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HomeMy WebLinkAboutConstruction site runoff permitBuilding Division, 410 E. Washington St. Iowa City, IA 52240 319/356-5120 www.icgov.org Construction Site Runoff (CSR) Permit Application Permit Fee $150.00 Site Address or Lot and Subdivision Applicant Applicant’s E-Mail Address City, State, ZIP Telephone (office) (cell) Applicant’s Designated Agent E-Mail Address City, State, ZIP Telephone (office) (cell) Project Description Is the Applicant responsible for Iowa Department of Natural Resources (IDNR) National Pollutant Discharge Elimination System (NPDES) General Permit #2 (GP2)? Yes No REQUIRED CERTIFICATION I certify under penalty of law that I understand the terms and conditions of the NPDES GP2 that authorizes the stormwater discharges associated with industrial activity from the construction site as part of this certification. Further, by my signature, I understand that I am becoming the permittee or a co-permittee, along with the owner(s) and other contractors and subcontractors signing such certifications, to the IDNR NPDES GP2 for “Stormwater Discharge Associated with Industrial Activity for Construction Activities” at the identified site. As a permittee or co-permittee, I understand that I, and my company, am legally required under the Clean Water Act and the Code of Iowa, to ensure compliance with the terms and conditions of the stormwater pollution prevention plan (SWPPP) developed under this CSR/NPDES permit and the terms of this CSR/NPDES permit. Applicant’s/Agent’s Signature Title Date: The CSR permit will not be issued until an initial inspection of the site is conducted & required controls are properly installed. City Staff Use Only NPDES Permit Authorization from IDNR Yes No Notice of Intent to IDNR Yes No Proof of Publication to IDNR Yes No Permittee SWPPP Yes No Co-Permittee/Transferee SWPPP Yes No CSR Permit # City Approval by Date Building Division, 410 E. Washington St. Iowa City, IA 52240 319/356-5120 www.icgov.org Construction Site Runoff Permit (CSR) Required Information Project Address or Lot and Subdivision Subcontractors Company Name Contact Name and Telephone Excavation Geothermal Foundation Flatwork Framing Plumbing Electric Mechanical Siding Painting Landscaping Drywall Mason Pollution Prevention Miscellaneous Construction Schedule Dates (estimated) Pollution Prevention Schedule Dates (estimated) Excavation Perimeter Controls Geothermal Silt fence Rolled Other Foundation Site Entry & Exit (2” clean rock) Groundwork Inlet Protection Backfilling Concrete Wash-Out Flatwork Pit Above-ground enclosure Framing Solid Waste Removal Plumbing Portable Toilet Electrical Temporary Stabilization Mechanical After 14 days of inactivity on the site Insulation & Sheetrock Other Roofing Other Siding & Masonry Ongoing Maintenance Drives & Walks Paint & Interior Finish Landscaping Stabilization of all Disturbed Areas The CSR permit will not be issued until an initial inspection of the site is conducted & required controls are properly installed. Building Division, 410 E. Washington St. Iowa City, Iowa 52240 319/356-5120 www.icgov.org Construction Site Runoff Permit Review Checklist Address Reviewed by Date Received Comments Action Required Application Information Name & contact information (24-hour contact) Signed certification IDNR NPDES permit, proof of publication, & Notice Of Intent Sub-contractors & contact information Estimated sequence of construction activity Estimated sequence of pollution prevention measures Form for weekly & post-rain inspections (required after ½” rain) Stormwater Pollution Prevention Plan (SWPPP) Information Size of lot Area of site to be disturbed Local waterway potentially impacted by pollutants Site drainage patterns, shown by arrows Slope stabilization methods or limits of construction Perimeter controls Stormwater inlets Stabilized exit (2” clean rock or existing pavement) Soil stockpile(s) with perimeter controls or temporary stabilization Concrete washout (note if on another lot) Equipment & material storage (hazardous material kept under cover) Construction waste disposal Portable toilet Location of SWPPP documents & inspection reports The CSR permit will not be issued until an initial inspection of the site is conducted & required controls are properly installed.