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RULE 13 STORM WATER QUALITY MANAGEMENT PLAN (SWQMP) ­
PART C: PROGRAM IMPLEMENTATION CERTIFICATION CHECKLIST
State Form 51280 (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:

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

NOTE:

This form must be used for compliance with a general NPDES permit pursuant to 327 IAC 15-13. Submit this completed form with a complete "SWQMP ­ Part C: Program Implementation" in accordance with 327 IAC 15-13-8. 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.

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PART A: SWQMP CERTIFICATION CHECKLIST Please check the appropriate box when the requirements for each numbered item have been met, or check "NA" if an item is not applicable. For some of the numbered items, the requirements must be met and "not applicable" is not provided as an option.

X

NA

ITEM
1. 2. 3. 4.
SWQMP ­ Part C: Program Implementation submitted within 1 year from the submission of the NOI letter or the expiration date of the previous 5-year permit term. Approved TMDL established for any MS4 discharge receiving water. * If yes, the SWQMP ­ Part C includes appropriate modifications to meet the TMDL SWQMP ­ Part C identifies that the required ordinances or similar regulatory mechanisms will be developed, revised, modified, and/or implemented within two (2) years from the submission of the NOI letter The SWQMP ­ Part C contains: a) b) c) d) e) f) g) h) i) j) k) An initial evaluation of the storm water program for the MS4 area * The initial evaluation includes all known structural and nonstructural storm water BMPs A detailed program description for each MCM A timetable for program implementation milestones and SWQMP-Part B conclusions A schedule for on-going receiving water characterization to evaluate BMP effectiveness and receiving water quality A narrative and mapped description of the MS4 area boundaries *The boundary description includes the specific section(s), or, as appropriate, street name(s) An estimate of the linear feet of MS4, segregated by conveyance type A narrative summary of allowed structural BMP types in new development and redevelopment A summary on structural BMP selection criteria and performance standards A narrative summary of the current and projected storm water budget A narrative summary of measurable goals for each MCM * Measurable goals relate to an environmental benefit Appropriate, completed state-issued certification forms (only required for the initial 5-year permit term) i) ii) iii) iv) v) vi) l) i) ii) iii) iv) v) vi) vii) viii) ix) x) xi) Public education and outreach MCM Public participation and involvement MCM Illicit discharge detection and elimination MCM Construction site storm water run-off control MCM Postconstruction storm water run-off control MCM (not required until end of second year of permit coverage) Pollution prevention and good housekeeping for operations MCM Number or percentage of citizens that have an awareness of storm water quality issues Number and description of meetings, training sessions, and events conducted to involve citizens Number or percentage of citizens that participate in storm water quality improvement projects Number and location of storm drains marked or cast Estimated or actual linear feet or percentage of MS4 conveyances mapped Number and location of MS4 area outfalls mapped Number and location of MS4 area outfalls screened for illicit discharges Number and location of illicit discharges detected Number and location of illicit discharges eliminated Number of, and estimated amount of material collected from, HHW collections Number and location of citizen drop-off centers for automotive fluids Page 1 of 4

A listing of programmatic indicators for each MCM. These indicators include:

PART A: SWQMP CERTIFICATION CHECKLIST Please check the appropriate box when the requirements for each numbered item have been met, or check "NA" if an item is not applicable. For some of the numbered items, the requirements must be met and "not applicable" is not provided as an option.

X

NA

ITEM
xii) xiii) xiv) xv) xvi) xvii) xviii) xix) xx) xxi) xxii) xxiii) xxiv) xxv) xxvi) xxvii) xxix) xxx) Number or percentage of citizens that participate in HHW collections Number of construction sites permitted for storm water quality Number of construction sites inspected Number and type of enforcement actions taken against construction site operators Number of public informational requests received related to construction sites Number, type, and location of structural BMPs installed Number, type, and location of structural BMPs inspected Number, type, and location of structural BMPs maintained, or improved, to function properly Type and location of nonstructural BMPs utilized Estimated acreage or square footage of open space preserved and mapped Estimated acreage or square footage of mapped pervious and impervious surfaces Number and location of retail gasoline outlets or municipal, state, federal, or institutional refueling areas with installed BMPs Number and location of entity facilities that have containment for accidental releases Estimated acreage or square footage and location where pesticides and fertilizers are applied by the regulated MS4 entity Estimated linear feet or percentage and location of unvegetated swales and ditches that have an appropriately-sized vegetated filter strip Estimated linear feet or percentage and location of MS4 conveyances cleaned or repaired

