J15_NOI NPDES Permit.pdf

ADEM Form 024 Notice of Intent – NPDES General Permit Number ALR100000

(Construction Stormwater)

Pursuant to ADEM Admin. Code r. 335-6-1-.04 and the NPDES General Permit Number ALR100000, Notices of Intent for NPDES General Permit Number ALR100000 (ADEM Form 024) are currently required to be submitted electronically. ADEM’s Alabama Environmental Permitting and Compliance System (AEPACS) at https:\\adem.alabama.gov/AEPACS is now the only method available for electronic submission of such Notices of Intent.

AEPACS allows for dynamic smart forms to be developed. Therefore, ADEM Form 024 has been transformed into multiple variations suited for the specific purpose of the Notice of Intent. This form package includes the following variations of this form in human readable format:

1. Construction Stormwater (ALR100000) - NOI - New (Form 024)

2. Construction Stormwater (ALR100000) - NOI - Information Update

(Form 024)

3. Construction Stormwater (ALR100000) - NOI - Modification/Transfer

(Form 024)

4. Construction Stormwater (ALR100000) - NOI - Reissuance (Form 024)

Applicants may apply for a waiver from electronic submittal of this form in accordance with ADEM Admin. Code r. 335-6-1-.04(6), but a hardcopy submittal of ADEM Form 024 may not be accepted unless the Department first approves such waiver. The hardcopy form is also include at the end of this form package. There are differences between the electronic versions of the forms due to the availability of conditionality and the ability to prefill data fields.

https://adem.alabama.gov/aepacs kara.malone Typewritten Text Attachment J15 NOI NPDES Permit 2 May 2023

Construction Stormwater (ALR100000) - NOI - New (Form 024) Notice of Intent – Construction Stormwater General Permit Number ALR100000 (Form 024)

NPDES permit ALR100000 is a general permit authorizing discharges associated with construction activities that will result in land disturbance equal to or greater than one (1) acre or from construction activities involving less than one (1) acre which are part of a larger common plan of development or sale equal to or greater than one (1) acre.

Priority Construction Site means any site that discharges to a waterbody which is listed on the most recent EPA approved 303(d) list of impaired waters for turbidity, siltation, or sedimentation, any waterbody with for which a TMDL has been finalized or approved by EPA for turbidity, siltation or sedimentation, any waterbody assigned the Outstanding Alabama Water use classification in accordance with ADEM Admin Code r. 335-6-10-.09, or any waterbody assigned a special designation in accordance with ADEM Admin Code r. 335-6-10-.10.

Please click here for the Alabama 303(d) list of Impaired Waters

Please click here for Information on Alabama TMDLs

Please click here for the permit fee schedule

Instructions

If your site meets the definition of a Priority Construction Site, a complete and comprehensive CBMPP must be attached to the application submittal. Click here for an ADEM CBMPP template.

Please complete all questions and attach all necessary documentation as prompted throughout the application process. Incomplete or incorrect information will delay processing.

***APPLICATION WILL NOT BE PROCESSED UNTIL FULL PAYMENT IS RECEIVED***

CONTACT INFORMATION

Main Address

Alabama Department of Environmental Management Water Division Stormwater Management Branch Post Office Box 301463 Montgomery, Alabama 36130-1463

CONTACTS

Phone : 334-271-7836

E-mail : cswmail@adem.alabama.gov

ADDITIONAL LINKS

Please click here for area assignments and contact information for Construction Stormwater Permit staff.

http://adem.alabama.gov/programs/water/303d.cnt http://adem.alabama.gov/programs/water/tmdl.cnt http://adem.alabama.gov/programs/water/waterforms/feescheduled.pdf http://adem.alabama.gov/programs/water/waterforms/CSW-CBMPPTemplate.pdf mailto:cswmail@adem.alabama.gov http://adem.alabama.gov/programs/water/waterforms/ConstructionPermitsAreaAssignmentMap.pdf

Construction Stormwater (ALR100000) - NOI - New (Form 024)

Form Input

Permittee Information

Permittee Permittee Name

Phone Type Number Extension

Home

Mobile

Other

Business

Mailing Address Address Line 1

Address Line 2

City State/Area Postal Code

Yes No

Co-Permittee

Co-Permittee Name

Phone Type Number Extension

Home

Mobile

Other

Business

Address Line 1

Address Line 2

City State/Area Postal Code

This form may contain one or more sections or controls that are conditionally displayed based on answers provided in other parts of the form*

Are you adding a Co-Permittee? *Select One

*This control is conditionally displayed based on answers provided in the question above

Responsible Official Prefix

First Name Last Name

Title

Organization Name

Phone Type Number Extension

Home

Mobile

Other

Business

Email

Physical/Delivery Address Address Line 1

Address Line 2

City State/Area Postal Code

Additional Responsible Officials

Responsible Official Prefix

First Name Last Name

Title

Organization Name

Phone Type Number Extension

Home

Mobile

Other

Business

Email

Address Line 1

Address Line 2

City State/Area Postal Code

Country

Additional Permit Contact(s)

Please provide the contact information for any person needing notifications regarding this Notice of Intent (NOI).

Required if Co-Permittee(s) are included*

Permit Contact

First Name Last Name

Title

Company Name

Phone Type Number Extension

Home

Mobile

Other

Business

Email

Facility/Site Information

Facility/Site Name

Corporation County Government/Commission

Federal LLC

LLP Municipality (City or Town)

Partnership School District or Board

Sole Proprietorship (i.e. Owned by Individual) State

... (More Options Available)

Facility/Site Contact Prefix

First Name Last Name

Title

Organization Name

Phone Type Number Extension

Home

Mobile

Other

Business

Email

Address Line 1

Address Line 2

Location Description

City State/Area Postal Code

Permittee Organization Type *Select One

Autauga Baldwin

Barbour Bibb

Blount Bullock

Butler Calhoun

Chambers Cherokee

... (More Options Available)

Detailed Directions to the Facility/Site

Facility/Site Front Gate Latitude and Longitude Latitude Longitude

Yes No

Beginning Location of Linear Project

Latitude Longitude

Ending Location of Linear Project

Latitude Longitude

Commercial Industrial

Linear - Highway/Road Linear - Utilities

Multi-Family Residential Other

Single-Family Residential Support Activity (i.e. Borrow area)

1521-General Contractors-Single-Family Houses 1522-General Contractors-Residential Buildings, Other Than Single-Family

1541-General Contractors-Industrial Buildings and Warehouses 1542-General Contractors-Nonresidential Buildings, Other than Industrial Buildings and Warehouses

1611-Highway and Street Construction, Except Elevated Highways 1622-Bridge, Tunnel, and Elevated Highway Construction

1623-Water, Sewer, Pipeline, and Communications and Power Line Construction 1629-Heavy Construction

236115-New Single-Family Housing Construction (except For-Sale Builders) 236116-New Multifamily Housing Construction (except For-Sale Builders)

236117-New Housing For-Sale Builders 236210-Industrial Building Construction

236220-Commercial and Institutional Building Construction 237110-Water and Sewer Line and Related Structures Construction

237120-Oil and Gas Pipeline and Related Structures Construction 237130-Power and Communication Line and Related Structures Construction

237310-Highway, Street, and Bridge Construction 237990-Other Heavy and Civil Engineering Construction

... (More Options Available)

Additional Site Contact(s)

Facility/Site County *Select One

Is this a linear project? *Select One

This control is conditionally displayed based on answers provided in other parts of the form*

This control is conditionally displayed based on answers provided in other parts of the form*

Construction Site Type *Select All That Apply

Primary SIC Code *Select One

Primary NAICS Code *Select One

This section is conditionally displayed based on answers provided in other parts of the form*

Facility Contact

First Name Last Name

Title

Organization Name

Number Extension

Home

Mobile

Other

Business

Email

Mailing Address Address Line 1

Address Line 2

City State/Area Postal Code

Country

Project Information

Brief Description of activity(s):

Total Facility/Site Area (acres)

Total Disturbed Area (acres)

**Total Disturbed Area MUST BE LESS THAN OR EQUAL TO Total Facility/Site Area**

Anticipated Commencement Date

**Commencement date MUST BE ON OR BEFORE Completion Date**

Anticipated Completion Date

Yes No

Safety Data Sheet (SDS)

Please attach an SDS sheet for *each* flocculant used.

