Permit_NPDES_NOI.pdf

NPDES

FORM

3510-9

UNITED STATES ENVIRONMENTAL PROTECTION AGENCY

WASHINGTON, DC 20460

NOTICE OF INTENT (NOI) FOR STORMWATER DISCHARGES

ASSOCIATED WITH CONSTRUCTION ACTIVITY UNDER AN

NPDES GENERAL PERMIT

Form Approved.

OMB Nos. 2040-0004

Submission of this Notice of Intent (NOI) constitutes notice that the operator identified in Section II of this form requests authorization to discharge pursuant to the NPDES Construction General Permit (CGP) permit number identified in Section I of this form. Submission of this NOI also constitutes notice that the operator identified in Section II of this form meets the eligibility requirements of Parts 1.1 and 1.2 of the CGP for the project identified in Section III of this form. Permit coverage is required prior to commencement of construction activity until you are eligible to terminate coverage as detailed in Part 8 of the CGP. To obtain authorization, you must submit a complete and accurate NOI form. Discharges are not authorized if your NOI is incomplete or inaccurate or if you were never eligible for permit coverage.

Refer to the instructions at the end of this form.

I. Approval to Use Paper NOI Form

Yes NOHave you been given approval from the Regional Office to use this paper NOI form*?

If yes, provide the reason you need to use this paper form, the name of the EPA Regional Office staff person who approved your use of this form, and the date of approval:

Reason for using paper form:

Name of EPA staff person:

Date approval obtained:

* Note: You are required to obtain approval from the applicable Regional Office prior to using this paper NOI form.

II. Permit Information: Tracking Number (EPA Use Only) DCR12A325

Permit Number: DCR120000 (see Appendix B of the CGP for the list of eligible permit numbers)

III. Operator Information

Name: Federal Highway Administration

Phone: (571) 434-1541 Fax (Optional):

Email: Kevin.Rose@dot.gov

IRS Employer Identification Number (EIN): 22-3934584

Point of Contact (First Name, Middle Initial, Last Name): Kevin Rose

Mailing Address:

Street: 21400 Ridgetop Circle

City: Sterling State: VA Zip: 20166

NOI Preparer (Complete if NOI was prepared by someone other than the certifier):

Prepared by (First Name, Middle Initial, Last Name): Lisa Landers

Organization: FEDERAL HIGHWAY ADMINISTRATION, EASTERN FEDERAL LANDS HIGHWAY DIVISION

Phone: (571) 434-1592 Fax (Optional):

E-mail: lisa.landers@dot.gov

Status: Submitted To EPAEPA Form 3510-9 Page: 1 of 4

IV. Project/Site Information

U.S.G.S topographical map EPA Web Site GPS Other: Google Earth

NAD 27 NAD 83 or WGS 84 Unknown

Yes No

Yes No

Yes No

Yes No

Yes No

Project/Site Name: PRA-ROCR 10(5)

Project/Site Address:

Street/Location: Beach Drive

City: District of Columbia State: DC Zip: 00000

County or similar government subdivision: District of Columbia

For the project/site for which you are seeking permit coverage, provide the following information:

Latitude/Longitude (Use one of three possible formats, and specify method)

Latitude 1. 38,55,3 N(degrees, minutes, seconds) Longitude 1. 77,2,28 W(degrees, minutes, seconds)

2. _________ N(degrees, minutes, decimal) 2. _________ W(degrees, minutes, decimal)

3. _________ N(degrees, decimals) 3. _________ W(degrees, decimals)

Latitude/Longitude Data Source:

If you used a U.S.G.S. topographic map, what was the scale?

Horizontal Reference Datum:

Is your project located in Indian Country lands?

If yes, provide the name of the Indian tribe associated with the area of Indian country (including name of Indian reservation, if applicable), or if not in Indian country, provide the name of the Indian tribe associated with the property:

Are you requesting coverage under this NOI as a "federal operator" as defined in Appendix A?

Estimated Project Start Date: 03/01/2016 Estimated Project Completion Date: 03/31/2019

Estimated Area to be Disturbed (to the nearest quarter acre): 6.0

Have earth-disturbing activities commenced on your project/site?

If yes, is your project an emergency-related project?

Have stormwater discharges from your project/site been covered previously under an NPDES permit?

