225236 10/22/2013 CITY OF CARMEL, INDIANA VENDOR: 146900 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF ENVIRONMENTAL M'�HECK AMOUNT: $50.00
i�t? CARMEL,INDIANA 46032 ATTN.RULE 13 MAIL CODE 65-42
•,«o�.�a 100 N SENATE AVE ROOM 1255 CHECK NUMBER: 225236
INDIANAPOLIS IN 46204-2251
CHECK DATE: 10122/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
211 4462838 50 . 00 STORM WATER PHASE II
RULE 13 NOTICE OF INTENT NOI LETTER For questions regarding this form,contact.
IDEM-Rule 13 Coordinator
State Form 51270 (R4/4-08)
Form Approved by State Board of Accounts,2003 100 North Senate Avenue,Rm 1255 MC 65-42
..ei'e;�• INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT Indianapolis,IN 46204-2251
Phone: (317)234-1601 or
NOTE: This form must be used to apply for general NPDES permit (800)451-6027,ext.41601(within Indiana)
PP Y 9 P We Access:
pursuant to 327 IAC 15-13. htto://v�rniw.in.gov/idem(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.
lig I'll
•
Permit coverage under 327 IAC 15-13 applies to all entities that: ❑Initial NOI letter
1. are not required to obtain an individual NPDES permit under 327 IAC 15-
2-9(b), ® Renewal NOI 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.
1. Operator Name: Michael T. McBride, P.E.
2. Operator Title: City Engineer
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): mmcbride@carmel.in.gov
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 Adminitrator
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): jthomas @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
•' • •'
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 correspondin annual report.
•
a The City of Carmel Ams Run 1
b The City of Carmel Almond Ditch 7
c The City of Carmel Bear Creek 0
d The City of Carmel Blue Woods Creek 47
e The City of Carmel Boone Creek 12
f The City of Carmel Brock Ditch 10
�g The City of Carmel Carmel Creek 25
-h The it of Carmel I Center Creek 3
Iz The City of Carmel Clay Creek 6
The City of Carmel Cool Creek 69
k The City of Carmel Crooked Creek 2
* The City of Carmel I Delaware Creek 12
=wm y The City of Carmel Elliot Creek 2
Sri The City of Carmel Henley Creek 13
o The City of Carmel Hiway Run 9
pThe City of Carmel Hoover Run 16
+<'...m��rt,:" .,.
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:
19. Responsible Individual Title:
20. Responsible MS4 Entity
(e.g.municipality): 21. Phone Number:
22. Initial Receiving Water(s):
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 IDEM's 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
3
County Line
Ib
rac
, e
d
use x
;z
m
PF Reason=NOI 13 Page 2 of 5
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT MS4 Notice of Intent(NOI)Letter
OFFICE OF WATER QUALITY
• *I I I mks 11
► In addition to the information in Parts A,13, 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.):
r �✓s5 ATE, 'r t _'yu' x., E Q
r Gp a � .o-.k,T „�''d-s: y:.E 7`r"C.,: '?y$ r .r-.ti 'f ' a .,,+.,r s •'' r �a,- ;c+ -
A,X NA I 1 EM. *5 ro % 'x.rf.n � .. `r's._ r .y ^,. ^s,fr` .�-s- t �." xxc� .�'w^d `.r�''sy f..,� 'P'
9 v a T m
..Y_�a.-ti,. .e;'�. '
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).
•
• Upon submission of this NOI letter,the MS4 Operator shall pay a fee in the amount of fifty dollars($50). Make all checks and
money orders payable to"IDEM".
• 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.
e
• 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. I 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: Michael T. McBride, P.E.
Signature of Operator: mil !' G � Date: Ild(m /ear)
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=NO]13 Page 3 of 5
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT MS4 Notice of Intent(NOI)Letter
OFFICE OF WATER QUALITY
�TMMMM • • - 11MR. • • •
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(SWQMP).
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:
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 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑
Control
e. Postconstruction Storm Water Management in ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑
New Development and Redevelopment
If.Pollution Prevention and Good Housekeeping ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑
for Municipal Operations
g.Baseline Characterization and On-Going ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑
Monitoring 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, I 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
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 correspondin annual report.
•
g. The City of Carmel Hot Lick Creek 127
r The City of Carmel Kirkendall Creek 12
s:�fb The City of Carmel Lion Creek 1
t The City of Carmel Little Cool Creek 17
u The City of Carmel ( Little Eagle Creek 1
v. The City of Carmel Long Branch 116
awr The City of Carmel Mitchner Ditch 30
z The City of Carmel Ream Creek 0
y The City of Carmel Spring Mill Run 144
z The City of Carmel Trail Creek 0
$aa The City of Carmel Vestal Ditch 14
bti,kr The City of Carmel Well Run 6
cc The City of Carmel White River 15
dd The City of Carmel Will Creek 2
feed The City of Carmel Williams Creek 154
PF Reason=N0113 Page 5 of 5
City of Cannel
(Notice of Intent)
The City ofCamuel(City Hall,One Chic Square,Carmel,IN 46017)
intends to discharge storm water into the following watersheds:
WATERSHED NAME 14-digit Hydrologic Unit Code
Cool Creek-Grass Branch/Little Cool Creek 05120201090010
Cool Creek
Fliway Run
Little Cool Creek
Flot Lick Creek
White River
Crooked Creek(Marion) 0512020109000
Crooked Creek
Trail Creek
Delaware Creek
Eagle Creek-Long Branch/Irishman Run 05120301120080
Lone Branch
Little Eagle Branch-Woodruff Branch 05120301120070
Boone Creek
Bear Creek
Licit Creek
Little Eagle Creek
White River-Cannel Creek 05120201090040
Catmet Creek
White River
Blue Wood;Creek
White River-Hav'erstick Creek!How'land Ditch 051-20-101090050
Ream Creek
White Ricer-Shoemaker Ditch(Flamilton) 05120301090010
White River
White Ricer-Vestal DitchAlichener Ditch 05120_101090020
White River
Mitchner Ditch
Vestal Ditch
Kirkendall Creek
Brock Ditch
Williams Creek 05120201090060
Williams Creek
Henlev Creek
Almond Ditch
Elliot Creek
Ants Run
Will Creek
Clav Creek
Center Creek
Well Rum
Spring dill Run
Hoover Rum
and is;ubmittine a Notice of Intent letter to notify the Indiana Department
of Environmental illanaeentent of our intent to comply with the requirements
under 327 IAC 15-13 to discharge storm water tun-off associated with municipal
separate storm sewer systems.
