Free 51276.pdf - Indiana

RULE 13 ­
Monthly Summary Report of Construction Projects
State Form 51276 (R4 / 4-08) INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT

For questions regarding this form, contact:
IDEM ­ Rule 13 Coordinator 100 North Senate Avenue, Rm 1255 MC 65-42 Indianapolis, IN 46204-2251 Phone: (317) 234-1601 or (800) 451-6027, ext. 41601 (within Indiana) Web Access:

NOTE:

Starting one (1) year after the submittal of the Notice of Intent (NOI) letter and once the regulated MS4 entity has a sufficient construction site storm water run-off control program, this completed form must be submitted each month pursuant to 327 IAC 15-13-18(b). This completed form must be submitted by the last day of the following month. If no projects occur within a given month, this form does not need to be submitted. This exact form does not need to be used if the information is conveyed using a form of another format containing the same type of information - providing the form is preapproved by, and provided to, IDEM. Return this completed and signed form, and any required addenda by mail to the IDEM Rule 13 Coordinator at the address listed in the box on the upper-right.

http://www.in.gov/idem (Search for Stormwater)

X

Reporting Month/Year:
(check one in each column)

Month January February March April May June July August September October November December

X

Year 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

MONTHLY SUMMARY REPORT OF CONSTRUCTION PROJECTS

Project Name
1 2 3 4 5 6 7 8 9 10

Project Address

Project Duration

Permit Status

Enforcement Actions

MS4 Entity:
(typed or printed)

NPDES Permit #: Date:

INR040_________

Responsible Individual*:

(typed or printed) (mm/dd/year) *Example: the individual can be the MS4 Operator, or a responsible individual for a regulated MS4 entity.

Instruction Sheet for Completing the Monthly Summary Report of Construction Projects
Project Name
Project name refers to the proposed name of the development, as it is stated in the documentation provided by the developer or other person responsible for the construction project. If a project name is changed, the original and replacement name(s) should be indicated and provided.

Project Address
Project address refers to the physical address and location of the proposed construction project site. The address must include the section, township, and range for the site, and, if known, the street address.

Permit Duration
Permit duration refers to the proposed construction project duration. The duration will likely be an estimate, based on projected start and end dates. While exact start and end dates will change, due to weather, approvals, and other factors, the approximated duration will provide some idea of the project length. The duration could be expressed in whole yearly increments (for example, one, two, five, ten years), and should reflect the timetable known at the time of application or NOI letter submittal. The duration estimate will provide a general idea of when Notices of Termination should be issued.

Permit Status
Permit status refers to the key points in the permitting process that have occurred since the application or Notice of Intent (NOI) letter submittal for a construction project permit. At a minimum, the key points, as they occur within a given month, should identify and reference: (1) application or NOI letter reviewed; (2) construction plan reviewed; and (3) Notice of Termination issued.

Enforcement Actions
Enforcement actions refer to actions taken as a result of noncompliance with the construction site run-off control program requirements. Unless the environmental damage of noncompliance is severe, the state enforcement process is usually progressive, meaning that sufficient noncompliance warnings are given prior to notices involving financial or work-stoppage penalties. At a minimum, the actions should identify and reference the issuance of: (1) warning letters of noncompliance; (2) violation notices; (3) penalties assessed; and (4) work-stoppage orders.