STORM WATER POLLUTION PREVENTION PLAN

for Construction Activities Located at

AIRGAS ELK GROVE VILLAGE

SE Corner of Greenleaf Ave. & Nicholas Blvd. Elk Grove Village, IL

Date: December 22, 2008

Base Outline Prepared for:

Consolidated Construction Company 4300 N. Richmond Street

Appleton, WI 54913 Phone: (920) 739-3555

Facsimile: (920) 739-3933

Base Outline Prepared by:

Ruettiger, Tonelli & Associates, Inc. 2174 Oneida Street

Joliet, IL 60435 Phone: 815-744-6600

Facsimile: 815-744-0101 Project No.: 20072511.00

N:\Clerical\2007\2511\SWPPP\SWPPP Booklet.doc_12-22-08.doc

TABLE OF CONTENTS INTRODUCTION 1. PROJECT & SITE DESCRIPTION

A. Project Overview B. Existing Site Drainage Conditions C. Proposed Site Drainage Conditions D. Sequence of Major Construction Activities

2. CONTROLS

A. Erosion and Sediment Controls B. Structural Practices C. Stormwater Management D. Other Controls

3. MAINTENANCE 4. INSPECTION REQUIREMENTS 5. NON-STORMWATER DISCHARGE 6. CERTIFICATIONS ATTACHMENTS Attachment 1 – Owner Certification Attachment 2 – Contractor Certifications Attachment 3 – Notice of Intent (NOI) Attachment 4 – General Permit (ILR 10) Attachment 5 – Incidence of Non-Compliance (ION) Attachment 6 – Notice of Termination (NOT) Attachment 7 – Inspection Reports APPENDICES Appendix A – Grading and Erosion Control Plan

INTRODUCTION This Stormwater Pollution Prevention Plan shall be kept onsite and maintained in accordance with the requirements of NPDES Permit Number ILR 10, issued by the Illinois Environmental Protection Agency (IEPA) for stormwater discharges from Construction Site Activities. As the future phases of construction are designed, the corresponding SESC plans will be developed and should be reviewed and inserted into this binder as per ILR 10 permit. 1. PROJECT & SITE DESCRIPTION

• Acreage: 3.8 Acres • Receiving Waters: Higgins Creek • Wetland and Waters: N/A • Proposed Condition Runoff Curve Number: 88 • Hydrologic Soil Group: Soil Group D • Time of Concentration: 20 minutes • Approved State or Local Plans: The management practices, controls, and other provisions contained in this Plan are

intended to be in accordance with the standards and specifications contained in the Illinois Environmental Protection Agency “Illinois Urban Manual” 2002 edition.

Local Permitting Agencies include Elk Grove Village and Metropolitan Water

Reclamation District of Greater Chicagoland.

A. Project Overview: Project consists of building, parking lot, underground utilities and underground storm

water detention construction. B. Existing Site Drainage Conditions Overland drainage into Village storm sewer system. C. Proposed Site Drainage Conditions Overland drainage into site storm sewer and then into underground storm water

detention area. Outlet flow is restricted into Village storm sewer. D. Sequence of Major Construction Activities

1. Install erosion control measures. 2. Mass grade site. 3. Begin building construction. 4. Install underground utilities. 5. Install curb, pavement, site lighting, loading docks, pads, lighting. 6. Finish building and install landscaping.

2. CONTROLS The Soil Erosion and Sediment Control (SESC) Plans are included within this report. The plans indicate surface drainage patterns, the extent of site disturbance, and the various soil erosion and sediment controls planned to be used on the site. Prior to the start of construction, the plans present a base line for limiting soil erosion and providing an action plan for establishing sediment control. As construction progresses, the SESC plan should be continually reviewed and modified to address issues identified during the routine inspections. The narrative below outlines the general practices of implementing the various controls. The SESC plans and project specifications should be consulted for project specifies. A. Erosion and Sediment Controls Stabilization Practices The contractor shall remove vegetated areas only as required to complete the work.

The SESC plans identify temporary and permanent stabilization practices after earthwork activities have ceased. Both the Engineering Plans and the Landscape plans should be consulted for permanent restoration measures.