If yes, provide the Tracking Number if you had coverage under EPA's CGP or the NPDES permit number if you had coverage under an EPA individual permit:

V. Discharge Information

Yes No

Yes No

Does your project/site discharge stormwater into a Municipal Separate Storm Sewer System (MS4)?

Are there any surface waters within 50 feet of your project's earth disturbances?

Receiving Waters and Wetlands Information: (Attach a separate list if necessary)

Surface water(s) to which discharge

Impaired Water Listed Water Pollutant(s) Tier 2, 2.5 or 3 Source TMDL Name and Pollutant

Rock Creek Yes CAUSE UNKNOWN -

IMPAIRED BIOTA

FLOW ALTERATION(S)

MERCURY

METALS (OTHER THAN

MERCURY)

POLYCHLORINATED

BIPHENYLS (PCBS)

SEDIMENT

TOXIC ORGANICS

No 303(d) List

Describe the methods you used to complete the above table: Please refer to the Source(s) in the above table.

Status: Submitted To EPAEPA Form 3510-9 Page: 2 of 4

VI. Chemical Treatment Information

Yes No

Yes No

Yes No

Will you use polymers, flocculants, or other treatment chemicals at your construction site?

If yes, will you use cationic treatment chemicals* at your construction site?

If yes, have you been authorized to use cationic treatment chemicals by your applicable EPA Regional Office in advance of filing your NOI*?

If you have been authorized to use cationic treatment chemicals by your applicable EPA Regional Office, attach a copy of your authorization letter and include documentation of the appropriate controls and implementation procedures designed to ensure that your use of cationic treatment chemicals will not lead to a violation of water quality standards.

Please indicate the treatment chemicals that you will use:

* Note: You are ineligible for coverage under this permit unless you notify your applicable EPA Regional Office in advance and the EPA office authorizes coverage under this permit after you have included appropriate controls and implementation procedures designed to ensure that your use of cationic treatment chemicals will not lead to a violation of water quality standards.

VII. Stormwater Pollution Prevention Plan (SWPPP) Information

Yes NoHas the SWPPP been prepared in advance of filing this NOI?

SWPPP Contact Information:

First Name, Middle Initial, Last Name: Kevin Rose

Organization: FHWA-EFLHD

Phone: (571) 434-1541 Fax (Optional): (571) 434-1577

E-mail: Kevin.Rose@dot.gov

VIII. Endangered Species Protection

A B C D E F

Using the instructions in Appendix D of the CGP, under which criterion listed in Appendix D are you eligible for coverage under this permit (only check 1 box)?

Provide a brief summary of the basis for criterion selection listed in Appendix D (e.g., communication with U.S. Fish and Wildlife Service or National Marine Fisheries Service, specific study):Determination made by National Park Service

If you select criterion B, provide the Tracking Number from the other operator's notification of authorization under this permit:

If you select criterion C, you must attach a copy of your site map (see Part 7.2.6 of the permit), and you must answer the following questions:

What federally-listed species or federally-designated critical habitat are located in your "action area":

What is the distance between your site and the listed species or critical habitat (miles):

If you select criterion D, E, or F, attach copies of any letters or other communications between you and the U.S. Fish and Wildlife Service or National Marine Fisheries Service.

IX. Historic Preservation

Yes No

Yes No

Yes No

Yes No

Yes No

Is your project/site located on a property of religious or cultural significance to an Indian tribe?

If yes, provide the name of the Indian tribe associated with the property:

Are you installing any stormwater controls as described in Appendix E that require subsurface earth disturbance? (Appendix E, Step 1)

If yes, have prior surveys or evaluations conducted on the site have already determined historic properties do not exist, or that prior disturbances have precluded the existence of historic properties? (Appendix E, Step 2)

If no, have you determined that your installation of subsurface earth-disturbing stormwater controls will have no effect on historic properties? (Appendix E, Step 3)

If no, did the SHPO, THPO, or other tribal representative (whichever applies) respond to you within the 15 calendar days to indicate whether the subsurface earth disturbances caused by the installation of stormwater controls affect historic properties? (Appendix E, Step 4)

If yes, describe the nature of their response:

Status: Submitted To EPAEPA Form 3510-9 Page: 3 of 4

Written indication that adverse effects to historic properties from the installation of stormwater controls can be mitigated by agreed upon actions.

