Date
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Please check:
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Initial Permit
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Agency Interest No.
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AI
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Existing Facility
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LWDPS Permit No.
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WP
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Proposed/New Facility
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NPDES/LPDES Permit No.
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LA
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Modified Coverage
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STATE OF LOUISIANA
DEPARTMENT OF ENVIRONMENTAL QUALITY
Office of Environmental Services, Water Permits Division
Post Office Box 4313
Baton Rouge, LA 70821‑4313
PHONE#: (225) 219-3181
LPDES NOTICE OF INTENT TO DISCHARGE
EXTERIOR VEHICLE AND EQUIPMENT WASH WASTEWATER
(Attach additional pages if needed.)
This NOI is for
(check one):
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Portable Coverage
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Site-Specific Coverage
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SECTION I - FACILITY INFORMATION
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A. Permit is to be issued to the following: (must have operational control over the facility operations - see LAC 33:IX.2501.B and LAC 33:IX.2503.A and B).
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1. Legal Name of Applicant
(Company, Partnership, Corporation, etc.) | ||||||||||||||||||||||||||||||||||||
Facility Name
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Mailing Address
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Zip Code:
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If applicant named above is not also the owner, state owner name, phone # and address.
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Please check status:
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Federal
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Parish
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Municipal
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Other:
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State
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Public
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Private
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2. Location of facility. Please provide a specific street, road, highway, interstate, and/or River Mile/Bank location of the facility for which the NOI is being submitted.
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City
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Zip Code
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Parish
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Front Gate Coordinates:
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Latitude-
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deg.
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min.
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Sec.
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Longitude-
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deg.
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min.
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sec.
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Method of Coordinate Determination:
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(Quad Map, Previous Permit, website, GPS)
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Is the facility located on Indian Lands?
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Yes
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No
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SECTION I - FACILITY INFORMATION (cont.)
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3. Name & Title of
Contact Person at Facility
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Phone
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Fax
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e-mail
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B. Name and address of responsible representative who completed the NOI:
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Name & Title
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Company
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Phone
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Fax
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e-mail
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Address
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C. Facility Information.
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Yes
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No
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If yes, refer to Appendix A to determine sanitary wastewater flow.
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Does this facility conduct vehicle/equipment maintenance/repairs? If yes explain:
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SIC (Standard Industrial Classification) Code(s):
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SIC codes can be obtained from the U. S. Department of Labor internet site at http://www.osha.gov/oshstats/sicser.html
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For Portable Pressure Washing Operations: Each portable unit must have its own permit number. You should submit one complete NOI form for each portable pressure-washing unit that you plan to use. If you are permitting more than one portable pressure washing unit please provide a description that can be used to distinguish this portable unit from your other portable unit(s). Mobile Unit #1, Mobile Unit #2, Portable Unit #1, Portable Unit #2, Truck #1, Truck #2, Baton Rouge Area Unit, New Orleans Area Unit, etc. are typical descriptions.
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D.
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Discharges Requiring Approval from the Division of Historic Preservation:
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If this NOI is being completed for a facility that has not yet been constructed, you should contact the Section 106 Review Coordinator in the Office of Cultural Development, Archaeology Division (P. O. Box 44247, Baton Rouge, LA 70804 or telephone (225) 342-8170) to determine if construction activities or the proposed discharges will adversely affect properties listed or eligible for listing in the National Register of Historic Places
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This is an existing facility and no construction activities related to this NOI are proposed.
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This is a new facility and construction activities were completed prior to the submission of this NOI form.
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This is a proposed facility and construction activities are not yet complete but I have obtained approval from the State Historic Preservation Officer for the proposed construction activities. (You must keep a copy of the approval letter on file with your facility’s permit records and compliance records.)
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SECTION II – DISCHARGE INFORMATION
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A.
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Complete this section only if you are applying for SITE-SPECIFIC permit coverage. An Outfall is the point at which wastewater is monitored prior to mixing with other waters. An outfall can be identified either at the point that effluent discharges by pipe from a treatment plant or treatment system or the point at which effluent discharges into a roadside ditch, into a storm drain, or directly into a receiving water body such as a creek, coulee, bayou, canal or river. An internal outfall is an outfall for a waste stream that combines with other waste stream(s) before discharging into an external outfall. You should read Section B – Effluent Limitations of the permit before completing this section of the NOI. You should place an “X” in the column next to any of the outfall numbers for all types of discharges that occur at your facility. The outfall numbers listed below correspond to the outfall numbers listed in the permit, which are the only types of discharges that are permissible under the general permit. If more than one outfall of a particular type occurs at a facility, then each separate outfall point should be clearly identified as RLP 1 Outfall 01A, RLP 1 Outfall 01B, RLP 1 Outfall 01C, or RLP 2 Outfall 02A, RLP 2 Outfall 02B, RLP 2 Outfall 02C, etc.
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SECTION II – DISCHARGE INFORMATION continued
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1
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Place an “X” in the appropriate box(es) in this column for all outfalls that will occur at the permitted site.