Exposed soil surfaces shall be stabilized with vegetation and/or protective mulches or

blankets after soil disturbing activities have ceased. If conditions prevent effective use or placement of such measures then the installation of structural controls such as sediment barrier fencing and sediment traps, in addition to those identified on the SESC plans, may be required. Stabilization measures shall be initiated as soon as practical after the soil disturbing activities have temporarily or permanently ceased, but in no case more than 14 days after such operations have ceased. If construction activity is scheduled to cease for a period of less than 21 calendar days, then stabilization measures do not have to be initiated on that portion of site by the 14th day after construction activity temporarily or permanently ceases is precluded by snow cover, stabilization measures shall be initiated as soon as practical.

The project’s SESC Plans identify the placement of the various ground cover

stabilization practices. Seed and mulch has been specified as the primary means of stabilization after earthwork activities have ceased. Erosion control blankets are specified where the ground slope exceeds the gradient at which mulch can sufficiently protect against erosion from runoff prior to the establishment of vegetation. The blankets are to be installed per manufacture’s guidelines which must also meet the project specifications. After blankets are installed around detention basins, a silt fence will be installed at the top of the slope to protect the area as the vegetation becomes established.

Seeded areas susceptible to significant wind or water erosion as identified during the

routine site inspections, shall be protected by the use of applied mulch or erosion control blankets. Applicable specifications are included on the project plans.

Unvegetated Areas Unvegetated areas anticipated to remain unpaved or unrestored for longer than 21 days

shall be protected with temporary erosion control seeding and/or mulching within 14 days after soil disturbing construction activities have ceased. If unvegetated areas are to remain unpaved or unrestored for less than 21 days, sediment barrier fences shall be installed where the person conducting the routine inspections determines that sediment runoff will affect adjacent areas.

Vegetative Ground Covers Permanent vegetative ground covers (seeding, sodding, and planting) and associated

erosion control measures (protective mulches and blankets) shall be in accordance with the requirements of the Project Plans and Specifications.

B. Structural Practices Sediment Barrier Fences (Silt Fence) shall be installed at the locations indicated on the

plans and around soil stockpiles and other locations where it is deemed necessary to filter sediment from storm runoff. Such barriers shall be installed prior to the initiation of construction activities that will disturb soils for significant portions of the site (i.e., earthwork operations or the installation of underground utilities). These barriers shall be installed as detailed in the plans and shall be maintained until final stabilization is achieved. “Final Stabilization” shall mean that all soil disturbing activities at the site have been completed, that a uniform perennial vegetative cover with a density of 70% has been established over all disturbed areas and that equivalent stabilization measures (such as the use of riprap, concrete block mats or geotextiles) have been employed where the use of vegetative cover is not suitable.

Storm drain systems will be installed concurrently with earthwork operations. Runoff

from proposed pavement areas will be collected by inlet structures and drain via storm sewer to the detention basins. Filter fabric barriers shall be installed on all drainage structure grates and maintained in place for the duration of construction activities. Filter fabric fence barriers shall be placed around structures receiving surface runoff where indicated on the plans and where required by the person conducting the routine SESC inspections due to site conditions during construction. Siltation control measures shall be installed at inlet structure grates in accordance with the details and specifications included in the Plan Documents.

Soil Stockpiles Topsoil and subgrade material stockpiles scheduled to remain in place longer than 14

days shall be surrounded with a sediment barrier fence unless runoff from the stockpile area drains directly to a constructed sediment trap serving only the stockpile.

Topsoil stockpiles that will remain in place longer than 21 days shall be stabilized with

temporary erosion control seeding (seeds and mulch) within 14 days after construction of the stockpile.

C. Stormwater Management Various stormwater management measures to control drainage and flow velocity will be

installed as part of this project. These measures include the installation of grass swales, numerous storm drains with inlet and outlet protection, numerous detention basins, and control structures between the basins.

Permanent Controls The designed stormwater management system will function together to control the

transport of pollutants (primarily sediment) downstream off the project site. The stormwater basins will provide attenuation of stormwater runoff and provide the opportunity for sediment settling. The shorelines of the basins will be planted with the appropriate vegetation or reinforced to be protected against erosion per the Engineering and Landscape Plans.

Grass swales are incorporated where possible to minimize the amount of storm sewer

piping and increase pollutant filtering, encourage infiltration, and increase travel time to the detention basins. The swales will be lined with blankets and seeded. The blankets

will provide protection against erosion prior to the establishment of the permanent vegetation.

Storm structures will be used throughout the storm sewer systems to capture sediment

materials that may otherwise enter the system. These catch basins will require periodic inspection and sediment removal.

