Fillable Notice of Intent (NOI) for Stormwater Discharges Associated

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Notice of Intent (NOI) for Stormwater Discharges Associated

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DHEC 2611 (01/2011)
SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL
Submission of this Notice of Intent constitutes notice that the party identied in Section A of this form intends to be authorized by a NP-
DES permit issued for storm water discharges associated with industrial activity in a State location identied in Section B of this form.
Becoming a permittee obligates such a discharge to comply with the terms and conditions of the permit. ALL NECESSARY INFORMA-
TION MUST BE PROVIDED ON THIS FORM. AN ANNUAL FEE OF $75 IS REQUIRED FOR COVERAGE UNDER THIS PERMIT.
Date: __ __/__ __/__ __ __ __
Facility Operator InformationA.
1. Name: ____________________________________________________________________________________
2. Company EIN: __ __ - __ __ __ __ __ __ __ Phone: __ __ __-__ __ __-__ __ __ __ Fax: __ __ __-__ __ __-__ __ __
3. Mailing Address: ____________________________________________________________________________
City: __________________________________________ State: __ __ Zip: __ __ __ __ __
4. Facility Contact: ________________________________ Phone: __ __ __-__ __ __-__ __ __ __Ext. _________
5. Facility Contact Email address: _________________________________________________________________
6. Facility Billing Address (If different from Mailing address): ____________________________________________
City: _________________________________________ State: __ __ Zip: __ __ __ __ __
Facility InformationB.
1. Facility Name:
2.
Are stormwater discharges from your facility covered under the Industrial Stormwater General Permit?
o Yes o No
If yes, provide your coverage number: __________ SCR00 __ __ __ __
3. Facility Location:
a. Street:
b. City:
c. County: Zip Code
d. Latitude: __ __°__ __’__ __” N e. Longitude: -__ __°__ __’__ __” W
e. Lat/Long Data Source: o USGS topographic map o GPS o website:
f. Estimated area of industrial activity at your site exposed to stormwater: (acres)
g. Is this a Federal facility? o Yes o No
h. Is this facility located on Indian lands? o Yes o No If yes, name: ________________________________
C. Discharge Information
Does your facility discharge stormwater to a permitted Municipal Separate Storm Sewer System (MS4)?
1.
o Yes
o No
If yes, name of MS4 operator:
2. Does your facility have stormwater discharges that are mixed with non-stormwater discharges covered under
another NPDES permit? o Yes o No If yes, provide permit number(s):
3. Receiving Waters (if additional space is needed for this question, ll out Attachment 1)
a. What are the names of your receiving waters
that receive stormwater from your facility and/or
through an MS4?
b. Distance to receiving waters c. Classication of receiving waters
4. Impaired waters found on the most current 303(d) List of Impaired Waters (use the table below for only those waters
found on the most current 303(d) List of Impaired Waters – if additional space is needed for this question, ll out Attachment 1)
a. Name of Impaired Water
(303(d) Listed)
b. Name of Impaired Water
Quality Monitoring Stations
(WQMS) that receives storm-
water from your facility and/or
through an MS4?
c. What pollutants are causing
the impairment?
d. Are the pollutants causing
the impairment present in your
discharge?
o
Yes
o
No
o
Yes
o
No
o
Yes
o
No
o
Yes
o
No
Notice of Intent (NOI) for Stormwater Discharges Associated with
Industrial Activities (Except Construction)
NPDES General Permit SCR000000
DHEC 2611 (01/2011)
5. Impaired waters with an EPA approved or established TMDL (use the table below for only those waters covered under
an EPA approved or established TMDL – if additional space is needed for this question, ll out Attachment 1)
a. Name of Impaired Water
covered by a EPA approved or
established TMDL
b. Name of Impaired Water
Quality Monitoring Stations
(WQMS) that receive storm-
water from your facility and/or
through an MS4?
c. What pollutants are listed in
the TMDLs for this waterbody?
d. Are the pollutants causing
the impairment present in your
discharge?
o Yes o No
o Yes o No
o Yes o No
o Yes o No
6. Efuent Limitation Guidelines and Sector-Specic Requirements
a. Is this facility subject to the efuent limitation guidelines found in SCR000000? o Yes o No
b. If yes, identify in the table below which efuent limitation guidelines apply to your stormwater discharges?
