Instructions to Apply for Coverage under the Sand and Gravel General Permit(the permit) to Discharge Process Water Storm Water, and Mine Dewatering Water Associated with Sand and Gravel Operations, Rock Quarries, and Similar Mining Operations, including Stockpiles of Mined Materials, Concrete Batch Operations, and Hot Mix Asphalt Operations.
Introduction
Theseinstructionsareforapplyingforcoverageunder Ecology'ssandandgravelgeneral permit. Usethis permit application toapplyfor coverage underthe permit or to make major changes to permitted activities. Complete theapplication andreturn it to the appropriate regional officelisted at the end oftheseinstructions. Public notice is required for a complete application and Ecology must address publiccommentsbeforeissuingthepermit to theapplicant.Attachtheaffidavitofpublicnotice fromthenewspaper tothisapplication.Ecologyrequires the permit applicationtobe completed thoroughlyand accuratelyandmayrequireadditional details after reviewingtheapplication.It typicallytakes45 to 60 days to issue thepermit.
When issued, the permit isa legal documentcommittingthe applicantto complywiththeconditions in the permit. To assure that your information is legible, please print in inkortype. Besurethe application is signed in ink. Ecology's web pagefor the permit, application,related forms, and technicalassistance isat theheading, "Sand and Gravel General Permit."You maycall the regional officelisted on the last page for assistance with this application.
Line-by-LineInstructions
Section I. Permit Applicant
ThePermitteeistheentity thatisapplyingforcoverageunderthe sandandgravelgeneralpermit. ThePermitteemusthavethelegalauthority toenterintothiscontractwithEcologyandtoassure that the siteis managed accordingtothetermsandconditions of the permit.
Business/Company/ProprietorName:The legal name of entitythat is applying for permit coverage.
ResponsiblePerson:Thenameofthepersonwhohasthelegalauthority torepresentthe entityandcommittothetermsandconditionsofthepermit.Thispersonmustsign the application.
Federalregulations requirethe application to be signedas follows:
A.)Foracorporation,byaprincipalexecutiveofficerofat least thelevel ofvice president.
B.)For a partnership or soleproprietorship,bya general partner orthe proprietor, respectively.
C.) For a municipality, State,Federal, or otherpublicfacility,byeitheraprincipalexecutive officer or ranking electedofficial.
To ask about the availability of this document in a version for the visually impaired, call the Water Quality Program at 360-407-6600. Persons with hearing loss, call 711 for Washington Relay Service. Persons with a speech disability, call 877-833-6341.
Sand & Gravel Permit Application Instructions
ECY 070-31 (Rev. 11/11)1
Ifyoucurrentlyhaveapermitandareapplyingtomakechangestocoverage, checkthepermitmodificationbox.
Permitholdersmustapplytomodifypermit coverage for major changesatapermittedfacility. Addinga new surface water, concrete batch plant,concrete recycling,awash plant, or addingnew mined products (newNAICS code)requiresapermitmodification. Typically,addingactivities listed intheapplicationrequiresapermit modification. Modifyingthe permit coverage is unnecessaryfor adding additional pollution control measures, buildingnewroads, replacingequipment,and revising the reclamation plan. Permit modification requires public notice. Sometimes an applicant must also completetheStateEnvironmentalPolicyAct (SEPA) process beforethepermitmodification.When applyingto modifypermit coverage, fill out the entirepermit application and circle or highlight new activities. Contact the Ecologypermit manager for help with modifyingpermit coverage.
Section II. Responsible Parties Mailing and Contact Information
Ecologymust have at least one complete addressformailingpurposes.The“PrimaryMailing Address”istheaddressthatyou want all official Ecologycorrespondence mailed to. Official correspondence includesanyinformation about permit compliance or clarification. Official correspondencecanhavelegalconsequencesandcan requirean action or response fromthe permittee. It is important to provide addressinformation thatassures the right person will be notified.This address can be the “Owner”,the “Operator”, or “Other”.
EcologymustalsohaveamailingaddressfortheOwner and the Operatorofthe site. Ifthe owner and operator are the same andare enteredas the primarymailing address then no further information isrequired. If theprimarymailingaddress is“Other”, thenyou must include a mailing address for the owner and operator.You mayhave to include 3 addresses.
Name: The legal name of the owner/operator orperson receivingthe mail. This will typicallybethecompanyname asitappearsonthebusinesslicense.