Velocity dissipation devices Stabilized swales are incorporated where possible to minimize the amount of storm

sewer piping. The use of these swales reduces the velocity of runoff compared to if storm sewers were used. Where storm sewers are necessary, outlet protection is specified at the discharge location of the sewers. The outlet protection detail is included on the SESC detail sheet of the engineering plans.

Check Dams are used to reduce the velocity of runoff through swale areas. Types of

check dams to be used include rock check dams and triangular silt dikes. D. Other Controls Waste Disposal Waste Disposal practices shall prevent the discharge of solid materials, including

building material, to waters located downstream of the site. No solid materials shall be discharged into waters of the State or waters of the U.S. The contractor shall comply with applicable waste disposal and sanitary sewer regulations.

Spill Prevention Contractor shall maintain good housekeeping practices for the duration of the project.

All soluble and liquid materials stored on-site shall be suitably covered, or placed within an enclosure. The contents of partially used containers of such materials shall be placed in sealable containers to avoid spills.

All on-site vehicles shall be monitored for leaks. Petroleum products shall be stored in

tightly sealed containers that are clearly labeled. Cleanup material, such as absorbent pillows and trash containers, shall be maintained on site. Incident spills (less than 12.5 gallons of gasoline and 25 gallons of diesel) shall be cleaned up immediately upon discovery. Larger spills shall be recovered only by qualified personnel as defined by OSHA (29 CFR 1910.120). Contractor shall take immediate action, however to prevent spill from spreading or discharging off site. Such action may include construction of earthen dikes and plugging culverts. All spills shall be reported to the Owner’s representative in a prompt manner. The Owner’s representative shall report spills to government agencies as required.

Construction Entrances Construction entrances shall be constructed prior to the start of earthwork activities. All

construction vehicles shall enter and exit the site only through approved construction entrances as identified on the SESC plans.

3. MAINTENANCE Silt fence and structure grate sediment barriers shall be cleaned or replaced as needed to provide adequate filtering and flow capacity for its effective use. Seeded and planted areas shall be maintained by watering, fertilizing, mulching, reseeding, filling of rivulets, etc. as necessary to develop an acceptable stand of vegetation.

Construction access and public road pavements shall be cleaned daily as needed to remove and prevent the spread of mud and debris from construction operations. Sediment Traps and Basins will be cleaned out when they are ½ full. 4. INSPECTION REQUIREMENTS Qualified personnel shall inspect:

• Disturbed areas of the construction site which have not been stabilized with impervious materials or vegetative ground cover

• Structural control measures (i.e., silt fences, grate fabrics, etc.) • Off-site roads and on-site pavements which the contractors’ vehicles and/or

equipment operate. Such inspections shall be conducted at least once every 7 calendar days and within 24 hours of the end of a storm event that has 0.5 inches or more of precipitation. a. Disturbed areas and areas used for storage of materials that are exposed to precipitation

shall be inspected for evidence of (or potential for) silt and other pollutants entering the drainage system or discharging off-site. Erosion and sediment control measures shall be observed to ensure they are operating correctly. Discharge locations shall be inspected to determine the effectiveness of erosion control measures in preventing significant impacts to receiving waters. Roadways on which vehicles (associated with this project travel) shall be inspected for evidence of off-site sediment tracking.

b. Based on the results of the inspection, pollution prevention measures shall be revised as

appropriate, as soon as practical after such inspection. Such modifications shall provide for timely implementation of any changes to the Plan within 7 calendar days following the inspection.

c. Inspection reports shall be prepared. These reports shall indicate the scope of the

inspection, name(s) and qualifications of personnel conducting the inspection, the date(s) of the inspection, major observations relating to the implementation of this Plan and actions taken. The reports shall be retained as part of the Plan for at least 3 years after the date that the permit coverage expires or is terminated. The reports can be made on the sample forms included in this binder and shall be signed in accordance with part VI.G of the General Permit.

d. If violations of the provisions of the Plan are identified during the performance of the

associated work, such violations will be reported promptly to the Owner’s representative. The Owner’s representative or its authorized representative shall complete and file an “Incidence of Noncompliance” (ION) report, a copy is provided in this binder, for the identified violation. The submittal shall include specific information on the cause of the noncompliance, and a statement detailing any environmental impact that may have resulted from such. All reports of noncompliance shall be signed by an authorized representative of the Owner in accordance with Part VI.G of the General Permit. The report shall be mailed to:

Illinois Environmental Protection Agency

Division of Water Pollution Control Attn: Compliance Assurance Section

1021 North Grand East P.O. Box 19276

Springfield, IL 62794-9276

5. NON-STORM WATER DISCHARGES Non-storm water discharges from the site include flows from fire fighting activities and groundwater pumped for construction dewatering. All water originating from construction dewatering operations shall be suitably filtered prior to discharge from the site. There shall be no other sources of non-storm water combined with storm water discharges associated with construction activity from the project site. 6. CERTIFICATIONS Certifications to be signed by the Owner and the Contractors retained to perform the work are included in the binder. Any contractor conducting work on site should review and sign the certification.