xxviii) Estimated linear feet or percentage and location of roadside shoulders and ditches stabilized Number and location of storm water outfall areas remediated from scouring conditions Number and location of de-icing salt and sand storage areas covered or otherwise improved to minimize storm water exposure xxxi) Estimated amount, in tons, of salt and sand used for snow and ice control xxxii) Estimated amount of material by weight collected from catch basin, trash rack, or other structural BMP cleaning xxxiii) Estimated amount of material by weight collected from street sweeping xxxiv) Number or percentage and location of canine parks sited at least 150 feet away from a surface water body xxxv) Other

5.

SWQMP ­ Part C identifies, as a minimum, the following compliance schedule for implementation from the submission day of the NOI letter: a) "SWQMP ­ Part B: Baseline Characterization and Report" submitted within 180 days b) c) d) e) f) g) h) i) j) Public education and outreach program developed and implemented within 1 year Public involvement and participation program developed and implemented within 1 year Illicit discharge plan and ordinance developed and program implemented and all major outfall conveyances mapped within 1 year 25% of storm water outfall conveyance systems mapped each year after 1 year All known storm water outfalls with a diameter greater than 12 inches and open ditches mapped within 5 years Construction site plan and ordinance developed and program implemented within 1 year O&M plan developed and program implemented within 2 years Postconstruction plan and ordinance developed and program implemented within 2 years Operations pollution prevention program developed and implemented within 1 year Plan identifies and schedules implementation of an informational program for constituents Plan identifies initial assessment of constituents Plan identifies specific target outreach or reduction goal percentages and timetables For CSS communities, the current LTCP has been reviewed for ensuring that there is consistency with this MCM Plan identifies and schedules implementation of a public participation program Plan identifies initial assessment of constituents Plan identifies specific public involvement and reduction goal percentages and timetables For CSS communities, the current LTCP has been reviewed for ensuring that there is consistency with this MCM Plan schedules development of a storm sewer system map Page 2 of 4

6.

For the Public Education and Outreach MCM: a) b) c) d)

7.

For the Public Participation/Involvement MCM: a) b) c) d)

8.

For the Illicit Discharge Detection and Elimination MCM: a)

PART A: SWQMP CERTIFICATION CHECKLIST Please check the appropriate box when the requirements for each numbered item have been met, or check "NA" if an item is not applicable. For some of the numbered items, the requirements must be met and "not applicable" is not provided as an option.

X

NA

ITEM
b) c) Plan schedules development and implementation of an ordinance or other regulatory mechanism that prohibits illicit discharges into the storm sewer system Plan identifies and schedules implementation of a plan to detect, address, and eliminate illicit discharges, including illegal dumping, into the storm sewer system i) This plan requires that problem areas be located via dry weather screening or other means ii) This plan requires that the source of the problem be located, the illicit connection be removed or corrected, and the actions taken be documented iii) This plan identifies all known active industrial facilities that discharge into a regulated MS4 conveyance Plan identifies and schedules implementation of an education program for public employees, businesses, and the general public about the hazards associated with illicit discharges and improper disposal of waste Plan establishes a recycling program for commonly dumped wastes

d) e) f) g)

