38-8. 62-621.300 2b 2.pdf

DEP Form 62-621.300(2)(b) incorporated in subsection 62-621.300(2), F.A.C.

Effective 02/2015

NOTICE OF INTENT

TO USE THE GENERIC PERMIT

FOR DISCHARGE OF GROUND WATER

FROM DEWATERING OPERATIONS

(subsection 62-621.300(2), F.A.C.)

PART I INSTRUCTIONS

A. Will dewatering operations be performed as part of construction activities?

NO Continue completing this form.

YES You may elect to obtain coverage under the Generic Permit for Stormwater Discharge from Large and Small Construction Activities (CGP), DEP Form 62-621.300(4)(b), which will cover both the construction and dewatering operations.

B. This Notice of Intent (NOI) form shall be completed and submitted to the industrial wastewater program at the local DEP office as part of the request for coverage under the Generic Permit for Discharge of Ground Water from Dewatering Operations subsection 62-621.300(2)(a), F.A.C., at least 14 days prior to planned commencement of discharge. For the purposes of this generic permit, ‘dewatering operations’ means temporarily lowering the water table by draining or pumping of ground water from activities such as excavations, building foundations, vaults, trenches and aquifer performance tests for exploratory purposes. Applicants should be familiar with the rule, generic permit document and instructions before completing this NOI form. Attach additional information on separate sheets as necessary.

1. Submit this completed form and supporting documentation and the $100.00 application fee to the industrial wastewater program at the local DEP office. Electronic submittal is preferred and may be available at http://www.dep.state.fl.us/water/wastewater/iw/iw-forms.htm. To locate a local DEP office, go to:

http://www.dep.state.fl.us/secretary/dist/default.htm.

2. Checks should be payable to the Florida Department of Environmental Protection. DEP will not process this form without the appropriate fee.

3. If an item is not applicable to your project, indicate “NA” in the appropriate space provided.

PART II DEWATERING INFORMATION:

A. Is the project site currently identified as contaminated, or is there a site within 500 feet of the dewatering project identified as contaminated, by a DEP or EPA cleanup/restoration program?

You may use the Quick Links to DEP’s Contamination Locator Map (CLM) and DEP’s Institutional Controls Registry (ICR) Web Viewer to determine cleanup restoration status. You may access the CLM at: http://webapps.dep.state.fl.us/DepClnup/welcome.do, or http://ca.dep.state.fl.us/mapdirect/?focus=contamlocator. The ICR may be accessed at:

http://www.dep.state.fl.us/waste/categories/brownfields/pages/ICR.htm, or http://ca.dep.state.fl.us/mapdirect/?focus=icr

YES Continue to B.

NOS Continue to D.

Effective 02/2015

B. Has the site been remediated?

YES Continue to D.

NOS Continue to C.

C. Are the pollutants of concern (i.e. contamination) present in ground water at the dewatering project site at concentrations equal to or exceeding the surface water criteria in Rule 62-302.530?

YES Dewatering operations do not qualify for coverage under this generic permit. However, the site may qualify for coverage under Rule 62-621.300(1), F.A.C., or under an individual wastewater permit on the appropriate form listed in Rule 62-620.910, F.A.C.

NOS Continue to D.

D. Have Best Management Practices (BMPs) for this generic permit been developed or addressed in an existing BMP plan in accordance to the requirements of this generic permit. BMPs must be implemented upon commencement of the discharge

YES Continue to Part III.

NOS Your application cannot be processed until this item is complete.

NOTE: Chemical treatment is allowed as described in the Best Management Practices of the Generic Permit. However, sites that use cationic treatment chemicals are not eligible for coverage under Generic Permit for Discharge of Ground Water from Dewatering Operations unless concurrence from the applicable local DEP office is obtained in advance of the submittal of this NOI. Appropriate controls and implementation procedures designed to ensure that the use of cationic treatment chemicals will not cause or contribute to a violation of water quality standards shall be included in the site specific BMPs.

PART III DISCHARGE INFORMATION:

A. Please identify receiving surface water body.

PART IV SITE INFORMATION

A. COVERAGE STATUS:

1. Is this application for new coverage or for renewal of coverage under the generic permit? New Renewal

2. If this application is for renewal of coverage under the generic permit, provide the FLG No. FLG No:

B. NAME OF SITE:

Site Name:

Effective 02/2015

C. PERMITTEE INFORMATION:

1. Name: 2. Title (Owner, Operator, Contractor, etc.):

3. Phone No.: ( )___ - 4. Fax No.: ( )___ -

4. Email Address:

5. Street or P. O. Box:

6. City or Town: 7. State: 8. Zip Code:

D. SITE LOCATION INFORMATION:

1. Street, Route or Other Specific Identifier:

2. County:

3. City or Town: 4. State: 5. Zip Code:

6. Latitude: °_____ ′_____ ″ 7. Longitude: °_____ ____ ″ ′_

8. If records required in accordance with Part V. of DEP Document 62-621.300(2)(a), are kept off-site, please provide the physical address of site where records will be kept. Note: location must be accessible for inspection of records by the Department.

PART V CERTIFICATIONS

A. OWNER OR OPERATOR1

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 qualified 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 significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.

Name & Official Title (type or print) Signature

Telephone No. Date signed

Email Address

1 Signatory requirements are contained in Rule 62-620.305, F.A.C.