ATTACHMENTS

ATTACHMENT 1

STORMWATER POLLUTION PREVENTION PLAN OWNER CERTIFICATION STATEMENT

STORMWATER POLLUTION PREVENTION PLAN

OWNER CERTIFICATION STATEMENT

Project: Airgas - Elk Grove Village Project Location: NE Corner of Greenleaf Ave. & Nicholas Blvd., Elk Grove Village, IL This certification statement is a part of the Stormwater Pollution Prevention Plan for the project identified above in accordance with NPDES Permit No. ILR10, issued by the Illinois Environmental Protection Agency on May 30, 2003, for stormwater discharges from Construction Site Activities. I 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 gathered and evaluated the information submitted. Based on my inquiry of the person(s) 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.

Signature Date

Position

Airgas - North Central

Owner Name

1250 W. Washington

Address

West Chicago, IL 60185

630-231-9260

Telephone

ATTACHMENT 2

STORMWATER POLLUTION PREVENTION PLAN CONTRACTOR CERTIFICATION STATEMENT

STORMWATER POLLUTION PREVENTION PLAN CONTRACTOR’S CERTIFICATION STATEMENT

Project: Airgas - Elk Grove Village Project Location: NE Corner of Greenleaf Ave. & Nicholas Blvd., Elk Grove Village, IL I certify under penalty of law that I understand the terms and conditions of the general National Pollutant Discharge Elimination System (NPDES) permit (ILR10) that authorizes the stormwater discharges associated with industrial activity from the construction site identified as part of this certification.

Signature Date

Position

Consolidated Construction Company

Firm Name

4300 N. Richmond Street

Address

Appleton, WI 54913

920-739-3555

Telephone

ATTACHMENT 3

NPDES PERMIT NOTICE OF INTENT (NOI)

ILLINOIS ENVIRONMENTAL PROTECTION AGENCY NOTICE OF INTENT (NOI)

GENERAL PERMIT TO DISCHARGE STORM WATER CONSTRUCTION SITE ACTIVITIES

OWNER INFORMATION Owner Type: (SELECT ONE) PRIVATE CITY FEDERAL

COUNTY SPECIAL DISTRICT STATE MS4 COMMUNITY YES NO COMPANY OR OWNER NAME: Airgas - North Central MAILING ADDRESS: 1250 W. Washington CITY: West Chicago

STATE: IL

ZIP CODE: 60185

PHONE: (630) 231 - 9260 EXT.

CONTACT PERSON: Eric Peterson

FAX: (630) 231 - 0172

CONTRACTOR INFORMATION NAME: Consolidated Construction Company MAILING ADDRESS: 4300 N. Richmond Street CITY: Appleton

STATE: WI

ZIP CODE: 54913

PHONE: (920) 739 - 3555 EXT.

CONSTRUCTION SITE INFORMATION SELECT ONE: NEW SITE CHANGE OF INFORMATION FOR: ILR10_ PROJECT NAME: Airgas - Elk Grove Village

COUNTY: Cook

STREET/LOCATION: SE corner of Greenleaf Ave. & Nicholas Blvd. CITY Elk Grove Village ILLINOIS

ZIP CODE: 60007

LATITUDE: DEG. 42° MIN. 00' SEC. 13" N

LONGITUDE: DEG. 87° MIN. 56' SEC. 54" W

SECTION: 35

TOWNSHIP: 41N

RANGE:11E

APPROX CONST START DATE: 01/05/2009

APPROX CONST END DATE: 07/06/2009

TOTAL SIZE OF CONSTRUCTION SITE IN ACRES: 3.8 If less than 1 acre, is site part of larger common plan of development? YES NO