No agreement has been reached regarding measures to mitigate effects to historic properties from the installation of stormwater controls.

Other: ____

X. Certification Information

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 gathered and evaluated 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.

First Name, Middle Initial, Last Name: Kevin Rose

Title: Environmental Team Leader

Signature: Date: Friday, June 5, 2015

E-mail: Kevin.Rose@dot.gov

Status: Submitted To EPAEPA Form 3510-9 Page: 4 of 4

From: noreply@epa.gov To: Landers, Lisa (FHWA) Cc: Rose, Kevin (FHWA); cgp@epa.gov Subject: Construction General Permit NOI Certification Complete Date: Friday, June 05, 2015 2:17:03 PM Attachments: Attachment - 1.pdf

Attachment - 2.pdf

Company: Federal Highway Administration ATTN: Kevin Rose Beach Drive District of Columbia DC 00000

Project/Site: PRA-ROCR 10(5) Beach Drive District of Columbia DC 00000

Permit Tracking Number: DCR12A325

Thank you for using the eNOI system to prepare your Construction General Permit (CGP) Notice of Intent (NOI).

This correspondence acknowledges that you have submitted a complete NOI form to be covered under EPA''s 2012 CGP. Your NOI has been assigned permit tracking number DCR12A325 Coverage under this permit begins at the conclusion of your 14-day waiting period on Friday, June 19, 2015, unless you are otherwise notified that a hold has been placed on your permit authorization. You will receive an email informing you of the date your coverage under the CGP is active.

If you have any questions, please call the EPA NOI Processing Center at 1-866-352- 7755 (toll free) or send an email to noi@avanticorporation.com.

EPA NOI Processing Center Operated by Avanti Corporation 1200 Pennsylvania Ave., NW Mail Code: 4203M Washington, DC 20460 mailto:noreply@epa.gov mailto:Lisa.Landers@dot.gov mailto:Kevin.Rose@dot.gov mailto:cgp@epa.gov

Company: Federal Highway Administration ATTN: Kevin Rose Beach Drive District of Columbia DC 00000

Project/Site: PRA-ROCR 10(5) Beach Drive District of Columbia DC 00000

Permit Tracking Number: DCR12A325

Thank you for using the eNOI system to prepare your Construction General Permit (CGP) Notice of Intent (NOI).

This correspondence acknowledges that you have submitted a complete NOI form to be covered under EPA''s 2012 CGP. Your NOI has been assigned permit tracking number DCR12A325 Coverage under this permit begins at the conclusion of your 14-day waiting period on Friday, June 19, 2015, unless you are otherwise notified that a hold has been placed on your permit authorization. You will receive an email informing you of the date your coverage under the CGP is active.

If you have any questions, please call the EPA NOI Processing Center at 1-866-352-7755 (toll free) or send an email to noi@avanticorporation.com.

EPA NOI Processing Center Operated by Avanti Corporation 1200 Pennsylvania Ave., NW Mail Code: 4203M Washington, DC 20460

NPDES

FORM

3510-9

UNITED STATES ENVIRONMENTAL PROTECTION AGENCY

WASHINGTON, DC 20460

NOTICE OF INTENT (NOI) FOR STORMWATER DISCHARGES

ASSOCIATED WITH CONSTRUCTION ACTIVITY UNDER AN

NPDES GENERAL PERMIT

Form Approved.

OMB Nos. 2040-0004

Submission of this Notice of Intent (NOI) constitutes notice that the operator identified in Section II of this form requests authorization to discharge pursuant to the NPDES Construction General Permit (CGP) permit number identified in Section I of this form. Submission of this NOI also constitutes notice that the operator identified in Section II of this form meets the eligibility requirements of Parts 1.1 and 1.2 of the CGP for the project identified in Section III of this form. Permit coverage is required prior to commencement of construction activity until you are eligible to terminate coverage as detailed in Part 8 of the CGP. To obtain authorization, you must submit a complete and accurate NOI form. Discharges are not authorized if your NOI is incomplete or inaccurate or if you were never eligible for permit coverage.

Refer to the instructions at the end of this form.

I. Approval to Use Paper NOI Form

Yes NOHave you been given approval from the Regional Office to use this paper NOI form*?