Mailing Address: The mailingaddress shouldinclude onlyinformationnecessaryfor mailingpurposes but it can include two lines ofinformation. Itcan include the name of a person or mail stop ifthat is necessaryto properlydirect the mail. Do not include thestreet address ifdeliveryis to a post office box.
City:Provide the city, state, andZIP Code+4 designation.
Responsible Person: Givethenameandtelephonenumber of the person whois the responsibleperson.In thecaseofacorporation, a responsible corporate officer or a duly authorizedrepresentative; for apartnershiporsoleproprietorship, bya general partner or proprietor; for a municipal, state, orotherpublic agency, byeither a principal executive officer, ranking electedofficial, or other dulyauthorized employee.
UBI Number: TheUnifiedBusinessIdentifier(also calledWashington State Tax Identification Number,Labor andIndustriesIdentificationNumber,orLicensingNumber) is also necessaryfor the owner andmaybeapplicablefortheoperator.
Sand & Gravel Permit Application Instructions
ECY 070-31 (Rev. 11/11)1
Section III. Billing Address and Contact Information
Thisisthemailingaddresswhere Ecology willsendpermitfeeinformation. Permitfee informationincludestheannualfeeinvoice,noticeofdelinquencyand noticeoffeerule actions. Fill out this section evenif it is the same as SectionII.
Business/Company Name: Thelegalnameof thebusiness/companythat is responsible for payingthe permit fee.
Mailing Address: The mailingaddress shouldinclude onlyinformationnecessaryfor mailingpurposes but it can include two lines ofinformation. Itcanincludethename ofa person or mail stop ifthat is necessaryto properlydirect the mail. Do not include thestreet address ifdeliveryis to a post office box.
City:Provide the city, state, andZIPCode+4 designation.
Billing Contact:Givethenameandtelephonenumberofthe person whowill serve as the contact personwithEcologyfor fee related questions.
Site Identifier: The siteidentifier is not required.Ifyou want fee mailingsfromEcologyto reference an identifier thatyou useto trackbillings,enterthatidentifierhere.
Section IV. Physical Location of Facility/Site
Theinformation will beused to locate the facilityfordatatrackingpurposesand for site visits. This section provides information about the physicallocationof the site.This is not for mailingpurposes.Enter thefacility's official or legal name.Provide the street addressforthefacility. Ifnostreetaddress is available, provide appropriate location information, such as a highwayor road designation.
SiteName: The legal name ofthe business/companythat operates the permitted site.
StreetAddress: Provide the streetaddress where the permitted facilityislocated. Ifno street address is available, provide appropriate location information, such as a highwayor road designation.
City andCounty: Thenameofthecityandcountywherethe site is located. When located outside of citylimits, provide the name ofthecityclosest to the site.
Site ContactPerson: Provide the name and telephonenumber of the person who will typicallybeatthesiteand would be the designated person to contact whenEcology conducts a site visit.
Landowner Name: Provide the propertyowner'sname.
LegalDescription: Therearetwooptionstodesignatethegeographical location of thesite. Latitude/Longitudeis required information for Ecology’s computer data system.Ifyou do not have that information, it will be generatedfromthe other location information.Youmust provide at least oneof thetwo types of location information:
Section/Township/Range- A legal descriptionofthe propertyto the nearest 40 acretract.
Latitude/Longitude:LatitudeandLongitudeofthepropertyindecimalformattofourdecimal places at the mainentrance tothe property.
Directions to site: The directions boxshould brieflydescribehowtofindthesite froma readilyidentifiable nearbylandmark/location, attach a vicinitymap, or both.
SectionV. Regulatory Status
Thissectionisdividedinto threeareas:
The first part requests information on anyexistingpermits for the facilityother than the Sand and
Gravel Permit. Check theboxes thatapply.
The second part covers compliancewith the State Environmental PolicyAct (SEPA). Statelaw requires SEPA review when government agenciesareaskedto issue a permit for activities related to the site. All new permittedsites and new permit applicants should document compliance with SEPA. Exceptionsshouldbeexplainedina separate letter and include anyrelated documents fromother governmentagencies.Permitmodifications usuallyrequire SEPA review. SEPA review is requiredif any other governmentagencyissues a permitrelatedtothepermitmodification. Permit modifications for existingdischargesthat containconditions no less stringent thanfederaleffluent limitations and state rules arenot subjecttoSEPA review.