Plan identifies specific outreach and reduction goal percentages and timetables For CSS communities, the current CSOOP and LTCP have been reviewed for ensuring that there is consistency with this MCM 9. For the Construction Site Storm Water Run-off Control MCM: a) Plan schedules development and implementation of an ordinance or other regulatory mechanism that controls polluted run-off from construction sites with a land disturbance of greater than or equal to one (1) acre b) Plan established written agreement or process to allow local SWCD input c) Plan identifies and schedules implementation of a requirement to use appropriate BMPs on construction sites to control sediment and erosion and other waste at a site d) Plan identifies and schedules implementation of procedures for plan review, site inspection (including prioritization of sites) and enforcement of control measures to deter infractions e) Plan identifies procedures for plan review of projects operated by the MS4 operator f) Plan requires annual training for MS4 personnel responsible for implementing this MCM g) Plan identifies and schedules implementation of procedures for receipt and consideration of public inquiries, concerns, and information submitted regarding local construction activities h) Plan identifies specific outreach, compliance, and implementation goals and timetables 10. For the Postconstruction Storm Water Run-off Control MCM: a) Plan schedules development and implementation of an ordinance or other regulatory mechanism that requires the implementation of planning procedures to promote improved water quality i) Plan procedures include the postconstruction requirements of 327 IAC 15-5-6.5(a)(8) ii) Where appropriate, procedures include buffer strip and riparian zone preservation iii) Where appropriate, procedures include filter strip creation iv) Where appropriate, procedures include minimization of land disturbance and surface imperviousness v) Where appropriate, procedures include maximization of open space vi) Where appropriate, procedures include directing community physical growth away from sensitive areas and towards areas that can support it without compromising water quality b) Plan identifies the use of any storage, infiltration, filtering, and/or vegetative practice to reduce the impact of pollutants on storm water run-off to meet narrative water quality standards on receiving waters i) Plan prohibits using infiltration practices in well head protection areas ii) As site conditions allow, plan requires an appropriately-sized vegetated filter strip width along unvegetated swales/ditches iii) Plan prohibits discharges directly to sinkholes or fractured bedrock, without appropriate treatment to meet Indiana ground water quality standards iv) Plan requires any discharge from a storm water practice that is a Class V injection well to meet Indiana ground water quality standards v) Plan requires installation of appropriate BMPs to reduce metals and hydrocarbons at new retail gasoline outlets or municipal/institutional refueling areas vi) As site conditions allow, plan regulates the rate of storm water flow through the MS4 conveyances vii) Plan requires annual training for MS4 personnel responsible for implementing this MCM viii) Plan identifies and schedules implementation of a written O&M plan for structural BMPs. c) Plan identifies specific goals for reduction percentages and timetables 11. For the Municipal Operations Pollution Prevention and Good Housekeeping MCM: a) Plan identifies and schedules implementation of a written program to ensure that existing municipal, State or Federal operations are performed in ways that will minimize contamination of storm water discharges i) Program addresses written documentation of maintenance activities, maintenance schedules, and long-term inspection procedures for BMPs to reduce floatables and other pollutants discharged from the storm sewer system ii) Program addresses controls for reducing or eliminating the discharge of pollutants from operational areas, including roads, parking lots, maintenance and storage yards, and waste transfer stations iii) Program requires a minimum distance of 150 feet for canine parks to be sited away from a surface water body iv) Program addresses written procedures for the proper disposal of waste removed from MS4 conveyances and operational areas v) Program addresses written documentation to ensure that new flood management projects assess their impacts on water quality and examine existing projects for incorporation of additional water quality protection devices or practices vi) Program addresses documentation for MS4 area personnel to attend annual training regarding this MCM b) Plan identifies specific reduction goal percentages and timetables Page 3 of 4

PART A: SWQMP CERTIFICATION CHECKLIST Please check the appropriate box when the requirements for each numbered item have been met, or check "NA" if an item is not applicable. For some of the numbered items, the requirements must be met and "not applicable" is not provided as an option.

X

NA

ITEM
For CSS communities, the current CSOOP and LTCP have been reviewed for ensuring that there is consistency with this MCM 12. "SWQMP ­ Part C: Program Implementation" has been certified by a Qualified Professional and the MS4 Operator. c)

PART B: CERTIFICATION AND SIGNATURE The Qualified Professional and MS4 Operator (referenced in Part A, Item #12 of this form) must sign the following certification statement: and provide the pertinent NPDES permit number: "By signing this checklist, I hereby certify under penalty of law that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate 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."

Name of Qualified Professional:
(typed or printed)

NPDES Permit #:

INR040_________

Signature of Qualified Professional:

Date:
(mm/dd/year)

Name of MS4 Operator:
(typed or printed)

Signature of MS4 Operator:

Date:
(mm/dd/year)

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