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online system? www.ecy.wa.gov/pi-og ams/w /sfbr:mw,
NOTICE OF INTENT (
APPLICATION FORM
Construction Stormwater General
DEPARTMENT OF Permit
ECOLOGY
State of Washington
sing our secure, easy to use
construction/enoi.html
Check if applicable:
❑ Change or Update Permit Information
❑ Modification of Permit Coverage
Permit #WAR
Please print or type all sections of this application. All fields are required unless otherwise marked.(use Itab) to navigate through fields)
(.Operator/Permittee (Party with operational control over plans and specifications or day-to-day operational control of activities that
ensure compliance with Stormwater Pollution Prevention Plan (SWPPP) and permit conditions. Ecology will send correspondence and
permit fee invoices to the permittee on record.
Name: Matt Finch
Company: Edmonds School District No.15
E-mail:finchm@edmonds.wedneLedu
Unified Business Identifier (UBI): None
(UBI is a nine -digit number used to identify a business entity.
Business Phone:
Ext.
425-431-7167
Write "none" if you do not have a UBI number.)
Cell Phone (Optional):
Fax (Optional):
Mailing Address:
City:
State:
Zip + 4:
20420 681h Avenue West
Lynnwood
WA
98036
II. Property Owner (The party listed on the County Assessor's records as owner and taxpayer of the parcel[s] for which permit
coverage is requested. Ecology will not send correspondence and permit fee invoices to the Property Owner unless he/she is also
the permittee. The Property Owner information will be used for ern er enc contact purposes.)
Name: Edmonds School District No. 15
Company (if applicable): N/A
Business Phone:
Ext.
Unified Business Identifier (UBI): None
425-431-7167
(UBI is a nine -digit number used to identify a business entity.
Cell Phone (Optional):
Fax (Optional):
Write "none" if you do not have a UBI number.)
E-mail:finchm@edmonds.wednet.edu
Mailing Address: City: State: Zip + 4:
20420 681h Avenue West Lynnwood WA 98036
III. On -site Contact Person (Typically the Certified Erosion & Sediment Control Lead or O_ perator/Permittee)
Name:
l Company:
To be determined - publicly bid project
Mailing Address:
Business Phone:
Ext.
Cell Phone (Optional) Fax (Optional): City: State: Zip + 4:
E-mail:
IV. WQWebDMR Electronic Discharge Monitoring Reporting)
You must submit monthly discharge monitoring reports using Ecology's WQWebDMR system. To sign up for WQWebDMR,
or to register anew site, go to www.ecy.wa..ov/programs/wq(permits/Daris/i)ortal.litml. If you are unable to submit your DMRs
electronically, you may contact Ecology to request a waiver. Ecology will generally only grant waiver requests to those permittees
without Internet access. Only a permittee or representative, designated in writing, may request access to or a waiver from
WQWebDMR. To have the ability to use the system immediately, you must submit the Electronic Signature Agreement with
your application. If you have questions on this process, contact Ecology's WQWebDMR staff at WQWebPoital d( ecy.wa.gov or
800-633-6193 or 360-407-7097 (local). _
ECY 020-85 (Rev._ 12/14)
V. Site Information
Site or Project Name
Former Woodway High School Multipurpose Sports
Fields
Street Address or Location Description (If the site lacks a
street address, list its specific location. For example,
Intersection of Highway 61 and 34.)
232001001hAvenue West
Parcel ID#: 27033600202200 (Optional)
Type of Construction Activity (check all that apply):
❑ Residential
❑ Commercial
❑ Industrial
❑ Highway or Road (city ,county, state)
® Utilities (specify): storm. electrical
® Other (specify): -grading
City (or nearest city): Edmonds
County: Snohomish
Site Acreage
Total size of your site/project, including support activities such as
off -site equipment staging yards, material storage areas, borrow
areas, etc. (that 1L own/control): 39.75acres.