The third part requests information regarding ground water protection designations.Indicate by checkingyesor no,whetherthesiteis in a Critical Aquifer RechargeArea,adesignatedWellhead Protection Area, or aSole Source Aquifer. Critical Aquifer Recharge Areas areareas with a critical recharging effect onaquifers usedfor drinkingwater. Theyare designated bylocalcities, counties, and districts. Wellhead protectioninformation is available fromyour localgovernment planning agencyand the water systemoperator inyour area.Internet sites for localgovernments usuallyshow these areas.Sole Source Aquifers aredesignated bythe U.S. E.P.A.and can be found on their websiteat Click on Sole Source Aquifers.
SectionVI. DischargeInformation
Include a map ofyour site whenyou submit the application(see the last page ofthese instructions for an example). The site mapwill locate and document drainage anddischargestructures,an outlineofthedrainageareasfor each discharge point includingdischarges togroundwater.The site map shall also identifynearbyand on-sitesurface water bodies. The map should identifyall areas associated with industrial activities.Lands adjacenttothesiteshall also be depicted where helpful in identifyingdischarge points or drainage routes.Thisinformation should be designated in the map legend.
Check the appropriate boxes todescribe the dischargeof water fromthe mine site in general:
Surfacewater: Discharges to surface water includedischarges fromthe site which flow directlyto surface watersof the state.Thisincludes discharges torivers, lakes, creeks, ditches, wetlands, estuaries, saltwateror othersurfacewaterbodies.
Stormsewer: Thenameofareceivingstormsewer could bea municipality, flood control district, utilityor private entity(e.g. industrial park).
Groundwater: Discharges to ground, include direct or indirect discharges to ground water. Discharges to drywells, drain fields,unlined truck washoutareas,infiltrationbasins orunlinedlagoonsareincluded in this category.
Providetheacreageofthepermitted facility.Thisacreage isthelandareapermittedfor miningover the life of mine or total acreageofafullydevelopedsite.
Complete Attachment 1- DischargeInformationto provide details aboutdischarge fromthe site. It isthelastsheetoftheapplication. Provide details about each dischargepointthatwillbe monitored.Identifythedischargepointbynumber.Includethelatitude andlongitudeofthe monitoringpoint. Checkthe appropriateboxestodescribe whatactivitiesandNAICScodes contributetothedischarge to the outfall. Completeaboxforeachdischargepoint.
Section VII.Site Activities Information
Thissectionprovidesthebasisforassessingpermit fees and for setting water monitoring requirements.
SiteActivities:Indicatewhatactivitiestakeplaceatthe sitebychecking the appropriate boxesand fillingintheNAICScodefortheactivity whereneeded.Forexample,ifapplicationisfora mine that produces construction sand & gravel, check mining and then fill in212321 as the NAICS code. Table1 belowdescribesNAICScodes.
AsphaltandCementProduction:
1. For NAICS 324121, Check the appropriate boxto indicate the amount of Asphalt producedperyearinTons perYear.
2. For NAICS codes 327xxxthat include concrete productionormakingproductsfrom concrete,checktheappropriate box to indicate the amountofCementConcrete produced peryear in cubic yards peryear. Recyclingcuredconcrete is not included here.
AdditionalActivitiesconductedonsite:Indicateotheractivities onthe site that can pollute water or treat water on the site.Check the appropriate boxes as theyapplytoyour site.
Table 1. North American IndustryClassificationSystem(NAICS)number.(See /naics/ fordetailed descriptions of eachcode.)
NAICSnumberanddescription113110Logging &Timber Tracts (longtermtimber farms)
212311 Dimension Stone Miningand Quarrying
212312 Crushed and BrokenLimestoneMiningandQuarrying
212313 Crushed and Broken GraniteMiningandQuarrying
212319 Other Crushed and Broken Stone Miningand Quarrying
212321 Construction Sand and Gravel Mining
212322Industrial SandMining
212324 Kaolin and Ball ClayMining
212325 Clayand Ceramic and RefractoryMinerals Mining
212319 Other Crushed and Broken Stone Miningand Quarrying
212399 All Other Nonmetallic Mineral Mining
Sand & Gravel Permit Application Instructions
ECY 070-31 (Rev. 11/11)1
NAICSnumberanddescription (cont’d)324121AsphaltPavingMixtureand Block Manufacturing
327320 Ready-MixConcrete Manufacturing
327331 ConcreteBlock and Brick Manufacturing
327332 Concrete Pipe Manufacturing
327390 Other Concrete Product Manufacturing
327999 All Other Miscellaneous Nonmetallic Mineral Product Manufacturing
Section VIII. Facility Activity Status:
1.Indicate whetheryour sitewillbeActiveorInactiveatthetimeofpermit reissuance.If mining is completed andmine reclamation is the onlyactivity,checktheboxfor 'Reclaimingsite.'