Multiple attachments are not allowed. Please be aware that files exceeding 500 MB in size are not allowed. The following file types are accepted: *.gif,*.jpeg,*.jpg,*.pdf,*.png

Comment

Confidential (Reason for Confidentiality)

Yes No

Reminder:

Phone Type *Only one phone number is accepted

Will flocculants or other chemical stabilization products be used on site? *Select One

This control is conditionally displayed based on answers provided in other parts of the form*

Are there any surface waters within 25 feet of your project�s land disturbances? *Select One

This control is conditionally displayed based on answers provided in other parts of the form*

Site CBMPP must meet Part III.B. of the permit.

Inspection Status

Yes No

Please be advised that a Greenfield fee may be assessed to the total permit fee since your facility/site was inspected prior to the submittal of your application and/or obtaining NPDES permit coverage.

Priority Construction Site

Yes No

Attach CBMPP

Please attach a copy of the CBMPP that meets or exceeds the requirements of Parts III A. and E. of the construction stormwater general permit.

Multiple attachments are not allowed. Please be aware that files exceeding 500 MB in size are not allowed. The following file types are accepted: *.gif,*.jpeg,*.jpg,*.pdf,*.png

Comment

Confidential (Reason for Confidentiality)

Outfalls

Outfall

Outfall - Point where the discharge leaves the site.

Outfall Identifier should have a prefix of 'OF' (i.e. OF001, OF002)

Outfall Identifier

Topo Map Identifier-Provide the point label from the topo map that correlates to the Outfall Point above.

Location of Outfall Latitude Longitude

Receiving Water(s)

RECEIVING WATER(S)

ID Receiving Water UT Strm Sewer MS4 A&I F&W LWF PWS SH S

WATER USE CLASSIFICATION DESCRIPTIONS:

A&I - Agricultural and Industrial Water Supply F&W - Fish and Wildlife LWF - Limited Warmwater Fishery PWS - Public Water Supply SH - Shell Harvesting S - Swimming and Other Whole Body Contact Sports

Topographic Map Submittal

Topographic Map File types are limited to: .gif, .jpeg, .jpg, .pdf, or .png

Multiple attachments are not allowed. Please be aware that files exceeding 500 MB in size are not allowed. The following file types are accepted: *.gif,*.jpeg,*.jpg,*.pdf,*.png

Comment

Confidential (Reason for Confidentiality)

Was this facility/site inspected and found to be either under construction or in operation prior to a NPDES permit application being submitted to the Department? *Select One

This control is conditionally displayed based on answers provided in other parts of the form*

Is this a Priority Construction Site as defined by Part V of the construction stormwater general permit? If yes, please attach a copy of the CBMPP that meets or exceeds the requirements of the construction stormwater general permit.

*Select One

Feature Type *Select One

Qualified Credentialed Professional (QCP) Certification

AL National Resources Conservation Service Professional certified by the State Conservationist Certified Professional in Erosion and Sediment Control (CPESC)

Certified Professional Soil Scientist (CPSS) Professional Engineer (PE)

Professional Geologist (PG) Registered Environmental Manager (REM)

Registered Forester Registered Land Surveyor (LS)

Registered Landscape Architect

Registration / Certification Number

Qualified Credentialed Professional Prefix

First Name Last Name

Title

Organization Name

Phone Type Number Extension

Home

Mobile

Other

Business

Email

Address Line 1

Address Line 2

City State/Area Postal Code

Duly Authorized Representative (DAR)

Pursuant to ADEM Administrative Code Rule 335-6-6-.09 (1), this NOI must be signed by a responsible official, as indicated below:

(a) In the case of a corporation, by a principal executive officer of at least the level of vice president, or a manager assigned or delegated in accordance with corporate procedures, with such delegation submitted in writing if required by the Department, who is responsible for manufacturing, production, or operating facilities and is authorized to make management decisions which govern the operation of the regulated facility;

(b) In the case of a partnership, by a general partner;

(c) In the case of a sole proprietorship, by the proprietor; or

(d) In the case of a municipal, state, federal, or other public entity by either a principal executive officer, or ranking elected official.

ADEM Administrative Code Rule 335-6-.09(2):

All reports required by permits and other information requested by the Department shall be signed by a person described in paragraph 335-6-6-.09(1) or by a duly authorized representative of that person. A person is a duly authorized representative only if:

(a) The authorization is made in writing by a person described in paragraph 335-6-6-.09(1);

(b) The authorization specifies either an individual or a position having responsibility for the overall operation of the regulated facility or activity and;

(c) The written authorization is submitted to the Department.

Yes No

DAR Documentation

Please attach appropriate documentation meeting the requirements above for a duly authorized representative. The document must be dated within the last 12 months.

Multiple attachments are not allowed. Please be aware that files exceeding 500 MB in size are not allowed. The following file types are accepted:

*.7Z,*.7z,*.AVI,*.avi,*.Avi,*.BMP,*.bmp,*.Bmp,*.CSV,*.csv,*.Csv,*.DAT,*.dat,*.Dat,*.DOC,*.doc,*.Doc,*.DOCX,*.docx,*.Docx,*.DWG,*.dwg,*.Dwg,*.EML,*.eml,*.Eml,*.GIF,*.gif,*.Gif,*.GPX,*.gpx,*.Gpx,*.HTM,*.htm,*.Htm,*.HTML,*.html,*.Html,*.HY8,*.hy8,*.Hy8,*.JPE,*.jpe,*.Jpe,*.JPEG,*.jpeg,*.Jpeg,*.JPG,*.jpg,*.Jpg,*.MOV,*.mov,*.Mov,*.MP3,*.mp3,*.Mp3,*.MP4,*.mp4,*.Mp4,*.MSG,*.msg,*.Msg,*.OGV,*.ogv,*.Ogv,*.PDF,*.pdf,*.Pdf,*.PNG,*.png,*.Png,*.PPS,*.pp2,*.Pps,*.PPT,*.ppt,*.Ppt,*.PPTX,*.pptx,*.Pptx,*.PRJ,*.prj,*.Prj,*.SDF,*.sdf,*.Sdf,*.TIF,*.tif,*.Tif,*.TIFF,*.tiff,*.Tiff,*.TXT,*.txt,*.Txt,*.WAV,*.wav,*.Wav,*.WEBM,*.webm,*.Webm,*.WMV,*.wmv,*.Wmv,*.WPD,*.wpd,*.Wpd,*.WPS,*.wps,*.Wps,*.XLS,*.xls,*.Xls,*.XLSX,*.xlsx,*.Xlsx,*.ZIP,*.zip,*.Zip,*.ZIPX,*.zipx,*.Zipx,*.F01,*.f01,*.F02,*.f02,*.F03,*.f03,*.F04,*.f04,*.F05,*.f05,*.F06,*.f06,*.F07,*.f07,*.F08,*.f08,*.F09,*.f09,*.F10,*.f10,*.F11,*.f11,*.F12,*.f12,*.F13,*.f13,*.F14,*.f14,*.F15,*.f15,*.F16,*.f16,*.F17,*.f17,*.F18,*.f18,*.F19,*.f19,*.F20,*.f20,*.G01,*.g01,*.G02,*.g02,*.G03,*.g03,*.G04,*.g04,*.G05,*.g05,*.G06,*.g06,*.G07,*.g07,*.G08,*.g08,*.G09,*.g09,*.G10,*.g10,*.G11,*.g11,*.G12,*.g12,*.G13,*.g13,*.G14,*.g14,*.G15,*.g15,*.G16,*.g16,*.G17,*.g17,*.G18,*.g18,*.G19,*.g19,*.G20,*.g20,*.O01,*.o01,*.O02,*.o02,*.O03,*.o03,*.O04,*.o04,*.O05,*.o05,*.O06,*.o06,*.O07,*.o07,*.O08,*.o08,*.O09,*.o09,*.O10,*.o10,*.O11,*.o11,*.O12,*.o12,*.O13,*.o13,*.O14,*.o14,*.O15,*.o15,*.O16,*.o16,*.O17,*.o17,*.O18,*.o18,*.O19,*.o19,*.O20,*.o20,*.P01,*.p01,*.P02,*.p02,*.P03,*.p03,*.P04,*.p04,*.P05,*.p05,*.P06,*.p06,*.P07,*.p07,*.P08,*.p08,*.P09,*.p09,*.P10,*.p10,*.P11,*.p11,*.P12,*.p12,*.P13,*.p13,*.P14,*.p14,*.P15,*.p15,*.P16,*.p16,*.P17,*.p17,*.P18,*.p18,*.P19,*.p19,*.P20,*.p20,*.R01,*.r01,*.R02,*.r02,*.R03,*.r03,*.R04,*.r04,*.R05,*.r05,*.R06,*.r06,*.R07,*.r07,*.R08,*.r08,*.R09,*.r09,*.R10,*.r10,*.R11,*.r11,*.R12,*.r12,*.R13,*.r13,*.R14,*.r14,*.R15,*.r15