Total area of soil disturbance (grading and/or excavating) for your
site/project over the life of the project: 5.92acres. (Note: 1 acre =
43,560 ft2.)
Concrete / Engineered Soils
How many yards of concrete will be poured over the life of the
project? 257yd3 (estimate)
How many yards of recycled concrete will be used over the life of
the project? 0 yd3 (estimate)
Will any engineered soils be used? (For example: manufactured
soil stabilizers, fly ash, cement treated base, cement kiln dust, etc.)
❑ Yes ® No
Zip Code: I Estimated project start-up date (mm/dd/yy): 05/25/2015
98020 Estimated project completion date (mm/dd/yy): 09/18/2015
Record the latitude and longitude of the main entrance to the site or the approximate center of site.
Latitude: 47.78643 ON
Conditions-
Longitude:-122.37080 °W
Are you aware of contaminated soils present on the site? ❑ Yes ® No
2. Are you aware of groundwater contamination located within the site boundary? ❑ Yes ® No
3. If you answered yes to questions 1 or 2, will any contaminated soils be disturbed or will any contaminated groundwater be
discharged due to the proposed construction activity? ❑ Yes ❑ No
["Contaminated" and "contamination" here mean containing any hazardous substance (as defined in WAC 173-340-200) that does not
occur naturally or occurs at greater than natural background levels.]
If you answered yes to Question 3, please provide detailed information on the locations, contaminants, and contaminant
concentrations (if known), and pollution prevention and/or treatment Best Management Practices (BMPs) proposed to control the
discharge of soil/groundwater contaminants. This information should include related portions of the Stormwater Pollution Prevention
Plan (SWPPP) that describe how contaminated and potentially contaminated construction stormwater and dewatering water will be
managed.
VII. Stormwater Pollution Prevention Plan i
You must develop a SWPPP prior to starting construction. Do not submit your SWPPP with your application. The exception is that
Ecology may request a copy of all or part of the SWPPP if you answered yes to the questions in Part VI.
ECY 020-85 (Rev. 12114)
Vill. Best Management Practices BMPs
You must use the BMPs listed in the Stormwater Management Manual for Western Washington or the Stormwater Management
Manual for Eastern Washington or other manuals approved by Ecology. Alternatively, you may use demonstrably equivalent BMPs
on the basis of permit condition S9.C.4. If you intend to use a BMP at your site that is not included in these manuals, but that you
believe meets the definition of a demonstrably equivalent BMP, you must notify the appropriate regional office.
www.ecy.wa.gov/programs/wq/stormwater/construction/contacts.litml (See Definitions in the Construction Stormwater General
Permit).*
*Note that if you receive permit coverage without indicating the preference for a demonstrably equivalent BMP and later decide to use one, you
must provide Ecology with notice of the selection of an equivalent BMP no less than 60 days before the intended use of the equivalent BMP.
IX. Discharge/ReceivingDischarge/Receiving Water Information
Indicate whether your site's stormwater and/or dewatering water could enter surface waters, directly and/or indirectly:
® Water will discharge directly or indirectly (through a storm drain system or roadside ditch) into one or more surface waterbodies
(wetlands, creeks, lakes, and all other surface waters and water courses).
If your discharge is to a storm sewer system, provide the name of the operator of the storm sewer system:
(e.g., City of Tacoma): City of Edmonds
(NOTE: If your stormwater discharges to a storm sewer system operated by the City of Seattle, King County, Snohomish County, City
of Tacoma, Pierce County, or Clark County, you must also submit a copy of this NO1 to the appropriate jurisdiction.)
❑ Water will discharge to ground with 100% infiltration, with no potential to reach surface waters under any conditions.
If your project includes dewatering, you must include dewatering plans and discharge locations in your site Stormwater Pollution
Prevention Plan.