2.Indicatewhetherornotthefacilityoperatesyearround.Ifnot, indicate which activities (byNAICS Code)occurduringwhichmonths.
Section IX. Plan Preparation and Review
Indicate thestatus of pieces ofthe Site Management Planbycheckingthe appropriate boxes. The Site Management Plan includes the Stormwater Pollution Prevention Plan,MonitoringPlan, Erosion &Sediment Control Plan, and Spill Plan.Explaininthecommentssectionwhyanyof these plans is not up to date and complete.Describewhentheywillbe completed.
Section X. Certification by Permittee
The Responsible Personmustsignthe application. The requirementsforsignaturearespecified below the signature block. Print ortype the namefor clarity, thensign anddate the document on the lines provided.
In thecase of co-permittees, boththeoperator/contractorandtheowner/representative must sign the application.
Sand & Gravel Permit Application Instructions
ECY 070-31 (Rev. 11/11)1
WheretoApply:
CompletedapplicationsshouldbemailedtotheappropriateEcologyRegionalOfficebased onthecountyinwhichthefacilityislocated:
Sand & Gravel Permit Application Instructions
ECY 070-31 (Rev. 11/11)1
REGIONALOFFICE ADDRESS
COUNTYINWHICH FACILITYISLOCATED
Sand & Gravel Permit Application Instructions
ECY 070-31 (Rev. 11/11)1
Persons with hearing loss can call 711 for Washington Relay Service. Persons with a speech disability can call 877-833-6341.
Sand & Gravel Permit Application Instructions
ECY 070-31 (Rev. 11/11)1
Washington State Dept of Ecology
Central Regional Office
15 West Yakima Avenue, Suite 200
Yakima, WA 98902-3452
Attn:WaterQualityPermitCoordinator
Phone509-454-7869
Benton Chelan Douglas Kittitas
Klickitat Okanogan Yakima
Sand & Gravel Permit Application Instructions
ECY 070-31 (Rev. 11/11)1
Sand & Gravel Permit Application Instructions
ECY 070-31 (Rev. 11/11)1
Washington State Dept of Ecology
Eastern Regional Office
North 4601 Monroe, Suite 202
Spokane, WA 99205-1295
Attn:WaterQualityPermitCoordinator
Phone509-329-3565
Adams Asotin Columbia Ferry Franklin Garfield Grant
Lincoln
Pend Oreille Spokane Stevens WallaWalla Whitman
Sand & Gravel Permit Application Instructions
ECY 070-31 (Rev. 11/11)1
Sand & Gravel Permit Application Instructions
ECY 070-31 (Rev. 11/11)1
Washington State Dept of Ecology
Northwest Regional Office
3190160th Avenue Southeast
Bellevue, WA 98008-5452
Attn:WaterQualityPermitCoordinator
Phone425-649-7276
Island King Kitsap San Juan
Skagit Snohomish Whatcom
Sand & Gravel Permit Application Instructions
ECY 070-31 (Rev. 11/11)1
Sand & Gravel Permit Application Instructions
ECY 070-31 (Rev. 11/11)1
Washington State Dept of Ecology
Southwest Regional Office
300 Desmond Drive
Post Office Box47775
Olympia, WA 98504-7775
Attn:WaterQualityPermitCoordinator
Phone360-407-6280
Clallam Clark Cowlitz
Grays Harbor
Lewis
Mason Pacific Pierce Skamania Wahkiakum
Sand & Gravel Permit Application Instructions
ECY 070-31 (Rev. 11/11)1
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Sand & Gravel Permit Application Instructions1
ECY 070-311
Permit Application for Coverage under the
Sand and Gravel General Permit
for the discharges of process water, stormwater or mine dewatering water associated with sand and gravel mining, rock quarries and similar mining operations, including stockpiles of mined material, concrete batch operations and hot mix asphalt operations
(Not for coverage of portable operations)
ECOLOGY WILL COMPLETE THIS SECTION. Applications to modify permit coverage should fill in the permit number:
Permit NumberWAG-50- / Ecology Region / W.R.I.A. / Date Received / Coverage Date
I.PERMIT APPLICANT
Business/Company/Proprietor Name / Responsible PersonPERMIT MODIFICATION - Check here if applying to make changes to an existing permit. Fill in the Permit number box above if modifying permit coverage.