If yes, provide the reason you need to use this paper form, the name of the EPA Regional Office staff person who approved your use of this form, and the date of approval:

Reason for using paper form:

Name of EPA staff person:

Date approval obtained:

* Note: You are required to obtain approval from the applicable Regional Office prior to using this paper NOI form.

II. Permit Information: Tracking Number (EPA Use Only) DCR12A325

Permit Number: DCR120000 (see Appendix B of the CGP for the list of eligible permit numbers)

III. Operator Information

Name: Federal Highway Administration

Phone: (571) 434-1541 Fax (Optional):

Email: Kevin.Rose@dot.gov

IRS Employer Identification Number (EIN): 22-3934584

Point of Contact (First Name, Middle Initial, Last Name): Kevin Rose

Mailing Address:

Street: 21400 Ridgetop Circle

City: Sterling State: VA Zip: 20166

NOI Preparer (Complete if NOI was prepared by someone other than the certifier):

Prepared by (First Name, Middle Initial, Last Name): Lisa Landers

Organization: FEDERAL HIGHWAY ADMINISTRATION, EASTERN FEDERAL LANDS HIGHWAY DIVISION

Phone: (571) 434-1592 Fax (Optional):

E-mail: lisa.landers@dot.gov

Status: Submitted To EPAEPA Form 3510-9 Page: 1 of 4

IV. Project/Site Information

U.S.G.S topographical map EPA Web Site GPS Other: Google Earth

NAD 27 NAD 83 or WGS 84 Unknown

Project/Site Name: PRA-ROCR 10(5)

Project/Site Address:

Street/Location: Beach Drive

City: District of Columbia State: DC Zip: 00000

County or similar government subdivision: District of Columbia

For the project/site for which you are seeking permit coverage, provide the following information:

Latitude/Longitude (Use one of three possible formats, and specify method)

Latitude 1. 38,55,3 N(degrees, minutes, seconds) Longitude 1. 77,2,28 W(degrees, minutes, seconds)

2. _________ N(degrees, minutes, decimal) 2. _________ W(degrees, minutes, decimal)

3. _________ N(degrees, decimals) 3. _________ W(degrees, decimals)

Latitude/Longitude Data Source:

If you used a U.S.G.S. topographic map, what was the scale?

Horizontal Reference Datum:

Is your project located in Indian Country lands?

If yes, provide the name of the Indian tribe associated with the area of Indian country (including name of Indian reservation, if applicable), or if not in Indian country, provide the name of the Indian tribe associated with the property:

Are you requesting coverage under this NOI as a "federal operator" as defined in Appendix A?

Estimated Project Start Date: 03/01/2016 Estimated Project Completion Date: 03/31/2019

Estimated Area to be Disturbed (to the nearest quarter acre): 6.0

Have earth-disturbing activities commenced on your project/site?

If yes, is your project an emergency-related project?

Have stormwater discharges from your project/site been covered previously under an NPDES permit?

If yes, provide the Tracking Number if you had coverage under EPA's CGP or the NPDES permit number if you had coverage under an EPA individual permit:

V. Discharge Information

Does your project/site discharge stormwater into a Municipal Separate Storm Sewer System (MS4)?

Are there any surface waters within 50 feet of your project's earth disturbances?

Receiving Waters and Wetlands Information: (Attach a separate list if necessary)

Surface water(s) to which discharge

Impaired Water Listed Water Pollutant(s) Tier 2, 2.5 or 3 Source TMDL Name and Pollutant

Rock Creek Yes CAUSE UNKNOWN -

IMPAIRED BIOTA

FLOW ALTERATION(S)

MERCURY

METALS (OTHER THAN

MERCURY)

POLYCHLORINATED

BIPHENYLS (PCBS)

SEDIMENT

TOXIC ORGANICS

No 303(d) List

Describe the methods you used to complete the above table: Please refer to the Source(s) in the above table.

Status: Submitted To EPAEPA Form 3510-9 Page: 2 of 4

VI. Chemical Treatment Information

Will you use polymers, flocculants, or other treatment chemicals at your construction site?

If yes, will you use cationic treatment chemicals* at your construction site?

If yes, have you been authorized to use cationic treatment chemicals by your applicable EPA Regional Office in advance of filing your NOI*?

