8000-PM-OOGM0005 Rev. 7/2013
    COMMONWEALTH OF PENNSYLVANIA
    Checklist
    DEPARTMENT OF ENVIRONMENTAL PROTECTION
    OFFICE OF WATER MANAGEMENT
    OFFICE OF OIL AND GAS MANAGEMENT
    - 1 -
    NOTICE OF INTENT (NOI) ADMINISTRATIVE COMPLETENESS CHECKLIST
    EROSION AND SEDIMENT CONTROL GENERAL PERMIT (ESCGP-2) FOR EARTH
    DISTURBANCE ASSOCIATED WITH OIL AND GAS EXPLORATION, PRODUCTION,
    PROCESSING, OR TREATMENT OPERATIONS OR TRANSMISSION FACILITIES
    Please check the following list to make sure that you have included all the required information. Place a check mark in the column
    provided for all items completed and/or provided. Failure to provide all of the requested information will delay the processing of the
    application, may preclude the use of the Expedited Review, and may result in the application being placed ON HOLD with NO ACTION, or
    being considered withdrawn and the application file closed.
    THIS CHECKLIST MUST BE COMPLETED AND ENCLOSED WITH YOUR GENERAL PERMIT NOI
    CHECKLIST FOR EROSION AND SEDIMENT CONTROL GENERAL PERMIT NOI
    NEW NOI
    RENEWAL
    SUBSEQUENT PHASE
    MAJOR MODIFICATION
    If a Renewal, Subsequent Phase or Revision, identify ESCGP-2 Permit Authorization #
    Minor revisions are
    not required to be
    submitted to the
    regional office for
    review.
    APPLICANT
    PROJECT and PHASE NAME
    (If applicable)
    Applicant
    Check
    if
    Included
    Official
    Use
    Only
    1.
    Fully completed, properly signed and notarized Notice of Intent form (1 original and 2 copies).
    (Not required for subsequent phases)
    2.
    Complete
    Erosion and Sediment Control (E&S) Plans.
    (1 original and 2 copies)
    NOTE: Identify Locations as Drawings (D), Narrative (N). (Identify Not Applicable as “N/A”)
    The E & S Plan must contain, at a minimum, the following:
    a. Topographic Features
    Existing topographic features of the project site and
    immediate surrounding area. Include the project area
    outlined on an 8 ½" x 11" photocopy of the U.S.G.S.
    topo map area. The map must include the name of the
    appropriate 1:24,000 scale U.S.G.S. 7.5 minute series
    quadrangle map where the project is located.
    Location:
    Page:
    b. Soil Characteristics
    Types, depth, slope, locations and limitations of the
    soils including methods for resolution of all soil
    limitations.
    Location:
    Page:
    c. Earth Disturbance Activity
    The characteristics of the earth disturbance activity,
    including the past, present and proposed land uses
    and proposed alteration to the project site.
    Location:
    Page:
    d. Project Site Runoff
    The Volume and rate of runoff from the project site and
    its upstream watershed area.
    Location:
    Page:
    e. Surface Water Classification
    The Location of all surface waters of this
    Commonwealth which may receive runoff within or
    from the project site including their classification under
    Chapter 93 and status as siltation-impaired water.
    Location:
    Page:
    f. BMP Description Narrative
    A narrative description of the location and type of
    perimeter and onsite BMPs used before, during, and
    after the earth disturbance activity.
    Location:
    Page:

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    Checklist
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    g. BMP Installation Sequence Narrative
    A sequence of BMP installation and removal in relation
    to the scheduling of earth disturbance activities, prior
    to, during and after earth disturbance activities that
    ensures proper functioning of BMPs.
    Location:
    Page:
    h. Supporting Calculations and Measurements.
    Location:
    Page:
    i. Plan Drawings.