Location of Outfall into Surface Waterbody
Enter the outfall identifier code, waterbody name, and latitude/longitude of the point(s) where the site has the potential to discharge
into a waterbody (the outfall). Enter all locations. See illustration of Surface Waterbody Outfall locations at the end of this form.
• Include the names and locations of both direct and indirect discharges to surface waterbodies, even if the risk of discharge is
low or limited to periods of extreme weather. Attach a separate list if necessary.
• Give each point a unique 14 digit alpha numeric code. This code will be used for identifying these points in WQWebDMR.
• Some large construction projects (for example, subdivisions, roads, or pipelines) may discharge into several waterbodies.
• If the creek or tributary is unnamed, use a format such as "unnamed tributary to Deschutes River."
• If the site discharges to a stormwater conveyance system that in turn flows to a surface waterbody, include the surface
waterbody name and location.
Outfall Identifier Code. These cannot be
Surface Waterbody Name at
Latitude
Longitude
symbols. Maximum of four characters).
the Outfall
Decimal Degrees
Decimal Degrees
Example: 001A
_
Example: Puget Sound
47.52890470 N
-122.31235500 W
0
0
1
A
Deer Creek
47.791520 N
-122.377900 W
ON
°W
ON
°W
If your site discharges to a waterbody that is on the impaired waterbodies list (e.g., 303(dj list) for turbidity, fine sediment, high pH, or
phosphorus, Ecology will require additional documentation before issuing permit coverage and these sites will be subject to additional
sampling and numeric effluent limits (per Permit Condition S8). Ecology will notify you if any additional sampling requirements apply.
Information on impaired waterbodies is available online at. littp:llwww.ecv.wa.govlprogramslwgl3O3dlindex./7tm/ .
ECY 020-85 (Rev. 12/14)
X. State Environmental Policy Act (SEPA)
This Notice of Intent (N01) is incomplete and cannot be approved until the applicable SEPA requirements under Chapter 197-11 WAC
are met.
Who is the SEPA lead agency on your site?Edmonds School District .
Has the SEPA lead agency issued a final decision on your checklist? (if there is a comment period, the SEPA decision is
final at the close of the comment period) [:]No ®Yes ❑ Exempt* (*attach written documentation if Exempt).
If No: The N01 is incomplete. Ecology will hold the application until a final SEPA decision is made or the Construction Stormwater
N01 public comment period ends, whichever is later. You must notify Ecology once the SEPA lead agency has issued a final
decision following any comment period.
If Yes: Type of SEPA threshold determination issued: ® Determination of Non -Significance (DNS) ❑ Mitigated DNS (MDNS)
❑ Determination of Significance (DS) ❑ Final Environmental Impact Statement (EIS) ❑ Other:
• Date when SEPA comment period ended or will end: 03/13/15
Notify Ecology if the SEPA determination is appealed. More SEPA information is available at:
www. ecy. wa.qov/programs/sea/sepa/e-review.hfml.
XI. Other Ecology National Pollutant Discharge Elimination System (NPDES) and/or State Waste Discharge Permits
List any other Water Quality permits (Industrial stormwater, Individual stormwater, etc.) for this site:
Name of Water Quality Permit
Permit Number
XII. Public Notice
You must publish a public notice at least once a week for two consecutive weeks with at least seven days between publications, in a
newspaper of general circulation in the county in which the construction is to take place. Ecology cannot grant permit coverage
sooner than the end of the 30-day public comment period, which begins on the date of the second public notice.
Mail or fax (360-407-6426) the N01 to Ecology on or before the first public notice date. If you fax the public notice to Ecology, you
must also mail a hard copy. Failure to do so may delay the issuance of your permit.
Provide the exact dates (mm/dd/yy) that the first and second public notices will appear in the newspaper(s):
Name of the newspaper publishing the notices: Seattle Daily Journal of Commerce
First notice: 04/30 /15
Second notice: 05/07 I15 (Begins 30-day public comment period.)
