1. NOTICE OF INTENT (NOI) ADMINISTRATIVE COMPLETENESS CHECKLIST
  1. 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

8000-PM-OOGM0005 Rev. 7/2013  COMMONWEALTH OF PENNSYLVANIA
Checklist  DEPARTMENT OF ENVIRONMENTAL PROTECTION
 OFFICE OF WATER MANAGEMENT
 OFFICE OF OIL AND GAS MANAGEMENT
 
 


NOTICE OF INTENT (NOI) ADMINISTRATIVE COMPLETENESS CHECKLIST

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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use of the Expedited Review, and may result in the application being placed ON HOLD with NO ACTION, or being considered withdrawn and the application file closed.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

ü 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 ü 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:            
  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:            
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:            
  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:            
  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.
   
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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