STORM WATER POLLUTION PREVENTION PLAN INFORMATION HAS STORM WATER POLLUTION PREVENTION PLAN BEEN SUBMITTED TO AGENCY? YES NO (SUBMIT SWPPP ELECTRONICALLY TO: epa.constilr10swppp@illinois.gov) WILL STORM WATER POLLUTION PREVENTION PLAN BE AVAILABLE AT SITE: YES NO

LOCATION OF SWPPP FOR VIEWING: ADDRESS: Construction trailer - onsite

CITY: Elk Grove Village

SWPPP CONTACT NAME: Greg Smith INSPECTOR QUALIFICATIONS: (SELECT ONE) P.E. CPESC CESSWI OTHER Site Superintendent

PHONE: (920) 428 - 1839

FAX: (920) 882 - 2642

EMAIL: gsmith@consolidated-const.com

PROJECT INSPECTOR NAME, IF DIFFERENT THAN ABOVE: Richard Lewandowski

INSPECTOR QUALIFICATIONS: (SELECT ONE) P.E. CPESC CESSWI OTHER Project Manager

PHONE: (920) 882 - 2520

FAX: (920) 882 - 2620

EMAIL: rlewandowski@consolidated-const.com

PAGE 1 OF 2

ILLINOIS ENVIRONMENTAL PROTECTION AGENCY NOTICE OF INTENT (NOI)

GENERAL PERMIT TO DISCHARGE STORM WATER CONSTRUCTION SITE ACTIVITIES

TYPE OF CONSTRUCTION (SELECT ALL THAT APPLY) RESIDENTIAL COMMERCIAL INDUSTRIAL RECONSTRUCTION TRANSPORTATION OTHER

TYPE DETAILED DESCRIPTION OF PROJECT: Construction of a building, PCC, pads, loading docks and parking lot on a previously

developed site.

HISTORIC PRESERVATION AND ENDANGERED SPECIES COMPLIANCE

HAS THIS PROJECT BEN SUBMITTED TO THE FOLLOWING STATE AGENCIES TO SATISFY APPLICABLE REQUIREMENTS FOR COMPLIANCE WITH ILLINOIS LAW ON:

HISTORIC PRESERVATION YES NO http://www.illinoishistory.gov/PS/rcdocument.htm ENDANGERED SPECIES YES NO http://dnrecocat.state.il.us/ecopublic/

RECEIVING WATER INFORMATION

DOES YOUR ST0RM WATER DISCHARGE DIRECTLY TO: WATERS OF THE STATE OR STORM SEWER

OWNER TO STORM SEWER SYSTEMS: Elk Grove Village

NAME OF CLOSEST RECEIVING WATERBODY TO WHICH YOU DISCHARGE: Higgins Creek I certify under penalty of law that this document and all attachments were prepared under my direction and 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 this 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. In addition, I certify that the provisions of the permit, including the development and implementation of a storm water pollution prevention plan and a monitoring program plan, will be complied with. OWNER SIGNATURE: _________________________________________________ DATE: __________________________________ FOR OFFICE USE ONLY

LOG:

PERMIT NO. ILR10 ___ ___ ___ ___ MAIL COMPLETED FORM TO:

ILLINOIS ENVIRONMENTAL PROTECTION AGENCY DIVISION OF WATER POLLUTION CONTROL ATTN: PERMIT SECTION POST OFFICE BOX 19276 SPRINGFIELD, ILLINOIS 62794-9276 www.epa.state.il.us DATE:

Information required by this form must be provided to comply with 415 ILCS 5/39 (1996). Failure to do so may prevent this form from being processed and could result in your application being denied. This form has been approved by the Forms Management Center. IL 532 2104 WPC 623 Rev. 8/08

PAGE 2 OF 2

ATTACHMENT 4

GENERAL PERMIT (ILR10)

ATTACHMENT 5

INCIDENCE OF NON-COMPLIANCE (ION)

ILLINOIS ENVIRONMENTAL PROTECTION AGENCY CONSTRUCTION SITE STORM WATER DISCHARGE

INCIDENCE OF NON-COMPLIANCE (ION) PERMITTEE NAME:

LAST

FIRST

MIDDLE INITIAL

AREA CODE & PHONE NUMBER

STREET: CITY: ST: ZIP: CONSTRUCTION SITE NAME: COUNTY: SECTION TOWNSHIP: RANGE: NPDES PERMIT NUMBER: I L R 1 0 LATITUDE:

DEG:

MIN:

SEC. LONGITUDE:

DEG:

MIN.

SEC.