    Location:
    Page:
    j. Maintenance Program
    A maintenance program which provides for the
    operation and maintenance of BMPs and the inspection
    of BMPs on a weekly basis and after each stormwater
    event, including the repair or replacement of BMPs to
    ensure effective and efficient operation. The program
    must provide for completion of a written report
    documenting each inspection and all BMP repair, or
    replacement and maintenance activities.
    Location:
    Page:
    k. Material Recycling and Disposal
    Procedures which ensure that the proper measures for
    the recycling or disposal of materials associated with or
    from the project site will be undertaken in accordance
    with this title.
    Location:
    Page:
    l. Soil Conditions and Geologic Formations
    Identification of naturally occurring geologic formations
    or soil conditions that may have the potential to cause
    pollution during earth disturbance activities and include
    BMPs to avoid or minimize potential pollution and its
    impacts from the formations.
    Location:
    Page:
    m. Thermal Impacts
    Identification of potential thermal impacts to surface
    waters of this Commonwealth from the earth
    disturbance activity including BMPs to avoid, minimize
    or mitigate potential pollution from thermal impacts.
    Location:
    Page:
    n. E&S Plan and PCSM/SR Plan Consistency
    The E&S Plan shall be
    planned, designed and
    implemented to be consistent with the PCSM Plan
    under § 102.8. Unless otherwise approved by the
    Department, the E&S Plan must be separate from the
    PCSM Plan and labeled “E&S” or “Erosion and
    Sediment Control Plan” and be the final plan for
    construction.
    Location:
    Page:
    o. Riparian Forest Buffers
    Identification of existing and proposed riparian forest
    buffers (When required).
    Location:
    Page:
    p. Antidegradation Requirements
    Satisfy antidegradation implementation requirements
    for special protection water and siltation-impaired
    waters
    including
    evaluation
    of
    nondischarge
    alternatives and ABACT.
    Location:
    Page:
    3. Permit NOI Filing Fees
    of $500 to the appropriate Clean
    Water Fund plus $100/Acre of earth disturbance payable
    to the Commonwealth of PA Clean Water Fund ($500
    filing fee not required for subsequent phases).
    Location:
    Page:

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    Checklist
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    4. Municipal Notification:
    (3 copies) Not required for subsequence phases.
    a.
    Act 14 Municipal Notifications to the local municipality
    and county governments that specify that the
    application is for Erosion and Sediment Control
    General Permit for Earth Disturbance Associated with
    Oil and Gas Activities.
    A "sample" notification letter is provided as
    Attachment C of the instructions.
    Proof or Receipt
    of municipal notifications: copies of
    certified mail receipts, proof of deliver from a
    commercial carrier or acknowledgment letters from the
    local municipality and county government
    Location:
    Page:
    b.
    Cultural Resource Notice: for permitted activities on
    lands of the Allegheny National Forest (ANF) are to be
    coordinated with the appropriate ANF Ranger.
    5. Pennsylvania Natural Heritage Program (PNHP).
    Include PNDI receipt and other information depending on
    the permit application option. (3 copies)
    Location:
    Page:
    6. Complete PCSM/SR Plans.
    (1 Original, 2 copies)
    NOTE: Identify location(s) as Drawing (D), Narrative (N). (Identify Not Applicable as “N/A”.)
    The PCSM/SR Plan must contain, at a minimum, the following:
    a. Topographic Features
    The existing topographic features of the project site
    and immediate surrounding area.
    Location:
    Page:
    b. Soil Characteristics
    The types, depth, slope, locations and limitations of the
    soils and geologic formations.
    Location:
    Page:
    c. Earth Disturbance Activity Characterization
    The characteristics of the project site, including the
    past, present and proposed land uses and the
    proposed alteration of the project site.
    Location:
    Page:
    d. Net Change in Volume and Rate of Runoff
    An identification of the net change in volume and rate
    of stormwater from preconstruction hydrology to post
    construction hydrology for the entire project site and
    each drainage area.