40 CFR Part/Subpart Eligible Discharges Affected IGP Sector Check if Applicable
Part 411, Subpart C
Runoff from material storage piles at cement
manufacturing facilities
E
o
Part 418 Subpart A
Runoff from phosphate fertilizer
manufacturing facilities that comes into
contact with any raw materials, nished
product, by-products or waste products (SIC
2874)
C
o
Part 423
Coal pile runoff at steam electric generating
facilities
O
o
Part 429, Subpart I
Discharges resulting from spray down or
intentional wetting of logs at wet deck stor-
age areas
A
o
Part 443, Subpart A Runoff from asphalt emulsion facilities D
o
Part 445, Subparts A & B
Runoff from hazardous waste and non-haz-
ardous waste landlls
K, L
o
7. If you are a Sector S (Air Transportation) facility, do you anticipate using more than 100,000 gallons of glycol-
based deicing/ anti-icing chemicals and/or 100 tons or more of urea on an average annual basis?
o Yes o No o N/A
8. Identify the applicable SIC Code(s), Sector(s) and Subsector(s) of industrial activity, including co-located industrial
activity, for which you are requesting permit coverage. List your facility’s primary SIC Code in Line a:
a. SIC Code: _ _ _ _ Sector _ _ Subsector _ _ b. SIC Code: _ _ _ _ Sector _ _ Subsector _ _
c. SIC Code: _ _ _ _ Sector _ _ Subsector _ _ d. SIC Code: _ _ _ _ Sector _ _ Subsector _ _
e. SIC Code: _ _ _ _ Sector _ _ Subsector _ _ f. SIC Code: _ _ _ _ Sector _ _ Subsector _ _
D. NOI Preparer
1. Prepared by: ________________________________________ Company: ______________________________
2. Mailing Address:
3. City: State: __ __ Zip: __ __ __ __ __
4. Phone: Ext. E-mail:
E. Certier Name and Title
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision
in accordance with a system designed to assure that qualied personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly
responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are signicant penalties for submitting false information, including the
possibility of ne and imprisonment for knowing violations
(See Section 122.22 of S.C. Reg. 61-9 for signatory
authority information.)
Printed Name: Title:
Signature: Date:
o Check here if you wish to make payment with a credit card. The Department will contact you to obtain the credit card’s
information.
INSTRUCTIONS
If you are uncertain whether you need to obtain coverage under the NPDES General Permit for Stormwater Discharges
Associated with Industrial Activities (Except Construction), SCR000000 (IGP), if you cannot access the websites listed
in these instructions, or if you have any other questions, contact the Bureau of Water Stormwater Permitting Section at
(803) 898-4300. Please see the Bureau of Water, Stormwater Permitting website (http://www.scdhec.gov/stormwater)
for guidance and additional information regarding the IGP.
Where To File the NOI:
SC Department of Health & Environmental Control
Bureau of Water
Stormwater Permitting Section
2600 Bull Street
Columbia, SC 29201-1708
Fees:
An application fee of $75 is required. Make check payable to S.C. DHEC or indicate in Section E if you wish to pay via
credit card using the DHEC’s online payment system. Please do not send fees directly to DHEC’s Bureau of Finance.
Section A:
Give the legal name of the rm, public organization, or any other entity that operates the facility described in this applica-
tion. The name of the operator may or may not be the same name as the facility. The operator of the facility is the legal
entity that controls the facility’s operation.
The Company EIN is the Employer Identication Number as established by the U.S. Internal Revenue Service and is
commonly referred to as the taxpayer ID. The Company EIN must be for the company listed as the facility operator. If
the company does not have an EIN (e.g., single member LLC, sole proprietorship), DO NOT list a Social Security Num-
ber. Put “not applicable” instead.
The Facility Billing Address will be the address to which the Department will send annual invoices.
Section B:
Enter the facility’s legal name and complete address. If the facility has had previous coverage, enter the
coverage number in the appropriate blanks in B.2. The four blanks provided should be lled with numbers 0
through 9. If the facility lacks a street address, list the road name(s) on which the site is located, the nearest
intersection, or other detailed description of the site location.
Latitude (from 32° to 35°) and longitude (-78° to -83°) should be for the center of the site. Minutes (’) and
seconds (”) should be from 0 to 59.
For the area of industrial activity exposed to stormwater, if this is unknown, use the size of the site.
Section C:
Permitted Municipal Separate Storm Sewer Systems (MS4) can be found at:
http://www.scdhec.gov/environment/water/swnsms4.htm . Review the lists to see if your site falls into one of
the urbanized areas.
Per 1.1.4.1 of the permit, the IGP does not cover the types of discharges requested in Item C.2. Please
include all applicable NPDES permit numbers.
The receiving waterbody (RWB) is the Waters of the State (WoS—see denition in §122.2 of S.C. Regulation
61-9— http://www.scdhec.gov/environment/water/regs/r61-9.pdf) to which the site’s stormwater discharges
will drain. The RWB must be listed in reference to a named waterbody if the RWB is unnamed. For example,
if the site’s stormwater discharges drain to a stream on the site, then the nearest RWB would be the stream.
If the stream is not named, then determine the nearest named waterbody (e.g., Grove Creek) into which the
stream will ow and list the nearest RWB as a tributary to the named waterbody (e.g., Tributary to Grove
DHEC 2611 (01/2011)
Creek). Then, the next/ nearest named RWB would be Grove Creek. If the site’s stormwater discharges drain
to multiple waterbodies, then list all such waterbodies. The classications of the RWB are found in S.C.