For example: First notice: Friday 01/01/14 Second notice: Friday 01/08/14
ECY 020-85 (Rev. 12/14)
PUBLIC NOTICE TEMPLATE
Complete this template using project -specific information and submit to a local newspaper with general circulation within the county
where the project is located. The language in bold is required by WAC 173-226-130 and must be included in its entirety. (Either use
the fill-in template below or attach on a separate sheet of paper, if necessary.)
Edmonds School District No. 15, contact Edward Peters , at 20420 6811, Avenue West, Lynnwood, WA 98036 , is
seeking coverage under the Washington State Department of Ecology's Construction Stormwater NPDES and State Waste
Discharge General Permit.
The proposed project, Former Woodway High School Mulfipurpose Sports Fields is located at 232001001h
Avenue West in the City of Edmonds in Snohomish County
This project involves 5.92 acres of soil disturbance for gratlinq, synthetic turf field resurfacing, paving and stormwater
improvements construction activities.
(List all construction activities; for example, residential, commercial, industrial, highway, utility).
The receiving water(s) islare Deer Creek (List all named and un-
named surface waterbodies, or ground water if applicable, waters identified in section IX).
Any persons desiring to present their views to the department of Ecology regarding this application may do so in writing
within thirty days of the last date of publication of this notice. Comments shall be submitted to the department of Ecology.
Any person interested in the department's action on this application may notify the department of their interest within thirty
days of the last date of publication of this notice. Ecology reviews public comments and considers whether discharges from
this project would cause a measurable change in receiving water quality, and, if so, whether the project is necessary and in
the overriding public interest according to Tier II antidegradation requirements under WAC 173-201A-320.
Comments can be submitted to:
Department of Ecology
Attn: Water Quality Program, Construction Stormwater
PO Box 47696, Olympia, WA 98504-7696
XIII. Certification of Permittees
"1 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 directly responsible forgathering 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."
Matt Finch / Edmonds School District No. 15 Design & Construction Manager
Printed Name / Company Title
;MAL 04129/2015
Signature of Operator/Permittee Date
* Signature of Operator/Permittee requirements:
A. For a corporation: By a responsible corporate officer of at least the level of vice president.
B. For a partnership or sole proprietorship: By a general partner or the proprietor, respectively.
C. For a municipality, state, federal, or other public facility: By either a principal executive officer or ranking elected official.
Please sign and return this document to the following address:
Department of Ecology
Attn: Water Quality Program, Construction Stormwater
PO Box 47696
Olympia, WA 98504-7696
ECY 020-85 (Rev. 12/14)
DEPARTMENT OF EC104.00'
DEPARTMENT Of
ECOLOGY
State of Washington
Transfer of Coverage JUL 17 2015
Construction Stormwater General Permit WATER QUALITY PROGRAM
This form transfers permit coverage for all, or a portion Permit # WAR--303159
of a site to one or more new operators.
Type of permit transfer (check one): ❑ Partial transfer ® Complete transfer
Specific date that permit responsibility, coverage, and liability, is transferred to new operator. 07/06/15
Please see instructions for details on type of transfer.
Current Operator/Permittee Information
For partial transfers:
•List total size of proiectisite remaining under your operational control following transfer. 5.92 acres_
•List total area of soil disturbance remaining under your operational control following transfer: 5.92 acres.
-Submitting this form meets the requirement to submit an updated N01(General Permit Condition G9)
Current Operator/Permittee Name::' �.
Company:__.- ______.
Stewart Mh re
Edmonds School District
Business Phone:
Ext:
Mailing Address:
425.431.7000
20420- 68th Avenue West
Cell Phone:
Fax (optional):
Email: mhyres@edmonds.wednet.edu
City: v
State:
Zip+4:
Lynnwood
WA
98036-7400
Signature" (see signatory requirements in section Viii): Title: Executive Director, Business Operations
2_4�� Date: _77 AS—']
U
New Operator/Permittee Information
1. New OperatorlPermittee (Party with operational control over plans and specifications or day-to-day operational control of activities
which ensue; compliance with Stormwater Pollution Prevention Plan (SWPPP) and permit conditions. Ecology will send correspondence
and permit fee invoices to the permittee on record.)
