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Home My WebLink About328321 07/31/18 ^% ��• CITY OF CARMEL, INDIANA VENDOR: 146900 ONE CIVIC SQUARE INDIANA DEPT OF ENVIRONMENTAL M&l'"ECK AMOUNT: $......**50.00* CARMEL, INDIANA 46032 100 N SENATE AVENUE CHECK NUMBER: 328321 M,iroN c� ROOM 1255 CHECK DATE: 07/31/18 INDIANAPOLIS IN 46204-2251 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 250 4350900 0 50.00 OTHER CONT SERVICES VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) Vendor# 146900 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER INDIANA DEPT OF ENVIRONMENTAL MGT IN SUM OF$ CITY OF CARMEL 100 N SENATE AVENUE An invoice or bill to be properly itemized must show:kind of service,where performed,dates service ROOM 1255 - rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. INDIANAPOLIS, IN 46204-2251 Payee $50.00 Purchase Order# ON ACCOUNT OF APPROPRIATION FOR Terms Engineering Date Due PO# ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT 0 43-509.00 $50.00 1 hereby certify that the attached invoice(s),or 7/25/18 0 Rule 13 N01 Letter Fee $50.00 2200 250 2200 250 bill(s)is(are)true and correct and that the materials or services itemized thereon for �LFASF G tv E �t-l;`Cf. which charge is made were ordered and TO �� Tt-Ya1�.tP�s received except I N r--rV G t fV E-'t2t Nj G Friday,July 27,2018 Jeremy Kashman Director I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 ,20 Clerk-Treasurer INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT MS4 Notice of Intent(NOI)Letter OFFICE OF WATER QUALITY PART D: MATERIALS TO BE SUBMITTED WITH THIS NOI ► In addition to the information in Parts A,B,and C,an MS4 operator must provide the following. (Check when completed,or check"NA"if an item is not applicable. For the first of the numbered items below,the requirement must be met and"not applicable"is not provided as an option.): Tg " .,.,a s- '°" "fi"'i'r-^ a•" '-`s .g u -am'}' Sn L` e t } ' 1) ® --- A copy of the Storm Water Quality Management Plan—Part A: Initial Application Certification Submittal and Checklist. 2) ® ---- Proof of publication in a newspaper of largest circulation in the affected area'. 3) ❑ ® Certification that appropriate legally-binding agreements or contracts between MS4 entities have been obtained(see APPENDIX A). APPLICATIONPART E: • Upon su mission of this NOI tetter,the MS4 Operator shall pa a fee in the amount of fi dollars($50). Make all cheeks and money order :abl "fQ= " • Pursuant to 327 IAC 15,the fee is NOT: - Transferable from one(1)MS4 operator to another; - Transferable from one(1)person to another; - Transferable to any other type of permit issued by IDEM;or - Refundable. Unless requested by the MS4 operator and approved by IDEM within three(3)days of submittal to IDEM or prior to the NOI letter processing by IDEM,whichever is earlier. CERTIFICATIONART F: • Allow a minimum of four(4)weeks for processing the NOI letter information and receipt of your Notice of Sufficiency. • Make sure you have completed all appropriate sections of this NOI letter and have included all required addenda. Sign and date the NOI letter and return it to the address shown on page one(1)of this NOI letter. Incomplete or incorrect NOI letters may result in a delay in processing and issuance of your Notice of Sufficiency. • All information requested in this NOI letter is MANDATORY for the administration and processing of your permit pursuant to 327 IAC 15-13. All data received will be regarded as a public record subject to disclosure in accordance with IC 5-14-3 and 327 IAC 12.1. ► The Operator listed in"Part A: GENERAL INFORMATION FOR MS4 OPERATOR"must sign the following certification statement: `By signing this N01 letter, 1 hereby certify under penalty of law that this document and all attachments were 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. /am aware that there are significant penalties for submitting false information,including the possibility of fine and imprisonment for knowing violations." Type or print Operator Name: Jeremy Kashman, P.E. Signature of Operator: Date: (mm/dd/year) 'The notice must be published one(1)time in at least one(1)newspaper of general circulation in each of the counties comprising the MS4 area represented by the entities seeking coverage under this NOI letter submittal. The publication of notice must,at