CAUSE OF NON-COMPLIANCE:

ACTIONS TAKEN TO PREVENT ANY FURTHER NON-COMPLIANCE:

ENVIRONMENTAL IMPACT RESULTING FROM THE NON-COMPLIANCE:

ACTIONS TAKEN TO REDUCE THE ENVIRONMENTAL IMPACT RESULTING FROM THE NON-COMPLIANCE:

SIGNATURE:________________________________________________ TITLE: DATE: FOR OFFICE USE ONLY

LOG:

PERMIT NO. ILR10 ___ ___ ___ ___

MAIL COMPLETED FORM TO: (DO NOT SUBMIT ADDITIONAL DOCUMENTATION UNLESS REQUESTED)

ILLINOIS ENVIRONMENTAL PROTECTION AGENCY DIVISION OF WATER POLLUTION CONTROL COMPLIANCE ASSURANCE SECTION #19 POST OFFICE BOX 19276 SPRINGFIELD, ILLINOIS 62794-9276

DATE:

Information required by this form must be provided to comply with 415 ILCS 5/39 (1996). Failure to do so may prevent this form from being processed and could result in your application being denied. This form has been approved by the Forms Management Center IL 532 2105 WPC 624 Rev. 6/98

GUIDELINES FOR COMPLETION OF INCIDENCE OF NON-COMPLIANCE (ION)

FORM Complete and submit this form for any violation of the Storm Water Pollution Prevention Plan observed during any inspection conducted, including those not required by the plan. Please adhere to the following guidelines.

Submit original, photocopy or facsimile copies. Facsimile and/or photo copies should be followed-up with an original signature copy as possible. Please write “copy” under the “For Office Use Only” box in the lower right hand corner.

Submit completed forms to: Illinois Environmental Protection Agency Division of Water Pollution Control Permit Section Post Office Box 19276 Springfield, IL 62794-9276 Reports must be typed or printed legibly and signed. Use the formats given in the following examples for correct form completion. Example Format SECTION 12 1 or 2 numerical digits TOWNSHIP 12N 1 or 2 numerical digits followed by “N” or “S” RANGE 12W 1 or 2 numerical digits followed by “E” or “W”

ATTACHMENT 6

NOTICE OF TERMINATION (NOT)

ILLINOIS ENVIRONMENTAL PROTECTION AGENCY NOTICE OF TERMINATION (NOT)

OF COVERAGE UNDER THE GENERAL PERMIT FOR STORM WATER DISCHARGES

ASSOCIATED WITH CONSTRUCTION SITE ACTIVITIES Please use the tab or arrow keys OWNER INFORMATION NAME:

LAST

FIRST

MIDDLE

OWNER TYPE:

MAILING ADDRESS:

CITY: STATE: ZIP:

CONTACT PERSON: TELEPHONE

NUMBER: AREA CODE

NUMBER

CONTRACTOR INFORMATION NAME:

LAST

FIRST

MIDDLE

TELEPHONE NUMBER:

AREA CODE

NUMBER

MAILING ADDRESS: CITY: STATE: ZIP:

CONSTRUCTION SITE INFORMATION FACILITY NAME: OTHER NPDES PERMIT NOS.:

FACILITY LOCATION:

CITY: ST: ZIP: LATITUDE: LONGITUDE:

COUNTY: SECTION: TOWNSHIP: RANGE:

DATE PROJECT HAS BEEN COMPLETED AND STABILIZED:

I certify under penalty of law that disturbed soils at the identified facility have been finally stabilized or that all storm water discharges associated with industrial activity from the identified facility that are authorized by an NPDES general permit have otherwise been eliminated. I understand that by submitting this notice of termination, that I am no longer authorized to discharge storm water associated with industrial activity by the general permit, and that discharging pollutants in storm water associated with industrial activity to Waters of the State is unlawful under the Environmental Protection Act and the Clean Water Act where the discharge is not authorized by an NPDES permit. OWNER SIGNATURE:______________________________________ DATE:_________________________________ FOR OFFICE USE ONLY

LOG:

PERMIT NO. ILR10__ __ __ __

MAIL COMPLETED FORM TO: (DO NOT SUBMIT ADDITIONAL DOCUMENTATION UNLESS REQUESTED)

ILLINOIS ENVIRONMENTAL PROTECTION AGENCY DIVISION OF WATER POLLUTION CONTROL ATTN: PERMIT SECTION POST OFFICE BOX 19276 SPRINGFIELD, ILLINOIS 62794-9276 DATE:

Information required by this form must be provided to comply with 415 ILCS 5/36 (1996). Failure to do so may prevent this form from being processed and could result in your application being denied. This form has been approved by the Forms Management Center. IL 532 2102 WPC 621 Rev. 1.04

GUIDELINES FOR COMPLETION OF NOTICE OF TERMINATION (NOT) FORM

Please adhere to the following guidelines:

Submit original, photocopy or facsimile copies. Facsimile and/or photo copies should be followed-up with an original signature copy as soon as possible. Please write "copy" under the "For Office Use Only" box in the lower right hand corner.