    Location:
    Page:
    e. Surface Water Classification
    An identification and location of surface waters of this
    Commonwealth, which may receive runoff within or
    from the project site and their classification under
    Chapter 93.
    Location:
    Page:
    f. BMP Description Narrative
    A written description of the location and type of
    PCSM/Site Restoration BMPs including construction
    details for permanent stormwater BMPs including
    permanent stabilization specifications and locations.
    Location:
    Page:
    g. BMP Installation Sequence Narrative
    A sequence of PCSM/Site Restoration BMP
    implementation or
    installation in relation to earth
    disturbance activities of the project site and a schedule
    of inspections for critical stages of PCSM/Site
    Restoration BMP installation.
    Location:
    Page:
    h. Supporting calculations.
    Location:
    Page:

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    i.
    Plan Drawings.
    Location:
    Page:
    j. Long Term Operation and Maintenance Schedule
    A Long term operation and maintenance schedule,
    which provides for inspection of PCSM/Site Restoration
    BMPs, including the repair, replacement or other routine
    maintenance of the PCSM/Site Restoration BMPs to
    ensure proper function and operation. The program
    must provide for completion of a written report
    documenting each inspection and all BMP repair and
    maintenance activities and how access to the
    PCSM/Site Restoration BMPs will be provided.
    Location:
    Page:
    k. Material Recycling and Disposal
    Procedures which ensure that the proper measures for
    recycling or disposal of materials associated with or
    from the PCSM/Site Restoration BMPs are in
    accordance with Department laws, regulations and
    requirements.
    Location:
    Page:
    l. Geologic Formations and Soil Conditions
    An identification of naturally occurring geologic
    formations or soil conditions that may have the potential
    to cause pollution after earth disturbance activities are
    completed and PCSM/Site Restoration BMPs are
    operational and development of a management plan to
    avoid or minimize potential pollution and its impacts.
    Location:
    Page:
    m. Thermal Impacts
    An Identification of potential thermal impacts from post
    construction stormwater to surface water of this
    Commonwealth including BMPs to avoid, minimize or
    mitigate potential thermal pollution from thermal
    impacts.
    Location:
    Page:
    n. Riparian Forest Buffer Management Plan
    A riparian forest buffer management plan when required
    under § 102.14.
    Location:
    Page:
    o. Antidegradation Requirements
    A demonstration of compliance with antidegradation
    implementation requirements including evaluation of
    nondischarge alternatives and ABACT for where
    activities will be conducted in special protection waters
    or siltation impaired waters.
    Location:
    Page:
    7. PCSM Plan Stormwater Analysis
    Do the regulated activities require site restoration or reclamation?
    Yes
    No
    If Yes, skip to Item 8.
    If No, provide the following information:
    a. Site Characterization and Assessment
    Predevelopment site characterization and assessment
    of soil and geology including infiltration and geotechnical
    studies that identify location and depths of test sites and
    methods used (If applicable).
    Location:
    Page:

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    b. Volume Reduction and Water Quality Requirements
    Analysis demonstrating that the PCSM BMPs will meet
    the volume reduction and water quality requirement
    specified in an applicable Department approved and
    current Act 167 stormwater management watershed
    plan;
    or
    manage the net change for storms up to and
    including the 2-year/24-hour storm event when
    compared to preconstruction runoff volume and water
    quality (If applicable).
    Location:
    Page:
    c. Rate Requirements
    Analyses demonstrating that the PCSM BMPs will meet
    the rate requirements specified in an applicable
    Department approved and current Act 167 stormwater
    management watershed plan;
    or
    manage the net
    change in peak rate for the 2-, 10-, 50-, and 100-
    year/24-hour storm event in a manner not to exceed
    preconstruction rates (If applicable).
    Location:
    Page:
    d. Calculation Methodologies
    Identification of the methodologies for calculating total
    runoff volume and peak rate of runoff and provide
    supporting
    documentation
    and
    calculations
    (If
    applicable).