Comment

Confidential (Reason for Confidentiality)

QCP Designation *Select One

Will a duly authorized representative be submitting this NOI? *Select One

Authorized Rep

Duly Authorized Representative Prefix

First Name Last Name

Title

Organization Name

Number Extension

Home

Mobile

Other

Business

Email

Mailing Address Address Line 1

Address Line 2

City State/Area Postal Code

Country

This control is conditionally displayed based on answers provided in other parts of the form*

Phone Type *Only one phone number is accepted

Construction Stormwater (ALR100000) - NOI - Information Update (Form 024) Construction Stormwater-Information Update for Permitted Facilities/Sites

NPDES permit ALR100000 is a general permit authorizing discharges associated with construction activities that will result in land disturbance equal to or greater than one (1) acre or from construction activities involving less than one (1) acre which are part of a larger common plan of development or sale equal to or greater than one (1) acre.

The following information may be updated for permitted facilities/sites on this form:

• Change in Responsible Official

• Change in Facility Contact information

• Change in QCP for the site/facility

• Change in Duly Authorized Representative (DAR)

• Suspension of Monitoring Request

• Decrease in Disturbed Area (acreage)

• Deletion of Receiving Water(s)

• Addition and/or Deletion of Outfalls Only

• Change in Flocculant Details

Instructions

Please complete all questions and attach all necessary documentation as prompted throughout the application process. Incomplete or incorrect information will delay processing.

***No Fee Required***

CONTACT INFORMATION

Main Address

Alabama Department of Environmental Management Water Division Stormwater Management Branch Post Office Box 301463 Montgomery, Alabama 36130-1463

CONTACTS

Phone : 334-271-7836

E-mail : cswmail@adem.alabama.gov

ADDITIONAL LINKS

Please click here for area assignments and contact information for Construction Stormwater Permit staff.

mailto:cswmail@adem.alabama.gov

Construction Stormwater (ALR100000) - NOI - Information Update (Form 024)

Processing Information

Brief description of the action/change that has resulted in the request for permit modification(s):

Yes No

Yes No

Yes No

Please provide a list of receiving waters that the permittee no longer discharges to:

Yes No

Yes No

Yes No

Additional outfalls may be added only if the discharge will be routed to an existing permitted receiving water. New receiving waters may not be added through the information update process. If you need to add additional receiving waters, please STOP HERE. A modification application will need to be completed.

Yes No

Yes No

Yes No

Yes No

Form Submission Reason Minor Modification

Permit Information

Permit Number

Permittee Permittee Name

Phone Type Number Extension

Home

Mobile

Other

Business

Mailing Address Address Line 1

Address Line 2

City State/Area Postal Code

Responsible Official Contact(s)

This form may contain one or more sections or controls that are conditionally displayed based on answers provided in other parts of the form*

Are you updating Responsible Official Contact information? *Select One

Are you updating Facility/Site Contact information? *Select One

Are you deleting Receiving Waters that the site discharges to? *Select One

This control is conditionally displayed based on answers provided in other parts of the form*

Are you deleting Outfall Points (points where stormwater leaves site)? *Select One

Are you adding Outfall Points (points where stormwater leaves site) associated with CURRENTLY permitted receiving waters? *Select One

Will the additional Outfall discharge to a previously permitted Receiving Water? *Select One

This control is conditionally displayed based on answers provided in other parts of the form*

This control is conditionally displayed based on answers provided in other parts of the form*

Are you decreasing Facility/Site acreage and/or Total Disturbed acreage? *Select One

Are you adding or changing Flocculants? *Select One

Are you requesting a Suspension of Monitoring? *Select One

Are you updating QCP Contact information? *Select One

First Name Last Name

Title

Organization Name

Phone Type Number Extension

Home

Mobile

Other

Business

Email

Physical/Delivery Address Address Line 1

Address Line 2

City State/Area Postal Code

Country

Additional Permit Contact(s)

Please provide the contact information for any person needing notifications regarding this Notice of Intent (NOI).

Permit Contact Prefix

First Name Last Name

Title

Company Name

Phone Type Number Extension

Home

Mobile

Other

Business

Email

Facility/Site Information

Facility/Site Name

Facility/Site Contact

First Name Last Name

Title

Organization Name

Phone Type Number Extension

Home

Mobile

Other

Business

Email

Yes No

Facility/Site Address or Location Description Address Line 1

Address Line 2

Location Description

City State/Area Postal Code

Autauga Baldwin

Barbour Bibb

Blount Bullock

Butler Calhoun

Chambers Cherokee

... (More Options Available)

Detailed Directions to the Facility/Site

Facility/Site Front Gate Latitude and Longitude Latitude Longitude

Yes No

Beginning Location of Linear Project

Latitude Longitude

Ending Location of Linear Project

Latitude Longitude

Additional Site Contact(s)

Do you have additional contacts associated with this site? *Select One

Facility/Site County *Select One

Is this a linear project? *Select One

This control is conditionally displayed based on answers provided in other parts of the form*

Facility Contact

First Name Last Name

Title

Organization Name

Number Extension

Home

Mobile

Other

Business

Email

Mailing Address Address Line 1

Address Line 2

City State/Area Postal Code

Country

Project Information

Anticipated Commencement Date

**Commencement date MUST BE ON OR BEFORE Completion Date**

Anticipated Completion Date

Yes

Safety Data Sheet (SDS)

Please attach an SDS sheet for *each* flocculant used.

Multiple attachments are not allowed. Please be aware that files exceeding 500 MB in size are not allowed. The following file types are accepted: *.gif,*.jpeg,*.jpg,*.pdf,*.png

Comment

Confidential (Reason for Confidentiality)

Acreage

NOTE

You may *ONLY DECREASE* Facility/Site acreage and/or Total Disturbed acreage. Please enter both Facility/Site acreage and Total Disturbed acreage below.