a minimum,include the language specified in 327 IAC 15-13- 6(a)(4)- PF Reason=N0113 Page 3 of 5 INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT MS4 Notice of Intent(NOI)Letter OFFICE OF WATER QUALITY APPENDIX A: LEGALLY-BINDING AGREEMENTICONTRACT CERTIFICATIONFOR IMPLEMENTATION OF • On (date), 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. (List entity names above) Entered into an agreement or contract to satisfy the implementation requirements in Parts B and C of the Storm Water Quality Management Plan(SWAMP). As stated in the agreement or contract,entities agree to the following responsibilities Please check the boxes corresponding with responsibilities,or portions thereof,of each entity(entity numbers correspond to entity name numbers listed above)entering into this agreement in the table below. "RESPONSIBILITY,,,,..," 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. a.Public Education and Outreach ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ b.Public Involvement and Participation ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ c.Illicit Discharge Detection and Elimination ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ d.Construction Site Storm Water Run-off 11 El El El El El 1:1 1:1 11 El El Control e.Postconstruction Storm Water Management in ❑ ❑ ❑ El El 11 1:1 1:1 El El 1:1 El Development and Redevelopment f.Pollution Prevention and Good Housekeeping 11 El 11 El El El ❑ El El El ❑ Elfor Municipal Operations g.Baseline Characterization and On-Going 11 1:1 11 1:1 11 11 1:1 1:1 11 11 1:1 ElMonitoring Plan h.Other: ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Specify: If any entity(s)is agreeing to accomplish only a portion of an aforementioned responsibility in the table, please elaborate below on the exact responsibility portion(e.g.entity 1 is responsible for storm drain marking in the MS4 area, entity 2 is responsible for conducting behavioral phone surveys for item(a)in the table). Attach separate sheets as needed. The following statement and the accompanying signatures serve as the required certification that an agreement or contract has been developed and agreed upon per the requirements of 327 IAC 15-13. "By signing this certification,/hereby certify under penalty of law that this document and all attachments are, to the best of my knowledge, 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." Entity Authorized Signature Date Entity Authorized Signature Date 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. PF Reason=N0113 Page 4 of 5 INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT MS4 Notice of Intent(NOI)Letter OFFICE OF WATER QUALITY PART C: GENERAL INFORMATION FOR MS4 ENTITIES 16. Receiving Water: List all separate storm water outfall receiving waters for all entities seeking coverage under this NOI submittal and corresponding outfall designations. Attach separate sheets as necessary. If all receiving waters and outfalls are not known at the time of the NOI letter submittal,state known ones and Urovidb the information in the corresUonding annual re ort. Entity Receiving Water • q The City of Carmel Hot Lick Creek 17 r The City of Carmel Kirkendall Creek 4 s _ The City of Carmel Lion Creek 1 �g =t � , The City of Carmel Little Cool Creek 56 The City of Carmel Little Eagle Creek 1 The City of Carmel Long Branch 7 � The City of Carmel Mitchner Ditch 42 >x The City of Carmel Ream Creek 4 y The City of Carmel Spring Mill Run 0 The City of Carmel Trail Creek 0 %Aa The City of Carmel Vestal Ditch 23 ebb The City of Carmel Well Run 0 cc F The City of Carmel White River 10 dd The City of Carmel Will Creek 3 'ee The City of Carmel Cemetery Creek 0 ff The City of Carmel Williams Creek 25 PF Reason=NO]13 Page 5 of 5 RULE 13 NOTICE OF INTENT (NOI) LETTER For questions regarding this form,contact: IDEM—Rule 13 Coordinator State Form 51270 (R4/4-08) 100 North Senate Avenue,Rm 1255 ' Form Approved by State Board of Accounts,2003 MC 65-42 lam INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT Indianapolis,IN 46204-2251 Phone: (317)234-1601 or NOTE: This form must be used to apply for a general NPDES permit Web Acces(800)451-6027,ext.41601(within Indiana) s: pursuant to 327 IAC 15-13. htto://www.in.00vfidem(Search for Stormwater) ■ Please type or print in ink. • This completed form must be submitted with the