total area to be disturbed;
existing impervious area to be disturbed (for redevelopment
activities); and the future impervious area constructed within the
disturbed area. (Round to the nearest tenth of an acre.)
Future Impervious
Total Site
Total Area To
Existing Impervious
Area Within
Area
Be Disturbed
Area To Be Disturbed
Disturbed Area
.
.
.
.
Yes
No
5. Do you plan to disturb more than 5 acres of soil at any one time?
6. Indicate the percentage of each Hydrologic Soil Group(HSG) at the site.
A
B
C
D
%
%
%
%
7. Is this a phased project?
Yes
No
Start Date
End Date
8. Enter the planned start and end
/
/
/
/
-
dates of the disturbance
activities.
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8600089821
9. Identify the nearest surface waterbody(ies) to which construction site runoff will
discharge.
Name
9a.
Type of waterbody identified in Question 9?
Wetland / State Jurisdiction On Site (Answer 9b)
Wetland / State Jurisdiction Off Site
Wetland / Federal Jurisdiction On Site (Answer 9b)
Wetland / Federal Jurisdiction Off Site
Stream / Creek On Site
Stream / Creek Off Site
River On Site
9b.
How was the wetland identified?
River Off Site
Lake On Site
Regulatory Map
Lake Off Site
Delineated by Consultant
Other Type On Site
Delineated by Army Corps of Engineers
Other (identify)
Other Type Off Site
10.
Has the surface waterbody(ies) in question 9 been identified as a
Yes
No
303(d) segment in Appendix E of GP-0-20-001?
11.
Is this project located in one of the Watersheds identified in
Yes
No
Appendix C of GP-0-20-001?
12.
Is the project located in one of the watershed
areas associated with AA and AA-S classified
Yes
No
waters?
If no, skip question 13.
13.
Does this construction activity disturb land with no
existing impervious cover and where the Soil Slope Phase is
Yes
No
identified as an E or F on the USDA Soil Survey?
If Yes, what is the acreage to be disturbed?
.
14.
Will the project disturb soils within a State
Yes
No
regulated wetland or the protected 100 foot adjacent
area?
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6403089820
15.
Does the site runoff enter a separate storm sewer
system (including roadside drains, swales, ditches,
Yes
No
Unknown
culverts, etc)?
16.
What is the name of the municipality/entity that owns the separate storm sewer
system?
17.
Does any runoff from the site enter a sewer classified
Yes
No
Unknown
as a Combined Sewer?
18.
Will future use of this site be an agricultural property as
Yes
No
defined by the NYS Agriculture and Markets Law?
19.
Is this property owned by a state authority, state agency,
Yes
No
federal government or local government?
20.
Is this a remediation project being done under a Department
approved work plan? (i.e. CERCLA, RCRA, Voluntary Cleanup
Yes
No
Agreement, etc.)
21.
Has the required Erosion and Sediment Control component of the
SWPPP been developed in conformance with the current NYS
Yes
No
Standards and Specifications for Erosion and Sediment Control
(aka Blue Book)?
22.
Does this construction activity require the development of a
SWPPP that includes the post-construction stormwater management
Yes
No
practice component (i.e. Runoff Reduction, Water Quality and
Quantity Control practices/techniques)?
If No, skip questions 23 and 27-39.
23.
Has the post-construction stormwater management practice component
of the SWPPP been developed in conformance with the current NYS
Yes
No
Stormwater Management Design Manual?
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