Name: Greg Weisbrich
Company: FieldTurf USA
Business Phone:
Ext:
Unified Business Identifier (UBI): 602 048 13 2
425.246.8087
(UBI is a nine -digit number used to identify a business entity.
Write "none" if you do not have a UB1 number
Cell Phone (Optional):.—�z
Fax (Optional):
E-mail:
= �—•—
----�. v_ __ .� -
greg.weisbrich@fieldturf.crmm "'` ----- -------.--
Mailing Address:
City:
State:
Zip + 4:
2804 269th Avenue NE
Redmond
WA
98053-2928
It. Property Owner (The party listed on the County Assessor's records as owner and taxpayer of the parcels) for which permit coverage
is requested. Ecology will not send correspondence and permit fee invoices to the Property Owner. The Property Owner information will
be used for emergency contact purposes.)
Name: Stewart Mh
Company: Edmonds School District
Business Phone: _ _
Fact:
Unified Business Identifier (UBI): 319009065
425.431.7000
(UBI is a nine -digit number used to identify a business entity.
Write "none" if you do not have a UBJ number.
Cell Phone (Optional):
Fax (Optional):
E-mail:
mhyres@edmonds.wed.net.edu
Mailing Address:
City:
State:
Zip +4:
20420 - 68th Avenue West
Lynnwood
WA
98036-7400
ECY U20-87a (fiev. 12/14) rorm Page i
ECY 020-87a ( Rev. 12/14) Form Page 2
1. Are you aware of contaminated soils present on the site? []Yes ® No
2. Are you aware of groundwater contamination located within the site boundary? ❑ Yes ®No
3. If you answered yes to questions 1 or 2, will any contaminated soils be disturbed orwil any contaminated groundwater be
discharged due to the proposed construction activity? ❑ Yes ❑ No
('Contaminated' and 'contamination' here mean containing any hazardous substance (as defined in WAC 173-340-200) that does not
occur naturally or occurs at greater than natural background levels.]
If you answered yes to Question 3, please explain below or on a separate paper in detail the locations, contaminants, and
concentrations, and pollution prevention and/or treatment BMPs proposed to control the discharge of soillgroundwater contaminants.
Ecology may request a copy of your SWPPP.
VI. WQWebDMR (Electronic Discharge Monitoring Reporting)
You -must submit monthly dischargemonitoring-reportsusing Ecology's WQWebDMR system. To sign up for-WQWebDMR, or..to
register a new site, go to mwr.ecy.wa.gov/stormwater, and click on the 'Construction Stormwater" link. You will find information on
WQWebDMR under the'WQWebOMR and PARIS' link on the right -stand side. If you are unable to submit your DMRs electronically,
you may contact Ecology to request a waiver. Ecology will generally only grant waiver requests to those permittees without intemet
access. Only a permittee or representative, designated in writing, may request access to or a waiver from WQWebDMR. To have the
ability to use the system immediately, you must submit the Electronic Signature Agreement with your transfer of coverage
I form. If you have questions on this process, contact Ecology's WQWebDMR staff at WebDMR-Stormwater(@ecy.ara.gov or 360.407-
1 7097.
fVII. DischargefReceiving Water Information
Indicate whether your site's stormwater and/or dewatering water could enter surface waters, directly and/or indirectly:
® Water will discharge directly or indirectly (through a storm drain system or roadside ditch) into one or more surface waterbodies
(wetlands, creeks, lakes, and all other surface waters and water courses).