Rule 13 Storm Water Quality Management Plan(SWQMP)—Part A:Initial Application Certification Submittal and Checklist,and proof of publication. • Return this form,required addenda,and payment by mail to the IDEM Rule 13 Coordinator at the address listed in the box on the upper-right. APPLICATIONAPPLICABILITY Permit coverage under 327 IAC 15-13 applies to all entities that: ❑Initial N01 letter 1. are not required to obtain an individual NPDES permit under 327 IAC 15- 2-9(b); ®Renewal NO[letter 2. meet the general permit rule applicability requirements under 327 IAC 15- 2-3; 3. do not have coverage under an individual MS4 permit;and 4. operate,maintain,or otherwise have responsibility for an MS4 conveyance within a designated MS4 area. PART A:GENERAL INFORMATION FOR MS4 OPERATOR 1. Operator Name: Jeremy Kashman, P.E. 2. Operator Title: Director of Engineering and Storm Water Management 3. Represented Entity': The City of Carmel 4. Mailing Address Address: One Civic Square ®City Of: Carmel Zip: 46032 County: Hamilton []Town 5. Phone Number: 317-571-2441 6. Facsimile Number if applicable): 317-571-2439 7. E-mail Address if applicable): 'kashman carmel.in. ov PART 13:GENERAL INFORMA I TIONFOR •NTACT PERSON FOR 8. Is the primary contact person for the MS4 area the same as the operator listed in Part A? ❑Yes* ®No** *If yes,omit items#9-15 below and skip to Part C. **If no,fill out items#9-15 below. 9. Contact Person Name: John G.Thomas 10. Contact Person Title: Storm Water Administrator 11. Represented Entity': The City of Carmel 12. Mailing Address Address: One Civic Square ®City Of: Carmel Zip: 46032 County: Hamilton []Town 13. Phone Number: 317-571-2441 14. Facsimile Number, if applicable): 317-571-2439 15. E-mail Address if applicable): 'thomas@carmel.in.gov 'The"Represented Entity"is the name of the facility and/or organization that you are representing for purposes of this application. This can be a business, municipality,university,etc. PF Reason=N0113 Page 1 of 4 INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT MS4 Notice of Intent(NOI)Letter OFFICE OF WATER QUALITY PART C:GENERAL INFORMATION FOR MS4 ENTITIES 16. Receiving Water: List all separate storm water outfall receiving waters for all entities seeking coverage under this NOI submittal and corresponding outfall designations. Attach separate sheets as necessary. If all receiving waters and outfalls are not known at the time of the NOI letter submittal,state known ones and provide the information in the corresponding annual report. • Entity Receiving Water a>" The City of Carmel Ams Run 2 The City of Carmel Almond Ditch 23 The City of Carmel Bear Creek 0 M. The City of Carmel Blue Woods Creek 23 le.—_ The City of Carmel Boone Creek 3 The City of Carmel Brock Ditch 9 The City of Carmel Carmel Creek 34 h: The City of Carmel Center Creek 2 The City of Carmel Clay Creek 1 The City of Carmel Cool Creek 102 The City of Carmel Crooked Creek 0 h` The City of Carmel Delaware Creek 0 The City of Carmel Elliot Creek 11 :=n .;. The City of Carmel Henley Creek 0 f=o The City of Carmel Hiway Run 0 ^ip The City of Carmel Hoover Run 0 17. Do any outfalls discharge to another MS4 conveyance?(These conveyances may either be regulated or non-regulated under Rule 13.) If yes,provide the name of the responsible individual for the storm sewer and provide the name of the initial receiving water. ®Yes* ❑No** *If yes,fill in items#18-22 below. **If no, omit items#18-22,and advance to item#23 below. 18. Responsible Individual Name: Kent Ward 19. Responsible Individual Title: Hamilton County Surveyor 20. Responsible MS4 Entity e. .municipality): Hamilton County 21. Phone Number: 317-776-8495 22. Initial Receiving Water(s): Hamilton County Regulated Drains located in MS4 Boundary 23. Has a TMDL study been completed on any of the receiving water(s)? (To determine if a TMDL study has been completed,you may contact IDEMs TMDL program area by phone at 1-317-308-3173.) If yes, note which outfall(s) is subject to effluent limitations and identify the impairment parameter(s)in the table provided below. (attach separate sheets as necessary) ®Yes* ❑No** *If yes,fill in items a.-m.below. **If no, omit items a.-m.and advance to Part D. • West Fork White River, Muncie to Hamilton County-Marion White River E.Coli County Line ,rCy,c gee; r. PF Reason=N0113 Page 2 of 5