···· Submit completed forms to:

Illinois Environmental Protection Agency Division of Water Pollution Control Permit Section Post Office Box 19276 Springfield, Illinois 62794-9276 217/782-0610

···· Reports must be typed or printed legibly and signed.

···· N0TE: FACILITY LOCATION IS NOT NECESSARILY THE FACILITY MAILING ADDRESS, BUT SHOULD DESCRIBE WHERE THE FACILITY IS LOCATED.

···· Use the formats given in the following examples for correct form completion.

Example Format

SECTION 12 1 or 2 numerical digits

TOWNSHIP 12N 1 or 2 numerical digits followed by "N" or "S"

RANGE 12W 1 or 2 numerical digits followed by "E" or "W"

···· Final stabilization has occurred when:

(a) all soil disturbing activities at the site have been completed (b) a uniform perennial vegetative cover with a density of 70% of

the native background vegetative cover for the area has been established on all unpaved areas and areas not covered by permanent structures,

(C) or equivalent permanent stabilization measures have been employed.

ATTACHMENT 7

INSPECTION REPORTS

Stormwater Construction Site Inspection Report General Information

Project Name NPDES Tracking No. Location Date of Inspection Start/End Time Inspector’s Name(s)

Inspector’s Title(s) Inspector’s Contact Information Inspector’s Qualifications

Describe present phase of construction

Type of Inspection: Regular Pre-storm event During storm event Post-storm event

Weather Information Has there been a storm event since the last inspection? Yes No If yes, provide: Storm Start Date & Time: Storm Duration (hrs): Approximate Amount of Precipitation (in): Weather at time of this inspection?

Clear Cloudy Rain Sleet Fog Snowing High Winds Other: Temperature:

Have any discharges occurred since the last inspection? Yes No If yes, describe: Are there any discharges at the time of inspection? Yes No If yes, describe:

Site-specific BMPs

• Number the structural and non-structural BMPs identified in your SWPPP on your site map and list them below (add as many BMPs as necessary). Carry a copy of the numbered site map with you during your inspections. This list will ensure that you are inspecting all required BMPs at your site.

• Describe corrective actions initiated, date completed, and note the person that completed the work in the Corrective Action Log.

BMP BMP Installed?

BMP Maintenance Required?

Corrective Action Needed and Notes

1 Yes No Yes No 2 Yes No Yes No 3 Yes No Yes No 4 Yes No Yes No 5 Yes No Yes No 6 Yes No Yes No 7 Yes No Yes No 8 Yes No Yes No 9 Yes No Yes No 10 Yes No Yes No 11 Yes No Yes No 12 Yes No Yes No 13 Yes No Yes No 14 Yes No Yes No

BMP BMP Installed?

BMP Maintenance Required?

Corrective Action Needed and Notes

15 Yes No Yes No 16 Yes No Yes No 17 Yes No Yes No 18 Yes No Yes No 19 Yes No Yes No 20 Yes No Yes No

Overall Site Issues Below are some general site issues that should be assessed during inspections. Customize this list as needed for conditions at your site.

BMP/activity Implemented? Maintenance Required?

Corrective Action Needed and Notes

1 Are all slopes and disturbed areas not actively being worked properly stabilized?

Yes No Yes No

2 Are natural resource areas (e.g., streams, wetlands, mature trees, etc.) protected with barriers or similar BMPs?

Yes No Yes No

3 Are perimeter controls and sediment barriers adequately installed (keyed into substrate) and maintained?

Yes No Yes No

4 Are discharge points and receiving waters free of any sediment deposits?

Yes No Yes No

5 Are storm drain inlets properly protected?

Yes No Yes No

6 Is the construction exit preventing sediment from being tracked into the street?

Yes No Yes No

7 Is trash/litter from work areas collected and placed in covered dumpsters?

Yes No Yes No

8 Are washout facilities (e.g., paint, stucco, concrete) available, clearly marked, and maintained?

Yes No Yes No

BMP/activity Implemented? Maintenance Required?