Total Facility/Site Area (acres)

Total Disturbed Area (acres)

**Total Disturbed Area MUST BE LESS THAN OR EQUAL TO Total Facility/Site Area**

Outfalls

Phone Type *Only one phone number is accepted

This section is conditionally displayed based on answers provided in other parts of the form*

Flocculants or other chemical stabilization products used on site will be added or changed. *Select One

This control is conditionally displayed based on answers provided in other parts of the form*

Outfall

Outfall - Point where the discharge leaves the site.

Outfall Identifier should have a prefix of 'OF' (i.e. OF001, OF002)

Outfall Identifier

Topo Map Identifier-Provide the point label from the topo map that correlates to the Outfall Point above.

Location of Outfall Latitude Longitude

Receiving Water(s)

RECEIVING WATER(S)

ID Receiving Water UT Strm Sewer MS4 A&I F&W LWF PWS SH S

Suspension of Monitoring

Suspension Request Please attach the written request for suspension.

Multiple attachments are not allowed. Please be aware that files exceeding 500 MB in size are not allowed. The following file types are accepted:

*.7Z,*.7z,*.AVI,*.avi,*.Avi,*.BMP,*.bmp,*.Bmp,*.CSV,*.csv,*.Csv,*.DAT,*.dat,*.Dat,*.DOC,*.doc,*.Doc,*.DOCX,*.docx,*.Docx,*.DWG,*.dwg,*.Dwg,*.EML,*.eml,*.Eml,*.GIF,*.gif,*.Gif,*.GPX,*.gpx,*.Gpx,*.HTM,*.htm,*.Htm,*.HTML,*.html,*.Html,*.HY8,*.hy8,*.Hy8,*.JPE,*.jpe,*.Jpe,*.JPEG,*.jpeg,*.Jpeg,*.JPG,*.jpg,*.Jpg,*.MOV,*.mov,*.Mov,*.MP3,*.mp3,*.Mp3,*.MP4,*.mp4,*.Mp4,*.MSG,*.msg,*.Msg,*.OGV,*.ogv,*.Ogv,*.PDF,*.pdf,*.Pdf,*.PNG,*.png,*.Png,*.PPS,*.pp2,*.Pps,*.PPT,*.ppt,*.Ppt,*.PPTX,*.pptx,*.Pptx,*.PRJ,*.prj,*.Prj,*.SDF,*.sdf,*.Sdf,*.TIF,*.tif,*.Tif,*.TIFF,*.tiff,*.Tiff,*.TXT,*.txt,*.Txt,*.WAV,*.wav,*.Wav,*.WEBM,*.webm,*.Webm,*.WMV,*.wmv,*.Wmv,*.WPD,*.wpd,*.Wpd,*.WPS,*.wps,*.Wps,*.XLS,*.xls,*.Xls,*.XLSX,*.xlsx,*.Xlsx,*.ZIP,*.zip,*.Zip,*.ZIPX,*.zipx,*.Zipx,*.F01,*.f01,*.F02,*.f02,*.F03,*.f03,*.F04,*.f04,*.F05,*.f05,*.F06,*.f06,*.F07,*.f07,*.F08,*.f08,*.F09,*.f09,*.F10,*.f10,*.F11,*.f11,*.F12,*.f12,*.F13,*.f13,*.F14,*.f14,*.F15,*.f15,*.F16,*.f16,*.F17,*.f17,*.F18,*.f18,*.F19,*.f19,*.F20,*.f20,*.G01,*.g01,*.G02,*.g02,*.G03,*.g03,*.G04,*.g04,*.G05,*.g05,*.G06,*.g06,*.G07,*.g07,*.G08,*.g08,*.G09,*.g09,*.G10,*.g10,*.G11,*.g11,*.G12,*.g12,*.G13,*.g13,*.G14,*.g14,*.G15,*.g15,*.G16,*.g16,*.G17,*.g17,*.G18,*.g18,*.G19,*.g19,*.G20,*.g20,*.O01,*.o01,*.O02,*.o02,*.O03,*.o03,*.O04,*.o04,*.O05,*.o05,*.O06,*.o06,*.O07,*.o07,*.O08,*.o08,*.O09,*.o09,*.O10,*.o10,*.O11,*.o11,*.O12,*.o12,*.O13,*.o13,*.O14,*.o14,*.O15,*.o15,*.O16,*.o16,*.O17,*.o17,*.O18,*.o18,*.O19,*.o19,*.O20,*.o20,*.P01,*.p01,*.P02,*.p02,*.P03,*.p03,*.P04,*.p04,*.P05,*.p05,*.P06,*.p06,*.P07,*.p07,*.P08,*.p08,*.P09,*.p09,*.P10,*.p10,*.P11,*.p11,*.P12,*.p12,*.P13,*.p13,*.P14,*.p14,*.P15,*.p15,*.P16,*.p16,*.P17,*.p17,*.P18,*.p18,*.P19,*.p19,*.P20,*.p20,*.R01,*.r01,*.R02,*.r02,*.R03,*.r03,*.R04,*.r04,*.R05,*.r05,*.R06,*.r06,*.R07,*.r07,*.R08,*.r08,*.R09,*.r09,*.R10,*.r10,*.R11,*.r11,*.R12,*.r12,*.R13,*.r13,*.R14,*.r14,*.R15,*.r15

Comment

Confidential (Reason for Confidentiality)

Inspection Report Please attach the most recent Inspection Report.

Multiple attachments are not allowed. Please be aware that files exceeding 500 MB in size are not allowed. The following file types are accepted:

*.7Z,*.7z,*.AVI,*.avi,*.Avi,*.BMP,*.bmp,*.Bmp,*.CSV,*.csv,*.Csv,*.DAT,*.dat,*.Dat,*.DOC,*.doc,*.Doc,*.DOCX,*.docx,*.Docx,*.DWG,*.dwg,*.Dwg,*.EML,*.eml,*.Eml,*.GIF,*.gif,*.Gif,*.GPX,*.gpx,*.Gpx,*.HTM,*.htm,*.Htm,*.HTML,*.html,*.Html,*.HY8,*.hy8,*.Hy8,*.JPE,*.jpe,*.Jpe,*.JPEG,*.jpeg,*.Jpeg,*.JPG,*.jpg,*.Jpg,*.MOV,*.mov,*.Mov,*.MP3,*.mp3,*.Mp3,*.MP4,*.mp4,*.Mp4,*.MSG,*.msg,*.Msg,*.OGV,*.ogv,*.Ogv,*.PDF,*.pdf,*.Pdf,*.PNG,*.png,*.Png,*.PPS,*.pp2,*.Pps,*.PPT,*.ppt,*.Ppt,*.PPTX,*.pptx,*.Pptx,*.PRJ,*.prj,*.Prj,*.SDF,*.sdf,*.Sdf,*.TIF,*.tif,*.Tif,*.TIFF,*.tiff,*.Tiff,*.TXT,*.txt,*.Txt,*.WAV,*.wav,*.Wav,*.WEBM,*.webm,*.Webm,*.WMV,*.wmv,*.Wmv,*.WPD,*.wpd,*.Wpd,*.WPS,*.wps,*.Wps,*.XLS,*.xls,*.Xls,*.XLSX,*.xlsx,*.Xlsx,*.ZIP,*.zip,*.Zip,*.ZIPX,*.zipx,*.Zipx,*.F01,*.f01,*.F02,*.f02,*.F03,*.f03,*.F04,*.f04,*.F05,*.f05,*.F06,*.f06,*.F07,*.f07,*.F08,*.f08,*.F09,*.f09,*.F10,*.f10,*.F11,*.f11,*.F12,*.f12,*.F13,*.f13,*.F14,*.f14,*.F15,*.f15,*.F16,*.f16,*.F17,*.f17,*.F18,*.f18,*.F19,*.f19,*.F20,*.f20,*.G01,*.g01,*.G02,*.g02,*.G03,*.g03,*.G04,*.g04,*.G05,*.g05,*.G06,*.g06,*.G07,*.g07,*.G08,*.g08,*.G09,*.g09,*.G10,*.g10,*.G11,*.g11,*.G12,*.g12,*.G13,*.g13,*.G14,*.g14,*.G15,*.g15,*.G16,*.g16,*.G17,*.g17,*.G18,*.g18,*.G19,*.g19,*.G20,*.g20,*.O01,*.o01,*.O02,*.o02,*.O03,*.o03,*.O04,*.o04,*.O05,*.o05,*.O06,*.o06,*.O07,*.o07,*.O08,*.o08,*.O09,*.o09,*.O10,*.o10,*.O11,*.o11,*.O12,*.o12,*.O13,*.o13,*.O14,*.o14,*.O15,*.o15,*.O16,*.o16,*.O17,*.o17,*.O18,*.o18,*.O19,*.o19,*.O20,*.o20,*.P01,*.p01,*.P02,*.p02,*.P03,*.p03,*.P04,*.p04,*.P05,*.p05,*.P06,*.p06,*.P07,*.p07,*.P08,*.p08,*.P09,*.p09,*.P10,*.p10,*.P11,*.p11,*.P12,*.p12,*.P13,*.p13,*.P14,*.p14,*.P15,*.p15,*.P16,*.p16,*.P17,*.p17,*.P18,*.p18,*.P19,*.p19,*.P20,*.p20,*.R01,*.r01,*.R02,*.r02,*.R03,*.r03,*.R04,*.r04,*.R05,*.r05,*.R06,*.r06,*.R07,*.r07,*.R08,*.r08,*.R09,*.r09,*.R10,*.r10,*.R11,*.r11,*.R12,*.r12,*.R13,*.r13,*.R14,*.r14,*.R15,*.r15

Comment

Confidential (Reason for Confidentiality)

Qualified Credentialed Professional (QCP) Certification

AL National Resources Conservation Service Professional certified by the State Conservationist Certified Professional in Erosion and Sediment Control (CPESC)

Certified Professional Soil Scientist (CPSS) Professional Engineer (PE)

Professional Geologist (PG) Registered Environmental Manager (REM)

Registered Forester Registered Land Surveyor (LS)

Registered Landscape Architect

Registration / Certification Number

Feature Type *Select One

This section is conditionally displayed based on answers provided in other parts of the form*

This section is conditionally displayed based on answers provided in other parts of the form*

QCP Designation *Select One

Qualified Credentialed Professional

First Name Last Name

Title

Organization Name

Phone Type Number Extension

Home

Mobile

Other

Business

Email

Address Line 1

Address Line 2

City State/Area Postal Code

Country

Duly Authorized Representative (DAR)

Pursuant to ADEM Administrative Code Rule 335-6-6-.09 (1), this NOI must be signed by a responsible official, as indicated below:

(a) In the case of a corporation, by a principal executive officer of at least the level of vice president, or a manager assigned or delegated in accordance with corporate procedures, with such delegation submitted in writing if required by the Department, who is responsible for manufacturing, production, or operating facilities and is authorized to make management decisions which govern the operation of the regulated facility;

(b) In the case of a partnership, by a general partner;

(c) In the case of a sole proprietorship, by the proprietor; or

(d) In the case of a municipal, state, federal, or other public entity by either a principal executive officer, or ranking elected official.

ADEM Administrative Code Rule 335-6-.09(2):

All reports required by permits and other information requested by the Department shall be signed by a person described in paragraph 335-6-6-.09(1) or by a duly authorized representative of that person. A person is a duly authorized representative only if:

(a) The authorization is made in writing by a person described in paragraph 335-6-6-.09(1);

(b) The authorization specifies either an individual or a position having responsibility for the overall operation of the regulated facility or activity and;

(c) The written authorization is submitted to the Department.

Yes No

DAR Documentation

Please attach appropriate documentation meeting the requirements above for a duly authorized representative. The document must be dated within the last 12 months.

Multiple attachments are not allowed. Please be aware that files exceeding 500 MB in size are not allowed. The following file types are accepted:

*.7Z,*.7z,*.AVI,*.avi,*.Avi,*.BMP,*.bmp,*.Bmp,*.CSV,*.csv,*.Csv,*.DAT,*.dat,*.Dat,*.DOC,*.doc,*.Doc,*.DOCX,*.docx,*.Docx,*.DWG,*.dwg,*.Dwg,*.EML,*.eml,*.Eml,*.GIF,*.gif,*.Gif,*.GPX,*.gpx,*.Gpx,*.HTM,*.htm,*.Htm,*.HTML,*.html,*.Html,*.HY8,*.hy8,*.Hy8,*.JPE,*.jpe,*.Jpe,*.JPEG,*.jpeg,*.Jpeg,*.JPG,*.jpg,*.Jpg,*.MOV,*.mov,*.Mov,*.MP3,*.mp3,*.Mp3,*.MP4,*.mp4,*.Mp4,*.MSG,*.msg,*.Msg,*.OGV,*.ogv,*.Ogv,*.PDF,*.pdf,*.Pdf,*.PNG,*.png,*.Png,*.PPS,*.pp2,*.Pps,*.PPT,*.ppt,*.Ppt,*.PPTX,*.pptx,*.Pptx,*.PRJ,*.prj,*.Prj,*.SDF,*.sdf,*.Sdf,*.TIF,*.tif,*.Tif,*.TIFF,*.tiff,*.Tiff,*.TXT,*.txt,*.Txt,*.WAV,*.wav,*.Wav,*.WEBM,*.webm,*.Webm,*.WMV,*.wmv,*.Wmv,*.WPD,*.wpd,*.Wpd,*.WPS,*.wps,*.Wps,*.XLS,*.xls,*.Xls,*.XLSX,*.xlsx,*.Xlsx,*.ZIP,*.zip,*.Zip,*.ZIPX,*.zipx,*.Zipx,*.F01,*.f01,*.F02,*.f02,*.F03,*.f03,*.F04,*.f04,*.F05,*.f05,*.F06,*.f06,*.F07,*.f07,*.F08,*.f08,*.F09,*.f09,*.F10,*.f10,*.F11,*.f11,*.F12,*.f12,*.F13,*.f13,*.F14,*.f14,*.F15,*.f15,*.F16,*.f16,*.F17,*.f17,*.F18,*.f18,*.F19,*.f19,*.F20,*.f20,*.G01,*.g01,*.G02,*.g02,*.G03,*.g03,*.G04,*.g04,*.G05,*.g05,*.G06,*.g06,*.G07,*.g07,*.G08,*.g08,*.G09,*.g09,*.G10,*.g10,*.G11,*.g11,*.G12,*.g12,*.G13,*.g13,*.G14,*.g14,*.G15,*.g15,*.G16,*.g16,*.G17,*.g17,*.G18,*.g18,*.G19,*.g19,*.G20,*.g20,*.O01,*.o01,*.O02,*.o02,*.O03,*.o03,*.O04,*.o04,*.O05,*.o05,*.O06,*.o06,*.O07,*.o07,*.O08,*.o08,*.O09,*.o09,*.O10,*.o10,*.O11,*.o11,*.O12,*.o12,*.O13,*.o13,*.O14,*.o14,*.O15,*.o15,*.O16,*.o16,*.O17,*.o17,*.O18,*.o18,*.O19,*.o19,*.O20,*.o20,*.P01,*.p01,*.P02,*.p02,*.P03,*.p03,*.P04,*.p04,*.P05,*.p05,*.P06,*.p06,*.P07,*.p07,*.P08,*.p08,*.P09,*.p09,*.P10,*.p10,*.P11,*.p11,*.P12,*.p12,*.P13,*.p13,*.P14,*.p14,*.P15,*.p15,*.P16,*.p16,*.P17,*.p17,*.P18,*.p18,*.P19,*.p19,*.P20,*.p20,*.R01,*.r01,*.R02,*.r02,*.R03,*.r03,*.R04,*.r04,*.R05,*.r05,*.R06,*.r06,*.R07,*.r07,*.R08,*.r08,*.R09,*.r09,*.R10,*.r10,*.R11,*.r11,*.R12,*.r12,*.R13,*.r13,*.R14,*.r14,*.R15,*.r15