    Location:
    Page:
    e. Construction Techniques
    Identification of construction techniques or special
    consideration to address soil and geologic limitations (If
    applicable).
    Location:
    Page:
    f. Antidegradation Requirements
    Demonstration of compliance with antidegradation
    implementation requirements including evaluation of
    nondischarge alternatives and ABACT for where
    activities will be conducted in special protection waters
    or siltation impaired waters.
    Location:
    Page:
    8. Expedited Review Process
    Is any part of your project located in or drain into a Special Protection
    watershed?
    Yes
    No
    Is the area surrounding an oil or natural gas wellhead that is subject to earth
    disturbance and that is used or planned for use for drilling, production or
    plugging of the well including associated support activities constructed on or in
    a flood plain?
    Yes
    No
    Is any earth disturbance located on land known to be contaminated?
    Yes
    No
    Is your project a transmission project?
    Yes
    No
    If yes, to any of the above questions your project is not eligible for Expedited
    Review. If your project is
    not
    a transmission protect complete items 8a and 8b.
    Is an expedited review being requested?
    Yes
    No
    If yes, all of the following items must be completed:
    a.
    E&S and PCSM/Site Restoration Plan drawings and narrative sealed by licensed
    professional.
    b. Licensed professional prepared, sealed, and certified Application/NOI.
    c. Licensed professional listed location and date of DEP training attended in application/NOI.

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    9. Phased Projects
    Is the activity being conducted as a phased project?
    Yes
    No
    If yes, all of the following must be completed:
    a.
    Initial Phase - Is the master plan included?
    Yes
    No
    b.
    Subsequent Phase(s) – Is(are) the subsequent phase(s) identified
    in the master plan?
    Yes
    No
    10. Preparedness, Prevention and Contingency (PPC) Plan
    Will fuels, chemicals, solvents, other hazardous materials be used or stored on
    site during earth disturbance activities?
    Yes
    No
    If yes, a PPC Plan must be maintained on the site during earth disturbance.
    11.
    Subsequent Phase Certification for Expedited Reviews
    Is the activity being conducted as a phased project?
    Yes
    No
    Is an expedited review being requested for subsequent phase?
    Yes
    No
    If yes, all of the following must be completed:
    I do hereby certify to the best of my knowledge, information, and belief, that the Erosion and Sediment Control and
    PCSM/Site Restoration Plan are true and correct, represent actual field conditions and are in accordance with the 25 Pa.
    Code Chapters 78 and 102 of the Department’s rules and regulations. I am aware that there are significant penalties for
    submitting false information, including the possibility of fine and imprisonment.
    Signature
    Professional Seal
    Company
    Address
    Phone
    Most Recent DEP Training Attended
    Location
    Date
    e-Mail Address
    EXPEDITED REVIEW PROCESS
    In addition to the certification required above, applicants using the expedited permit review process must attach an E&S and PCSM/Site
    Restoration Plan developed and sealed by a licensed professional engineer, landscape architect, surveyor or professional geologist. The plans
    shall contain the following certification:
    I do hereby certify to the best of my knowledge, information, and belief, that the Erosion and Sediment Control and
    PCSM/Site Restoration Plan and Post Construction BMPs are true and correct, represent actual field conditions and
    are in accordance with the 25 Pa. Code Chapters 78 and 102 of the Department’s rules and regulations. I am aware that
    there are significant penalties for submitting false information, including the possibility of fine and imprisonment.
    12. Permit Renewal
    Is a permit renewal being requested?
    Yes
    No
    If yes, all of the following must be completed:
    a. Administratively complete, signed, and notarized Notice of Intent Form, including Items 1-8.
    (1 signed original and 2 copies of the NOI/application)
    b. Permit filing fee of $500 payable to the appropriate clean water fund plus $100/Acre of
    earth disturbance payable to the Commonwealth of PA Clean Water Fund.

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