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2
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RLP 1 Outfall 001, RLP 2 Outfall 002, RLP 3 Outfall 003, RLP 4 Outfall 004, and/or RLP 5 Outfall 005 should be used if you have only one outfall of this type of wastewater and/or storm water. RLP 1 Outfall 01A, RLP 1 Outfall 01B, RLP 2 Outfall 02A, RLP 2 Outfall 02B, etc., should be used in instances where you have more than one outfall of that type of wastewater and/or storm water. If you have three or more outfalls of any listed wastewater and/or storm water you should write in the appropriate Outfall No. (RLP 1 Outfall 01C, RLP 1 Outfall 01D, RLP 2 Outfall 02C, RLP 2 Outfall 02D, etc.) in one of the blank columns and fill in the outfall location for that discharge.
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3
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This should be the point at which a sample of the discharge will be collected. Examples of outfall locations could be (but are not limited to): at the point of discharge from the settling basin located at the northeast corner of the facility; at the point of discharge from the washrack; at the southwest corner of the facility; or at the point of discharge from the STP located near the office building.
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4
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List any treatment that is utilized prior to discharge. Write “None” if wastewater is not treated prior to discharge.
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B.
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Discharge Information:
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Receiving Waters
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Indicate how the wastewater reaches state waters (named water bodies). This will usually be either directly, by open ditch (if it is a highway ditch, indicate the highway), or by pipe. You should specifically name all of the minor water bodies that your wastewater will travel through on the way to a major water body. This information can be obtained from U.S.G.S. Quadrangle Maps (See Section III). Include river mile of discharge point if available. If a discharge enters an unnamed water body, identify it as unnamed.
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Complete the discharge route and receiving stream information for all the outfalls at your facility. If all the outfalls discharge by the same route (i.e., open ditch) and into the same receiving stream, then you need only complete the first Outfall Number(s) section, however, you should list all the outfall numbers that you identified on pages 4-6 of 13 of this form. If different outfalls discharge by different routes or into different receiving streams then complete as many of the Outfall Number(s) sections as necessary to properly characterize all outfalls. If you need additional space, please attach a separate sheet and use the same format to supply the additional discharge route and receiving stream information for other outfalls.
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Outfall Numbers (s)
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By
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(effluent pipe, ditch, etc.)
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thence into
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(Parish drainage ditch, canal, etc.)
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thence into
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(named bayou, creek, stream, etc.)
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thence into
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(river, lake, etc.)
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Outfall Numbers (s)
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By
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(effluent pipe, ditch, etc.)
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thence into
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(Parish drainage ditch, canal, etc.)
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thence into
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(named bayou, creek, stream, etc.)
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thence into
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(river, lake, etc.)
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Outfall Numbers (s)
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By
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(effluent pipe, ditch, etc.)
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thence into
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(Parish drainage ditch, canal, etc.)
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thence into
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(named bayou, creek, stream, etc.)
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thence into
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(river, lake, etc.)
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SECTION III – MAPS/DIAGRAMS
(You do not need to complete this section of the NOI if you are applying for
statewide/portable permit coverage – proceed to Section IV.)
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A.
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Site Diagram. Attach to this NOI a complete site diagram of your facility showing the boundaries of your facility, the location of all buildings and/or storage areas, the location of treatment units (such as settling basins, wash racks, sewage treatment plants), and demonstrate how the wastewater flows through your facility into each clearly labeled discharge point. Indicate stormwater flow pattern with arrows on this diagram or provide additional diagrams if needed. Please indicate the location of the front gate or entrance to the facility on the site diagram. The diagram need not be to scale.
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B.
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Topographic Map. Applicants for portable pressure washing operations are not required to provide a topographic map with this NOI. For site specific coverage, attach to this NOI a map or a copy of a section of the map which has been highlighted to show the path of your wastewater from your facility to the first named water body. The highlighted map must be attached to BOTH NOIs that are submitted to LDEQ (i.e., the original NOI and the copy of the NOI). Include on the map the area extending at least one mile beyond your property boundaries. Indicate the outline of the facility, the location of each of its existing and proposed discharge structures, and any existing hazardous waste treatment storage or disposal facilities. Waterways and streets/highways must be clearly identified by name on the map.
A U.S.G.S. 1:24,000 scale map (7.5' Quadrangle) would be appropriate for this item. Appropriate maps can be obtained from local government agencies such as DOTD or the Office of Public Works. Maps can also be obtained online at http://map.deq.state.la.us/ or www.topozone.com. Private map companies can also supply you with these maps. If you cannot locate a map through these sources you can contact the Louisiana Department of Transportation and Development at:
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1201 Capitol Access Road
Baton Rouge, LA 70802
(225) 379-1107
maps@dotd.louisiana.gov
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C.
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Flow Diagram. Attach a line drawing of the water flow through the facility with a water balance showing operations contributing wastewater to the effluent and treatment units. The water balance must show average and maximum flows at intake and discharge points and between units, including treatment units. If a water balance cannot be determined, the applicant may provide instead a pictorial description of the nature and amount of any sources of water and any collection and treatment measures. Hand drawn maps are acceptable.
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