Comment

Confidential (Reason for Confidentiality)

Authorized Rep

First Name Last Name

Title

Organization Name

Number Extension

Home

Mobile

Other

Business

Email

Mailing Address Address Line 1

Address Line 2

City State/Area Postal Code

Country

Topographic Map Submittal

Topographic Map File types are limited to: .gif, .jpeg, .jpg, .pdf, or .png

Multiple attachments are not allowed. Please be aware that files exceeding 500 MB in size are not allowed. The following file types are accepted: *.gif,*.jpeg,*.jpg,*.pdf,*.png

Comment

Confidential (Reason for Confidentiality)

Additional Document Submittals

Additional Documents (Optional)

Multiple attachments are not allowed. Please be aware that files exceeding 500 MB in size are not allowed. The following file types are accepted: *.bmp,*.jpeg,*.jpg,*.pdf,*.png,*.tif,*.tiff

Comment

Confidential (Reason for Confidentiality)

This control is conditionally displayed based on answers provided in other parts of the form*

Phone Type *Only one phone number is

Construction Stormwater (ALR100000) - NOI - Modification/Transfer (Form 024)

Construction Stormwater-Modification and/or Transfer of Permit Coverage

NPDES permit ALR100000 is a general permit authorizing discharges associated with construction activities that will result in land disturbance equal to or greater than one (1) acre or from construction activities involving less than one (1) acre which are part of a larger common plan of development or sale equal to or greater than one (1) acre.

A modification to your current permit may include one or more of the following:

• Permittee name change (Requires a signed Transfer Agreement, Form 466)

• Change of ownership (Requires a signed Transfer Agreement, Form 466)

• Facility name change

• Addition of a Co-Permittee

• Addition of receiving water(s) and outfalls associated with the additional receiving waters

• For Priority sites – CBMPP will need to be resubmitted if adding receiving waters

Please contact the appropriate permitting staff member if you are unsure whether a modification or new permit is required for your project. Please contact the appropriate permitting staff based on the county where the site is located prior to beginning the application process. Please see the link on the right side of this screen for area assignments for Construction Stormwater Permit staff.

Please click here for the Transfer Agreement, Form 466

Please click here for the Alabama 303(d) list of Impaired Waters

Please click here for Information on Alabama TMDLs

Please click here for the permit fee schedule

Priority Construction Site means any site that discharges to a waterbody which is listed on the most recently EPA approved 303(d) list of impaired waters for turbidity, siltation, or sedimentation, any waterbody with for which a TMDL has been finalized or approved by EPA for turbidity, siltation or sedimentation, any waterbody assigned the Outstanding Alabama Water use classification in accordance with ADEM Admin Code r. 335-6-10-.09, and any waterbody assigned a special designation in accordance with ADEM Admin Code r. 335-6-10-.10.

Instructions

If your site meets the definition of a Priority Construction Site, a complete and comprehensive CBMPP must be attached to the application submittal. Click here for an ADEM CBMPP template.

Please complete all questions and attach all necessary documentation as prompted throughout the application process. Incomplete or incorrect information will delay processing.

***APPLICATION WILL NOT BE PROCESSED UNTIL FULL PAYMENT IS RECEIVED***

CONTACT INFORMATION

Main Address

Alabama Department of Environmental Management Water Division Stormwater Management Branch Post Office Box 301463 Montgomery, Alabama 36130-1463

CONTACTS

Phone : 334-271-7836

E-mail : cswmail@adem.alabama.gov

ADDITIONAL LINKS

Please click here for area assignments and contact information for Construction Stormwater Permit staff.

http://adem.alabama.gov/DeptForms/Form466.pdf http://adem.alabama.gov/programs/water/303d.cnt http://adem.alabama.gov/programs/water/tmdl.cnt http://adem.alabama.gov/programs/water/waterforms/feescheduled.pdf http://adem.alabama.gov/programs/water/waterforms/CSW-CBMPPTemplate.pdf http://adem.alabama.gov/programs/water/waterforms/CSW-CBMPPTemplate.pdf mailto:cswmail@adem.alabama.gov

Construction Stormwater (ALR100000) - NOI - Modification/Transfer (Form 024)

Processing Information

Brief description of the action/change that has resulted in the request for permit modification(s):

Modification Modification with Transfer of Ownership

Transfer of Ownership Only

Please download, print, and sign the following:

Transfer Agreement (Form 466)

Attach Transfer Agreement (Form 466)

Please attach the signed Transfer Agreement (Form 466) here.

Multiple attachments are not allowed. Please be aware that files exceeding 500 MB in size are not allowed. The following file types are accepted:

*.7Z,*.7z,*.AVI,*.avi,*.Avi,*.BMP,*.bmp,*.Bmp,*.CSV,*.csv,*.Csv,*.DAT,*.dat,*.Dat,*.DOC,*.doc,*.Doc,*.DOCX,*.docx,*.Docx,*.DWG,*.dwg,*.Dwg,*.EML,*.eml,*.Eml,*.GIF,*.gif,*.Gif,*.GPX,*.gpx,*.Gpx,*.HTM,*.htm,*.Htm,*.HTML,*.html,*.Html,*.HY8,*.hy8,*.Hy8,*.JPE,*.jpe,*.Jpe,*.JPEG,*.jpeg,*.Jpeg,*.JPG,*.jpg,*.Jpg,*.MOV,*.mov,*.Mov,*.MP3,*.mp3,*.Mp3,*.MP4,*.mp4,*.Mp4,*.MSG,*.msg,*.Msg,*.OGV,*.ogv,*.Ogv,*.PDF,*.pdf,*.Pdf,*.PNG,*.png,*.Png,*.PPS,*.pp2,*.Pps,*.PPT,*.ppt,*.Ppt,*.PPTX,*.pptx,*.Pptx,*.PRJ,*.prj,*.Prj,*.SDF,*.sdf,*.Sdf,*.TIF,*.tif,*.Tif,*.TIFF,*.tiff,*.Tiff,*.TXT,*.txt,*.Txt,*.WAV,*.wav,*.Wav,*.WEBM,*.webm,*.Webm,*.WMV,*.wmv,*.Wmv,*.WPD,*.wpd,*.Wpd,*.WPS,*.wps,*.Wps,*.XLS,*.xls,*.Xls,*.XLSX,*.xlsx,*.Xlsx,*.ZIP,*.zip,*.Zip,*.ZIPX,*.zipx,*.Zipx,*.F01,*.f01,*.F02,*.f02,*.F03,*.f03,*.F04,*.f04,*.F05,*.f05,*.F06,*.f06,*.F07,*.f07,*.F08,*.f08,*.F09,*.f09,*.F10,*.f10,*.F11,*.f11,*.F12,*.f12,*.F13,*.f13,*.F14,*.f14,*.F15,*.f15,*.F16,*.f16,*.F17,*.f17,*.F18,*.f18,*.F19,*.f19,*.F20,*.f20,*.G01,*.g01,*.G02,*.g02,*.G03,*.g03,*.G04,*.g04,*.G05,*.g05,*.G06,*.g06,*.G07,*.g07,*.G08,*.g08,*.G09,*.g09,*.G10,*.g10,*.G11,*.g11,*.G12,*.g12,*.G13,*.g13,*.G14,*.g14,*.G15,*.g15,*.G16,*.g16,*.G17,*.g17,*.G18,*.g18,*.G19,*.g19,*.G20,*.g20,*.O01,*.o01,*.O02,*.o02,*.O03,*.o03,*.O04,*.o04,*.O05,*.o05,*.O06,*.o06,*.O07,*.o07,*.O08,*.o08,*.O09,*.o09,*.O10,*.o10,*.O11,*.o11,*.O12,*.o12,*.O13,*.o13,*.O14,*.o14,*.O15,*.o15,*.O16,*.o16,*.O17,*.o17,*.O18,*.o18,*.O19,*.o19,*.O20,*.o20,*.P01,*.p01,*.P02,*.p02,*.P03,*.p03,*.P04,*.p04,*.P05,*.p05,*.P06,*.p06,*.P07,*.p07,*.P08,*.p08,*.P09,*.p09,*.P10,*.p10,*.P11,*.p11,*.P12,*.p12,*.P13,*.p13,*.P14,*.p14,*.P15,*.p15,*.P16,*.p16,*.P17,*.p17,*.P18,*.p18,*.P19,*.p19,*.P20,*.p20,*.R01,*.r01,*.R02,*.r02,*.R03,*.r03,*.R04,*.r04,*.R05,*.r05,*.R06,*.r06,*.R07,*.r07,*.R08,*.r08,*.R09,*.r09,*.R10,*.r10,*.R11,*.r11,*.R12,*.r12,*.R13,*.r13,*.R14,*.r14,*.R15,*.r15

