HomeMy WebLinkAboutNotice of Discontinuation (NOD)06/2019 cmc (over) DNR Form 542-8115
NOTICE OF DISCONTINUATION
OF A STORM WATER DISCHARGE
COVERED UNDER IOWA NPDES GENERAL PERMIT NUMBERS 1, 2, OR 3
Name of the owner or facility to which the storm water discharge general permit coverage was issued.
County:
List the complete permit authorization number for the discharge. This number is provided on the bottom of the
authorization sheet.
IA- ---
List the date the storm water discharge was discontinued as defined in the applicable general permit or, for
construction sites, the date the site reached final stabilization as defined on the back of thie form.
The following certification must be signed in accordance with the signatory requirements of the general permit
(see back side).
I certify under penalty of law that storm water discharges covered by a storm water general permit at the
identified site have ceased. If this is a construction site, I certify that the disturbed soils have been finally
stabilized and temporary erosion and sediment control measures have been removed or will be removed at an
appropriate time. I understand that by submitting this Notice of Discontinuation, I am no longer authorized to
discharge storm water associated with industrial activity or construction activities by Iowa Department of
Natural Resources NPDES General Permit No. 1, No. 2 or No. 3 under the authorization indicated above and that
discharging pollutants from storm water associated with industrial activity or construction activities to waters of
the United States is unlawful under the Clean Water Act where the discharge is not authorized by an NPDES
permit.
I further 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 known violations.
Name (print) Title
Signature Date
Return to: Storm Water Coordinator
Department of Natural Resources
502 E. 9th Street
Des Moines, IA 50319-0034
06/2019 cmc (over) DNR Form 542-8115
Final Stabilization means that all soil disturbing activities at the site have been completed and that a uniform
perennial vegetative cover for the area has been established or equivalent stabilization measures have been
employed. All building must be completed before the project is considered finally stabilized.
SIGNATORY REQUIREMENTS All Notices of Intent, storm water pollution prevention plans, reports,
certifications or information either submitted to the Department or the operator of a large or medium
municipal separate storm sewer system, or that this permit requires be maintained by the permittee,
shall be signed in accordance with rule 567--64.3(8) of the Iowa Administrative Code as follows:
64.3(8) Identity of signatories of operation permit applications. The person who signs the application for an
operation permit shall be:
a. Corporations. In the case of corporations, a responsible corporate officer including: a president, secretary,
treasurer, vice-president in charge of a principal business function, any other person who performs similar
policy or decision-making functions or the manager of manufacturing, production or operating facilities if
authority to sign documents has been assigned or delegated to the manager in accordance with corporate
procedures.
b. Partnerships. In the case of a partnership, a general partner.
c. Sole proprietorships. In the case of a sole proprietorship, the proprietor.
d. Public facilities. In the case of a municipal, state, or other public facility, by either the principal executive
officer or the ranking elected official.
e. Storm water discharge associated with construction activity. In the case of a storm water discharge
associated with industrial activity from construction as identified in 40 CFR 122.26(b)(14)(x), either the
owner of the site or the general contractor.