If your discharge is to a storm sewer system, provide the name of the operator of the storm sewer system:
(e.g., City of Tacoma): City of Edmonds
(NOTE: If your stormwater discharges to a storm sewer system operated by the City of Seattle, King County, Snohomish
County, City of Tacoma, Pierce County, or Clark County, you must also submit a copy of this NOI to the appropriate
jurisdiction.)
❑ Water will discharge to ground with 100% infiltration, with no potential to reach surface waters under any conditions.
If your project includes dewatering, you must include dewatering plans and discharge locations in your site Stormwater Pollution
-Prevention Plan.
Location of Outfall into Surface Waterbody
Enter the outfall identifier code, watertxxiy name, and latitudeflongitude of the point(s) where the site has the potential to discharge
into a waterbody (the outfal). Enter all locations.
• Include the names and locations of both direct and indirect discharges to surface waterbodies, even if the risk of discharge is
low or limited to periods of extreme weather. Attach a separate list if necessary.
• Give each point a unique 1A digit alpha numeric code. This code will be used for identifying these points in WQWebDMR.
• Some large construction projects (for example, subdivisions, .roads, or pipelines) may discharge into several waterbodies.
• If the creek or tributary is unnamed, use a format such as "unnamed tributary to Deschutes River'
• If the site discharges to a stormwater conveyance system that In turn flows to a surface waterbody, include the surface
waterbody name and location.
Outfall Identifier Code. These
Surface Waterbody Name at the
Latitude
_ Longitude
cannot be symbols. (Maximum
Outfall
Decimal Degrees
Decimal Degrees
of 4 charactersL_�
ECY 020.87a (Rev. 12114) Form Page 3
STATE OF WASHINGTON
DEPARTMENT OF ECOLOGY
PO Box 47600 - Olympia, WA 98504-7600 - 360-407-6000
711 for Washington Relay Service - Persons with a speech disability can call 877-833-6341
August 27, 2015
Greg Waisbrich
FieldTurf USA
2804 269 h Ave NE
Redmond, WA 98053-2928
RE: Transfer of coverage under the Construction Stormwater General Permit
Permit number: WAR303159
Site Name: Former Woodway HS Field Improvelments
Location: 23200 100'h Ave W
Edmonds, WA County: Snohomish
Disturbed Acres: 5.92
Dear Mr. Waisbrich:
The Washington State Department of Ecology (Ecology) received your Transfer of Coverage form
for coverage under the Construction Stormwater General Permit. Our records have been updated to
show FieldTurf USA as responsible for permit coverage effective July 6, 2015. Please retain this
transfer of permit coverage letter with your permit (enclosed), stormwater pollution prevention
plan (SWPPP), and site log book. These materials are the official record of permit coverage for
your site.
Please take time to read the entire permit and contact Ecology if you have any questions.
Electronic Discharge Monitoring Reports (WQWebDMR)
This permit requires that Permittees submit monthly discharge monitoring reports (DNM) electronically
using Ecology's secure online system, WQWebDMR. To sign up for WQWebDMR go to:
www.ecy.wa.gov/programs/wq/Perrnits/paris/webdmr.htmi, if you have questions, contact the portal staff
at (360) 407-7097 (Olympia area), or (800) 633-6193/option 3, or email WQWebPortal@ecy.wa.gov.
co
Greg Waisbrich
August 27, 2015
Page 2
Ecology Field Inspector Assistance
If you have questions regarding stormwater management at your construction site, please contact
Tracie Walters of Ecology's Northwest Regional Office in Bellevue at tracie.walters@ecy.wa.gov, or
(425) 649-4484.
Questions or Additional Information
Ecology is committed to providing assistance. Please review our web page at:
www.ecy.wa.gov/programs/wq/stormwater/construction/. If you have questions about the
construction stormwater general permit, please contact Charles Gilman at charles.gilman@
ecy.wa.gov, or (360) 407-6437.
Sincerely,
Bill Moore, P.E., Manager
Program Development Services Section
Water Quality Program
Enclosure