II.RESPONSIBLE PARTIES MAILING AND CONTACT INFORMATION
Responsible Party Information / Contact PersonName:
Phone No.
Email: / Operator
Owner
Other / Name
Phone No.
Email / Operator
Owner
Mailing Address / Mailing Address
PO Box (Optional) / PO Box (Optional)
City
/ State
/ Zip
/ City
/ State / Zip
UBI No. / UBI No.
III.BILLING ADDRESS AND CONTACT INFORMATION
Billing Address / Contact Person
Business/Company Name: / Billing Contact:
Mailing Address for Billing: / Phone No. Business Ext.
Email:
City
/ State
/ Zip
/ Site Identifier (optional)
To ask about the availability of this document in a version for the visually impaired, call the Water Quality Program at 360-407-6600. Persons with hearing loss, call 711 for Washington Relay Service. Persons with a speech disability, call 877-833-6341.
IV.PHYSICAL LOCATION of FACILITY/SITESite Name: / Site Contact:
Street Address: / Phone No. Business Ext.
Email:
City: / County: / Landowner Name:
Legal description of site by either:
- Latitude:
Report in decimal degrees such as 47.9382; 122.7614; or in degrees, minutes, seconds: 48 12’ 30”; 123º 16’ 04”
2. NWNWSWSE¼; Section Township Range
Directions to site from nearest highway or town (or attach a vicinity map):
V.REGULATORY STATUS (provide information for all that apply to your site)
1. NPDES Permit Number (other than Sand and Gravel Permit Number)2. State Waste Discharge Permit Number
3. Air Notice of Construction, Permit or Order, Agency
4. City or County Permit Number
5. Department of Natural Resources Reclamation Permit Number
6. UIC Registration Number
All NEWfacilities and new permit applicants applying for a permit must document compliance with the State Environmental Policy Act (SEPA) and conduct public notice. Permit modifications must conduct public notice and may require SEPA review, depending on the type of changes at the site and permitting requirements of other government agencies.
1. Has SEPA review been completed for all site activities? YES NO
Date SEPA determination issued
2. Lead agency issuing SEPA Determination:
3. SEPA Responsible Official: Title:
4. Type of SEPA Determination: DNS Mitigated DNS DS/ EIS
5. Attach affidavit of publication from newspaper.
GROUND WATER PROTECTION DESIGNATIONS
Is site within a Critical Aquifer Recharge Area?
Is site within a designated Wellhead Protection Area?
Is site within a Sole Source Aquifer? / YES
YES
YES / NO
NO
NO
VI. DISCHARGE INFORMATION
Attach a copy of the facility site map from the Stormwater Pollution Prevention Plan or the Monitoring Plan. The map must show the points of discharge and the outfall numbers. Check the boxes that apply for what type of water discharge(s) occur:
to a surface water body / Name of water body:
to a storm drain system / Owner of system:
to ground water
Acreage of permitted facility:
Describe each point of offsite discharge in Attachment 1 at end of application. Also list locations where staff collect representative ground water samples.
VII.SITE ACTIVITIES INFORMATION: (include ALL activities, current and planned, at the site)
In order for Ecology to properly calculate permit fees, the applicant must complete the followingsection. Check the boxes that apply. Refer to application instructions for NAICS Code definitions.
Site Activities / NAICS Code (s) / Production (averagelast 3 years)Timber Tracts, Logging / 113110 113310 / Asphalt Production (Tons Per Year)
Mining / 212311 212312 212313 / Less than 50,000
Screening, Crushing, or Stockpiles / 212319 212321 212322
212324 212325 212399 / 50,000 to 299,999
300,000 or greater
Aggregate Washing, Mine Dewatering, or both with any NAICS
Asphalt Paving and/or Asphalt Recycle / 324121 / Cement Concrete Production
(Cubic Yards Per Year)
Ready-Mixed Concrete / 327320 / Less than 25,000
Concrete Products (pipe, blocks, bricks, crush recycle) / 327331 327332 327390
327999 / 25,000 to 199,999
200,000 or greater
Additional activities conducted on site
Do you use chemical settling agents (flocculants, coagulants, etc.)? If Yes, attach MSDS