Regulation 61-69 (http://www.scdhec.gov/environment/water/regs/r61-69.pdf). If a RWB is unnamed, then
search the document for the nearest named RWB. If the nearest, named RWB is not listed, then continue
searching the document for the next, named waterbody, proceeding downstream from the site. For example,
a site in Anderson County drains to a tributary of Hornbuckle Creek, then to Hornbuckle Creek, then to Middle
Branch, and then to Brushy Creek/ Big Brushy Creek. First, search the document for Hornbuckle Creek, then
Middle Branch, then Brushy Creek until one of the RWB appears. In this example Brushy Creek is the rst
classied waterbody and has the classication of “FW—Freshwaters.” Therefore, the classication of the
tributary to Hornbuckle Creek is FW. Use attachment 1, if necessary.
For C.4. see the following website for the most current 303(d) List for Impaired Waters and related
information: http://www.scdhec.gov/environment/water/tmdl/index.htm - 303d. The 303(d) list is available
in Microsoft Excel and Adobe Reader formats. Maps showing WQMS locations are available for each
watershed at this website as well. To search the 303(d) List to determine whether a WQMS is listed, select
“Edit” from the top toolbar of your web browser. Then, select “Find.” Enter the WQMS exactly as listed on
the map and hit enter. If none of the WQMS(s) are found, then put “Not Applicable” in C.4.a. If a WQMS is
found, list the cause(s) of the impairment (see last column labeled “CAUSE”) in C.4.c. Use attachment 1, if
necessary.
For the impairment “bio,” DO NOT answer C.4.d. An impairment of the macroinvertebrates or biology of any
given waterbody is an effect based on other pollutants. As referenced in 6.2.4.1.d. of the IGP, until an EPA
approved/established Total Maximum Daily Load (TMDL) species the pollutant(s) of concern, there is no way
to denitively answer C.4.d.
For C.5. see the following website for a list of Approved S.C. TMDLs:
http://www.scdhec.gov/environment/water/tmdl/tmdlsc.htm The TMDLs are categorized on this site
alphabetically, by pollutant of concern, and by watershed for ease of searching. As in item C.4 above, to
search these lists, select “Edit” from the top toolbar of your web browser. Then, select “Find.” These lists
are updated roughly every two years and should be reviewed for changes periodically. Use attachment 1, if
necessary.
For C.8. refer to Part 8 of the IGP or Appendix D for a tabular summary. If you are unable to determine your
SIC code(s), refer to the following link:(http://www.osha.gov/pls/imis/sic_manual.html)
Section D:
A South Carolina registered Professional Engineer is NOT required to complete this NOI or to prepare the
Stormwater Pollution Prevention Plan (SWPPP). The NOI Preparer can be the same as the Facility Contact
as requested in A.4.
Section E:
DO NOT SIGN IN BLACK INK! The NOI submitted to DHEC must have original signatures. If the Operator
is a company, print the name of the person who is signing the NOI. A person with signatory authority for the
Operator must sign the application. The SWPPP Preparer cannot sign the application for the Operator. See
below for a summary and §122.22 of S.C. Reg. 61-9 for complete information about signatory authority
requirements.
Corporation: A responsible corporate ofcer (e.g., president, vice-president, certain managers)•
Partnership or Sole Proprietorship: A general partner or the proprietor, respectively•
Municipality, State, Federal or Other Public Agency: Principal executive ofcer or ranking elected•
ofcial
DHEC 2611 (01/2011)
Notice of Intent (NOI) for Stormwater Discharges Associated with
Industrial Activities (Except Construction)
NPDES General Permit SCR000000
Attachment 1
3. Receiving Waters
a. What are the names of your receiving waters that
receive stormwater from your facility and/or through
an MS4?
b. Distance to receiving waters c. Classication of receiving waters
4. Impaired waters found on the most current 303(d) List of Impaired Waters (use the table below for only those waters
found on the most current 303(d) List of Impaired Waters)
a. Name of Impaired Water
(303(d) Listed)
b. Name of Impaired Water
Quality Monitoring Stations
(WQMS) that receives storm-
water from your facility and/or
through an MS4?
c. What pollutants are causing
the impairment?
d. Are the pollutants causing
the impairment present in your
discharge?
o Yes o No
o Yes o No
o Yes o No
o Yes o No
o Yes o No
o Yes o No
o Yes o No
5. Impaired waters with an EPA approved or established TMDL (use the table below for only those waters covered under an
EPA approved or established TMDL)
a. Name of Impaired Water
covered by a EPA approved or established
TMDL
b. Name of Impaired Water
Quality Monitoring Stations
(WQMS) that receive storm-
water from your facility and/or
through an MS4?
c. What pollutants are listed in
the TMDLs for this water?
d. Are the pollutants causing
the impairment present in your
discharge?
o Yes o No
o Yes o No
o Yes o No
o Yes o No
o Yes o No
o Yes o No
o Yes o No
DHEC 2611 (01/2011)
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Completed 19 October 2020

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