T1.3S6-1 10/% 11 h.,pmdp
The Times Invoice
641 Westfield Rd.
Noblesville, Iii 146060 Date Invoice#
10/1712013 TL 3864
Bill To
City of Carmel -Clerk-Treasurer
One Civic Square
Carmel, IN 46032
ATTN: Sandy Johnson
Description Qty Rate Amount
Notice of Intent $40.72 $40.72
Ad Ran:
10/17/2013
PLEASE INCLUDE YOUR INVOICE NUMBER (TL3864) ON YOUR
CHECK WHEN MAKING A PAYMENT
Subtotal $40.72
Total $40.72
Balance Due $40.72
Prescribed by State Board of Accounts General form No.99P(Rev.2009A)
w City of Carmel :Clerk-Treasurer To The,Times
...................................................... ..........
Li (Govemmental Unit) 641 Westfield Rd.
= Noblesville, IN 46060
ZHamilton......County,Indiana ...................................................................................
w
w
PUBLISHER'S CLAIM
LINE COUNT
w Display Master(Must not exceed two actual lines, neither of which shall
Qtotal more than four solid lines of the type in which the body of the
Q advertisement is set)—number of equivalent lines ...........................
0 Head--number of lines
y. Body--number of lines
a Tail—number of lines -----------------------------------
U Total number of lines in notice ----------------------------- ..............................................
U
Q
COMPUTATION OF CHARGES
Q .....52.lines, ...?..... columns wide equals .104..equivalent lines at..0.3915
cents per line $.4.0.72....
--------------------------------------------------- . . .....
Additional charges for notices containing rule or tabular work(50 per cent
of above amount) $0.00
------------------------------------------------ ........
Charge for extra proofs of publication ($1.00 for each proof in excess
oftwo) ------------------------------------------------------ ........ ...............
TOTAL AMOUNT OF CLAIM $40:72
DATA FOR COMPUTING COST
Width of single column in picas.......I.4998....... Size of type..........point.
Number of insertions...............?..............
Pursuant to the provisions and penalties of IC 5-11-10-1, 1 hereby certify that the foregoing account is
just and correct, that the amount claimed is legally due,after allowing all just credits,and that no part of the same
has been paid.
I also certify that the printed matter attached hereto is a true copy,of the same column width and type size,
which was duly published in said paper............1........... times. The dates of publication being as follows:
................................................................................................................I........................
..
10/17/2013
.................................--.....................................................................................................
Additionally,the statement checked below is true and correct:
. Newspaper does not have a Web site.
X.. Newspaper has a Web site and this public notice was posted on the same day as it was published in
the newspaper.
...... Newspaper has a Web site, but due to technical problem or error, public notice was posted on ................
...... Newspaper has a Web site but refuses to post the public notice.
Thursday,Ob 17,
Date.................................cto.. er.............3013..... ........... Title...........................Legals..............Advertising..................................
TL 3864
PUBLISHER'S AFFIDAVIT
State of Indiana )
ss:
Hamilton County )
Personally appeared before me, a notary public in and for said county and state, the
undersigned Tim Timmons who, being duly sworn, says that he is Publisher of The Times
newspaper of general circulation printed and published in the English language in the cite
of Noblesville in state and county afore-said, and that the printed matter attached hereto
is a true copy, which was duly published in said paper for 1 time(s), the date(s) of
publication being as follows:
10/17/2013
Subscribed and sworn to before me this Thursday, October 17, 2013.
Notary Public
ii2[y commission expires: 05/28/2020
Jennifer Louise May
Resident of Marion County
Publisher's Fee: S 410.72
EJENINIFER LOUISE MM
Public-Seal
of Indiana
Expires May 26,2020
Y I TL 3864
Prescribed by State Board of Accounts City Form No.201(Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom,
rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
IDEM Purchase Order No.
100 North Senate Avenue, Rm 1255 Terms
Indianapolis, IN 46204-2251 Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s) Amount
110/1900 0 Permit renewal $ 50.00
Total $ 50.00
1 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
VOUCHER NC WARRANT NO.
IDEM ALLOWED 20
100 North Senate Avenue, Rm 1255 IN SUM OF $
Indianapolis, IN 46204-2251
$ 50.00
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po#or INVOICE NO. ACCT#/TITI- AMOUNT
DEPT# I hereby certify that the attached invoice(s),
0 0 211-4462838 $ 50.00 or bill(s) is (are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
10/21/2013
Signature
City Engineer
Cost Distribution ledger classification if Title
claim paid motor vehicle highway fund