Comment

Confidential (Reason for Confidentiality)

Yes No

This is the current Facility/Site Name:

Calculated

Yes No

Selecting 'No' to the question above will display "None Specified" under the Facility/Site Name indicating it will no longer be editable or displayed on this Modification form. The current Facility/Site Name is still stored in the AEPACS system.

Yes No

Yes No

Yes No

Yes No

Yes No

Form Submission Reason Calculated

Permit Information

Permit Number

This form may contain one or more sections or controls that are conditionally displayed based on answers provided in other parts of the form*

Please indicate which of the following applies to this submission: *Select One

This control is conditionally displayed based on answers provided in other parts of the form*

This control is conditionally displayed based on answers provided in other parts of the form*

Are you adding a Co-Permittee? *Select One

This control is conditionally displayed based on answers provided in other parts of the form*

Are you changing the Facility/Site Name? *Select One

This control is conditionally displayed based on answers provided in other parts of the form*

Do you have additional contacts associated with this site? *Select One

Are you adding/changing receiving waters? If a priority site, submittal of updated CBMPP may be required. *Select One

This control is conditionally displayed based on answers provided in other parts of the form*

Are you adding/changing outfall coordinates? If a priority site, submittal of updated CBMPP may be required. *Select One

This control is conditionally displayed based on answers provided in other parts of the form*

Are you adding additional acreage? If a priority site, submittal of updated CBMPP is required. Please note, depending on the additional acreage request, issuance of a new, separate permit may be required. Please contact the permit writer for your county.

*Select One

This control is conditionally displayed based on answers provided in other parts of the form*

Is this a Priority Construction Site as defined by Part V of the construction stormwater general permit? *Select One http://adem.alabama.gov/DeptForms/Form466.pdf

Permittee Permittee Name

Phone Type Number Extension

Home

Mobile

Other

Business

Mailing Address Address Line 1

Address Line 2

City State/Area Postal Code

Co-Permittee

Co-Permittee Name

Phone Type Number Extension

Home

Mobile

Other

Business

Address Line 1

Address Line 2

City State/Area Postal Code

Responsible Official Prefix

First Name Last Name

Title

Organization Name

Phone Type Number Extension

Home

Mobile

Other

Business

Email

Physical/Delivery Address Address Line 1

Address Line 2

City State/Area Postal Code

Additional Responsible Officials

First Name Last Name

Title

Organization Name

Phone Type Number Extension

Home

Mobile

Other

Business

Email

Address Line 1

Address Line 2

City State/Area Postal Code

Country

Additional Permit Contact(s)

Please provide the contact information for any person needing notifications regarding this Notice of Intent (NOI).

Permit Contact Prefix

First Name Last Name

Title

Company Name

Phone Type Number Extension

Home

Mobile

Other

Business

Email

Facility/Site Information

Facility/Site Name

Corporation County Government/Commission

Federal LLC

LLP Municipality (City or Town)

Partnership School District or Board

Sole Proprietorship (i.e. Owned by Individual) State

... (More Options Available)

First Name Last Name

Title

Organization Name

Phone Type Number Extension

Home

Mobile

Other

Business

Email

Facility/Site Address or Location Description

Address Line 1

Address Line 2

Location Description

City State/Area Postal Code

Autauga Baldwin

Barbour Bibb

Blount Bullock

Butler Calhoun

Chambers Cherokee

... (More Options Available)

Detailed Directions to the Facility/Site

Facility/Site Front Gate Latitude and Longitude

Latitude Longitude

Yes No

Beginning Location of Linear Project

Latitude Longitude

Ending Location of Linear Project

Latitude Longitude

Commercial Industrial

Linear - Highway/Road Linear - Utilities

Multi-Family Residential Other

Single-Family Residential Support Activity (i.e. Borrow area)

This control is conditionally displayed based on answers provided in other parts of the form*

Facility/Site County *Select One

This control is conditionally displayed based on answers provided in other parts of the form*

This control is conditionally displayed based on answers provided in other parts of the form*

This control is conditionally displayed based on answers provided in other parts of the form*

Is this a linear project? *Select One

This control is conditionally displayed based on answers provided in other parts of the form*

This control is conditionally displayed based on answers provided in other parts of the form*

This control is conditionally displayed based on answers provided in other parts of the form*

Construction Site Type *Select All That Apply

1521-General Contractors-Single-Family Houses 1522-General Contractors-Residential Buildings, Other Than Single-Family

1541-General Contractors-Industrial Buildings and Warehouses 1542-General Contractors-Nonresidential Buildings, Other than Industrial Buildings and Warehouses

1611-Highway and Street Construction, Except Elevated Highways 1622-Bridge, Tunnel, and Elevated Highway Construction

1623-Water, Sewer, Pipeline, and Communications and Power Line Construction 1629-Heavy Construction

236115-New Single-Family Housing Construction (except For-Sale Builders) 236116-New Multifamily Housing Construction (except For-Sale Builders)

236117-New Housing For-Sale Builders 236210-Industrial Building Construction

236220-Commercial and Institutional Building Construction 237110-Water and Sewer Line and Related Structures Construction

237120-Oil and Gas Pipeline and Related Structures Construction 237130-Power and Communication Line and Related Structures Construction

237310-Highway, Street, and Bridge Construction 237990-Other Heavy and Civil Engineering Construction

... (More Options Available)

Additional Site Contact(s)

Facility Contact Prefix

First Name Last Name

Title

Organization Name

Number Extension

Home

Mobile

Other

Business

Email

Mailing Address Address Line 1

Address Line 2

City State/Area Postal Code

Country

Project Information

Brief Description of activity(s):

Total Facility/Site Area (acres)

Total Disturbed Area (acres)

**Total Disturbed Area MUST BE LESS THAN OR EQUAL TO Total Facility/Site Area**

Anticipated Commencement Date

**Commencement date MUST BE ON OR BEFORE Completion Date**

Anticipated Completion Date

Primary SIC Code *Select One

This control is conditionally displayed based on answers provided in other parts of the form*

Primary NAICS Code *Select One

This control is conditionally displayed based on answers provided in other parts of the form*

This section is conditionally displayed based on answers provided in other parts of the form*

Phone Type *Only one phone number is accepted

This control is conditionally displayed based on answers provided in other parts of the form*

Yes No

Safety Data Sheet (SDS)

Please attach an SDS sheet for *each* flocculant used.