If you have been authorized to use cationic treatment chemicals by your applicable EPA Regional Office, attach a copy of your authorization letter and include documentation of the appropriate controls and implementation procedures designed to ensure that your use of cationic treatment chemicals will not lead to a violation of water quality standards.

Please indicate the treatment chemicals that you will use:

* Note: You are ineligible for coverage under this permit unless you notify your applicable EPA Regional Office in advance and the EPA office authorizes coverage under this permit after you have included appropriate controls and implementation procedures designed to ensure that your use of cationic treatment chemicals will not lead to a violation of water quality standards.

VII. Stormwater Pollution Prevention Plan (SWPPP) Information

Yes NoHas the SWPPP been prepared in advance of filing this NOI?

SWPPP Contact Information:

First Name, Middle Initial, Last Name: Kevin Rose

Organization: FHWA-EFLHD

Phone: (571) 434-1541 Fax (Optional): (571) 434-1577

VIII. Endangered Species Protection

A B C D E F

Using the instructions in Appendix D of the CGP, under which criterion listed in Appendix D are you eligible for coverage under this permit (only check 1 box)?

Provide a brief summary of the basis for criterion selection listed in Appendix D (e.g., communication with U.S. Fish and Wildlife Service or National Marine Fisheries Service, specific study):Determination made by National Park Service

If you select criterion B, provide the Tracking Number from the other operator's notification of authorization under this permit:

If you select criterion C, you must attach a copy of your site map (see Part 7.2.6 of the permit), and you must answer the following questions:

What federally-listed species or federally-designated critical habitat are located in your "action area":

What is the distance between your site and the listed species or critical habitat (miles):

If you select criterion D, E, or F, attach copies of any letters or other communications between you and the U.S. Fish and Wildlife Service or National Marine Fisheries Service.

IX. Historic Preservation

Is your project/site located on a property of religious or cultural significance to an Indian tribe?

If yes, provide the name of the Indian tribe associated with the property:

Are you installing any stormwater controls as described in Appendix E that require subsurface earth disturbance? (Appendix E, Step 1)

If yes, have prior surveys or evaluations conducted on the site have already determined historic properties do not exist, or that prior disturbances have precluded the existence of historic properties? (Appendix E, Step 2)

If no, have you determined that your installation of subsurface earth-disturbing stormwater controls will have no effect on historic properties? (Appendix E, Step 3)

If no, did the SHPO, THPO, or other tribal representative (whichever applies) respond to you within the 15 calendar days to indicate whether the subsurface earth disturbances caused by the installation of stormwater controls affect historic properties? (Appendix E, Step 4)

If yes, describe the nature of their response:

Status: Submitted To EPAEPA Form 3510-9 Page: 3 of 4

Written indication that adverse effects to historic properties from the installation of stormwater controls can be mitigated by agreed upon actions.

No agreement has been reached regarding measures to mitigate effects to historic properties from the installation of stormwater controls.

Other: ____

X. Certification Information

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 gathered and evaluated 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.

First Name, Middle Initial, Last Name: Kevin Rose

Title: Environmental Team Leader

Signature: Date: Friday, June 5, 2015

Status: Submitted To EPAEPA Form 3510-9 Page: 4 of 4

Yes: Off

No: Off

U.S.G.S topographical map: Off

EPA Web Site: Off

GPS: Off

Other: Google Earth: 4c809

NAD 27: Off

NAD 83 or WGS 84: Off

Unknown: dcb8a

Yes1: Off

No1: No

Yesfederal: Yes

Nofederal: Off yestoearth: Off

Notoearth: No

Yestoemergency: Off

Notoemergency: No

Yestostormwater: Off

Notostormwater: No

Yestodischarge: Yes

Notodischarge: Off

Yestostormwater2: Yes

Notostormwater2: Off

Yestopolymers: Off

Notopolymers: No

Yestocationic: Off

Notocationic: Off yestoAuthorized: Off notoAuthorized: Off

Yestoswppp: Yes

Notoswppp: Off

A: A

B: Off

C: Off

D: Off

E: Off

F: Off

Yesonreligious: Off

Noonreligious: No

Yestoinstalling: Yes

Notoinstalling: Off

Yestoshpothpo: Yes

Notoshpothpo: Off

Yestoinstall: Off

Notoinstall: Off

Yestorespond: Off

Notorespond: Off dns: Off wsa: Off

Otsds: Off