KENTUCKY POLLUTANT DISCHARGE ELIMINATION SYSTEM FORM eNOI-KYR00--INSTRUCTIONS

WHO MUST FILE A NOTICE OF INTENT (NOI) FORM

Federal law at 40 CFR Part 122 prohibits point source discharges of stormwater associated with industrial activity to a water body of the Commonwealth of Kentucky without a Kentucky Pollutant Discharge Elimination System (KPDES) permit. The operator of an industrial activity that has such a storm water discharge must submit a NOI-KYR00 to obtain coverage under the KPDES Storm Water General Permit for Other Industrial Facilities. If you have questions about whether you need a permit under the KPDES Storm Water program, or if you need information as to whether a particular program is  administered by the state agency, call the Storm Water Contact, Operational Permits Section, Kentucky Division of Water at (502) 564-3410.

WHERE TO FILE NOI FORM

Operators shall submit the eForm eNOI-KYR00 (https://dep.gateway.ky.gov/eForms/Default.aspx?FormID=30) a minimum of fifteen (15) days prior to discharge of stormwater from the facility:

COMPLETING THE FORM

Enter information in the appropriate areas only. (*) denotes a required field. Enter N/A (Not Applicable) for fields that are required but do not apply to your submission. If you have any questions regarding the completion of this form call the Storm Water Contact, Operational Permits Section, at (502) 564-3410.

Please enter a valid nine (9) digit KPDES ID.  For a Renewal of Coverage or Expansion of Existing Coverage, please enter the valid nine digit KYR00 KPDES Permit ID.  For New Coverage, this field is optional, but you may provide a valid KPDES Permit ID to help DEP identify this site.  Do not enter a KPDES ID for a different site as this may result in a Notice of Deficiency.

SECTION I – PURPOSE OF NOI

Indicate whether the NOI is for renewal of coverage, new coverage or expansion of coverage

SECTION II – FACILITY OPERATOR INFORMATION

 

Operator Name(s):  Enter the name or names of all operators applying for coverage under KYR00.

Mailing Address, City, State, and Zip Code:  Provide the mailing address of the primary operator

Phone No.:  Provide the telephone numbers of the person who is responsible for the operation.

Status of Owner/Operator:  Select the appropriate legal status of the operator of the facility from the dropdown list. (Federal, Public (other than federal or state), State, Private)

SECTION III – FACILITY/SITE LOCATION INFORMATION

Name of Facility:  Provide the name of the facility.

Physical Address, City, State, Zip Code and County:  Provide the physical address of the facility.

Latitude/Longitude:  Provide the general site latitude and longitude of the operation.

Receiving Water:  Provide the name of the primary receiving water

SECTION IV – FACILITY/SITE ACTIVITY INFORMATION

Primary SIC Code:  Select the SIC Code that best describes the industrial activity.

Primary SIC Code Description – Provide the SIC Code description

Industrial Activities Conducted – Describe in detail the industrial activities at the facility

Areas Contacted by Stormwater – Describe all areas where stormwater may contact industrial activities

Potential Pollutants – List of all chemicals, compounds, materials, products or substances that may contact stormwater. Attach additional sheets if necessary

SECTION V – OUTFALL INFORMATION

Identifier – Three digit identifier starting with 001

Latitude – Latitude of the outfall (decimal degrees)

Longitude – Longitude of the outfall (decimal degrees)

Wastewaters Discharged – Indicate: stormwater only, approved non-stormwater only, commingled stormwater and approved non-stormwater, commingled stormwater and non-process wastewaters, or commingled stormwater and process water

Area Drained – Describe in detail the area being drained by the outfall. Indicate sources of contamination and surface area type (e.g. grassy, concrete, etc.)

Potential Pollutants – List of all chemicals, compounds, materials, products or substances that may contact stormwater drained by this outfall

Receiving Water/MS4 – Provide the name of either the receiving water or the MS4 to which the outfall discharges

SECTION VI – DISCHARGE MONITORING REPORTS (DMRs)

DMR Signatory Official

Provide the name, mailing address, telephone number and eMail address of the DMR signatory authority, i.e. the company official responsible for signing DMRs, Applications, and any other documents required by the KPDES permit.

DMR Recipient

Provide the type, name, mailing address, telephone number and eMail address of the DMR recipient.

SECTION VII – NOI PREPARER INFORMATION

Provide the name, mailing address, telephone number and eMail address of the person preparing the NOI.

SECTION VIII –Attachments

Attach a USGS topographic map indicating the location of the activity and the proposed discharge points.

SECTION IX – CERTIFICATION

Provide the name, mailing address, telephone number and email address of the person who is responsible for the activity.

 

Signature:  Provide full name of the responsibility party. This will constitute a signature.

 

The NOI must be signed as follows:

 

Corporation: by a principal executive officer of at least the level of vice president

Partnership or sole proprietorship: by a general partner or the proprietor respectively