Multiple attachments are not allowed. Please be aware that files exceeding 500 MB in size are not allowed. The following file types are accepted: *.gif,*.jpeg,*.jpg,*.pdf,*.png

Comment

Confidential (Reason for Confidentiality)

Yes No

Reminder:

Site CBMPP must meet Part III.B. of the permit.

Priority Construction Site

Attach CBMPP Please attach a copy of the CBMPP that meets or exceeds the requirements of Parts III A. and E. of the construction stormwater general permit.

Multiple attachments are not allowed. Please be aware that files exceeding 500 MB in size are not allowed. The following file types are accepted:

*.7Z,*.7z,*.AVI,*.avi,*.Avi,*.BMP,*.bmp,*.Bmp,*.CSV,*.csv,*.Csv,*.DAT,*.dat,*.Dat,*.DOC,*.doc,*.Doc,*.DOCX,*.docx,*.Docx,*.DWG,*.dwg,*.Dwg,*.EML,*.eml,*.Eml,*.GIF,*.gif,*.Gif,*.GPX,*.gpx,*.Gpx,*.HTM,*.htm,*.Htm,*.HTML,*.html,*.Html,*.HY8,*.hy8,*.Hy8,*.JPE,*.jpe,*.Jpe,*.JPEG,*.jpeg,*.Jpeg,*.JPG,*.jpg,*.Jpg,*.MOV,*.mov,*.Mov,*.MP3,*.mp3,*.Mp3,*.MP4,*.mp4,*.Mp4,*.MSG,*.msg,*.Msg,*.OGV,*.ogv,*.Ogv,*.PDF,*.pdf,*.Pdf,*.PNG,*.png,*.Png,*.PPS,*.pp2,*.Pps,*.PPT,*.ppt,*.Ppt,*.PPTX,*.pptx,*.Pptx,*.PRJ,*.prj,*.Prj,*.SDF,*.sdf,*.Sdf,*.TIF,*.tif,*.Tif,*.TIFF,*.tiff,*.Tiff,*.TXT,*.txt,*.Txt,*.WAV,*.wav,*.Wav,*.WEBM,*.webm,*.Webm,*.WMV,*.wmv,*.Wmv,*.WPD,*.wpd,*.Wpd,*.WPS,*.wps,*.Wps,*.XLS,*.xls,*.Xls,*.XLSX,*.xlsx,*.Xlsx,*.ZIP,*.zip,*.Zip,*.ZIPX,*.zipx,*.Zipx,*.F01,*.f01,*.F02,*.f02,*.F03,*.f03,*.F04,*.f04,*.F05,*.f05,*.F06,*.f06,*.F07,*.f07,*.F08,*.f08,*.F09,*.f09,*.F10,*.f10,*.F11,*.f11,*.F12,*.f12,*.F13,*.f13,*.F14,*.f14,*.F15,*.f15,*.F16,*.f16,*.F17,*.f17,*.F18,*.f18,*.F19,*.f19,*.F20,*.f20,*.G01,*.g01,*.G02,*.g02,*.G03,*.g03,*.G04,*.g04,*.G05,*.g05,*.G06,*.g06,*.G07,*.g07,*.G08,*.g08,*.G09,*.g09,*.G10,*.g10,*.G11,*.g11,*.G12,*.g12,*.G13,*.g13,*.G14,*.g14,*.G15,*.g15,*.G16,*.g16,*.G17,*.g17,*.G18,*.g18,*.G19,*.g19,*.G20,*.g20,*.O01,*.o01,*.O02,*.o02,*.O03,*.o03,*.O04,*.o04,*.O05,*.o05,*.O06,*.o06,*.O07,*.o07,*.O08,*.o08,*.O09,*.o09,*.O10,*.o10,*.O11,*.o11,*.O12,*.o12,*.O13,*.o13,*.O14,*.o14,*.O15,*.o15,*.O16,*.o16,*.O17,*.o17,*.O18,*.o18,*.O19,*.o19,*.O20,*.o20,*.P01,*.p01,*.P02,*.p02,*.P03,*.p03,*.P04,*.p04,*.P05,*.p05,*.P06,*.p06,*.P07,*.p07,*.P08,*.p08,*.P09,*.p09,*.P10,*.p10,*.P11,*.p11,*.P12,*.p12,*.P13,*.p13,*.P14,*.p14,*.P15,*.p15,*.P16,*.p16,*.P17,*.p17,*.P18,*.p18,*.P19,*.p19,*.P20,*.p20,*.R01,*.r01,*.R02,*.r02,*.R03,*.r03,*.R04,*.r04,*.R05,*.r05,*.R06,*.r06,*.R07,*.r07,*.R08,*.r08,*.R09,*.r09,*.R10,*.r10,*.R11,*.r11,*.R12,*.r12,*.R13,*.r13,*.R14,*.r14,*.R15,*.r15

Comment

Confidential (Reason for Confidentiality)

Outfalls

Outfall

Outfall - Point where the discharge leaves the site.

Outfall Identifier should have a prefix of 'OF' (i.e. OF001, OF002)

Outfall Identifier

Topo Map Identifier-Provide the point label from the topo map that correlates to the Outfall Point above.

Location of Outfall Latitude Longitude

Receiving Water(s)

RECEIVING WATER(S)

ID Receiving Water UT Strm Sewer MS4 A&I F&W LWF PWS SH S

Please select at least one Waterbody Use Classification using an "X". For a detailed list of water use classifications, please refer to ADEM Admin. Code Ch. 335-6-11. If the segment of the receiving water to which the facility discharges has not been assigned a water use classification, select "F&W" (Fish and Wildlife).

Topographic Map Submittal

Will flocculants or other chemical stabilization products be used on site? *Select One

This control is conditionally displayed based on answers provided in other parts of the form*

This control is conditionally displayed based on answers provided in other parts of the form*

Are there any surface waters within 25 feet of your project�s land disturbances? *Select One

This control is conditionally displayed based on answers provided in other parts of the form*

This control is conditionally displayed based on answers provided in other parts of the form*

This section is conditionally displayed based on answers provided in other parts of the form*

This section is conditionally displayed based on answers provided in other parts of the form*

Feature Type *Select One

This section is conditionally displayed based on answers provided in other parts of the form*

Topographic Map File types are limited to: .gif, .jpeg, .jpg, .pdf, or .png

Multiple attachments are not allowed. Please be aware that files exceeding 500 MB in size are not allowed. The following file types are accepted: *.gif,*.jpeg,*.jpg,*.pdf,*.png

Comment

Confidential (Reason for Confidentiality)

Qualified Credentialed Professional (QCP) Certification

AL National Resources Conservation Service Professional certified by the State Conservationist Certified Professional in Erosion and Sediment Control (CPESC)

Certified Professional Soil Scientist (CPSS) Professional Engineer (PE)

Professional Geologist (PG) Registered Environmental Manager (REM)

Registered Forester Registered Land…