Corrective Action Needed and Notes

9 Are vehicle and equipment fueling, cleaning, and maintenance areas free of spills, leaks, or any other deleterious material?

Yes No Yes No

10 Are materials that are potential stormwater contaminants stored inside or under cover?

Yes No Yes No

11 Are non-stormwater discharges (e.g., wash water, dewatering) properly controlled?

Yes No Yes No

12 (Other)

Yes No Yes No

Non-Compliance

Describe any incidents of non-compliance not described above:

CERTIFICATION STATEMENT

“I 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 gathered and evaluated 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.” Print name and title: Signature:_________________________________________________________ Date:_____________________

EROSION AND SEDIMENT CONTROL INSPECTION REPORT Project Name: File No.: Inspection Date: Time: Inspected By:

Stage of Construction Pre-Construction Mtg. Rough Grading Finish Grading Clearing & Grubbing Building Construction Final Stabilization Yes No N/A Inspection Checklist

1. Have all disturbed areas requiring temporary or permanent stabilization been stabilized? Seeded? Mulched? Graveled?

2. Are soil stockpiles adequately stabilized with seeding and/or sediment trapping measures?

3. Does permanent vegetation provide adequate stabilization?

4. Have sediment trapping facilities been constructed as a first step in disturbance activity?

5. For perimeter sediment trapping measures, are earthen structures stabilized?

6. Are sediment basins installed where needed?

7. Are finished cut and fill slopes adequately stabilized?

8. Are on-site channels and outlets adequately stabilized?

9. Do all operational storm sewer inlets have adequate inlet protection?

10. Are stormwater conveyance channels adequately stabilized with channel lining and/or outlet protection?

11. Is in-stream construction conducted using measures to minimize channel damage?

12. Are temporary stream crossings of non-erodible material installed where applicable?

13. Is necessary restabilization of in-stream construction complete?

14. Are utility trenches stabilized properly?

15. Are soil and mud kept off public roadways at intersections with site access roads?

16. Have all temporary control structures that are no longer needed been removed? Have all control structure repairs and sediment removal been performed?

17. Are properties and waterways downstream from development adequately protected from soil erosion and sediment deposition due to increases in peak stormwater runoff?

SOIL EROSION AND SEDIMENT CONTROL SE/SC

INSPECTION REPORT Project Name: Permit#: Inspection Date: / / Time: Inspected by: STAGE OF CONSTRUCTION Pre-Construction Meeting Initial Installation of SE/SC Measures Clearing and Grubbing Rough Grading Temporary Stabilization Building Construction Finish Grading Final Stabilization INSPECTION CHECKLIST Yes No N/A

Have all sediment trapping measures been installed prior to site disturbance?

Have all soil erosion and sediment control devices indicated on the permitted plan set been installed?

Are all soil stockpiles adequately stabilized with the use of temporary seed and a sediment trapping device?

Are all perimeter sediment control devices properly installed and maintained?

Are all sediment basins and/or traps properly installed, stabilized and are maintained in working condition?

Have all stormwater management systems been constructed, stabilized and are functioning?

Have all disturbed areas been stabilized with temporary or permanent measures within 14 days of the end of active hydrologic disturbance?

Are finished cut and fill slopes adequately stabilized?

Has all erosion control blanket, hydro-mulch, mulch or other erosion control devices been installed where required?

Are stormwater conveyance channels adequately stabilized with channel lining and outlet protection?

Do all operational storm sewer inlets have adequate inlet protection?

Yes No N/A

Do all construction ingress and egress points have a stabilized construction entrance installed?

Are soil and mud being kept off all adjacent public roadways?

Are measures being taken to control dust?

Are all utility trenches being properly backfilled, tamped and stabilized?

Are temporary stream crossings of non-erodible material installed where applicable?

Is necessary re-stabilization of in-stream construction complete?

Have all temporary control structures that are no longer needed been removed within 30-days of final stabilization?

Is there evidence of sediment leaving the site affecting downstream property? Please explain?

WEATHER CONDITIONS: SITE CONDITIONS:

COMMENTS:

REPORT BY:

APPENDICES

APPENDIX A

Grading and Erosion Control Plan Dwg. No. 307-2511-C1

(sheet 04A of 12)