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Department of Ecology Agreement for Old Woodway High School Field TurfDid you know you can submit your NOI electronically using our secure, easy to use online system? www.ecy.wa.gov/procirams/wg/stormwater/construction/enoi.html NOTICE OF INTENT (N01) Check if applicable: APPLICATION FORM ❑ Change or Update Permit Information Construction Stormwater General ❑ Modification of Permit Coverage DEPARTMENT OF Permit Permit#WAR ECOLOGY -- State of Washington Please print ortype all sections of this application. All fields are re uired unless otherwise marked.(use ltab) b eavigafe through fferdsj (.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.wednetedu i Unified Business Identifier (UBI): None Business Phone: Ext. (U131 is a nine -digit number used to identify a business entity. Write "none" if you do not have a UBl number.) _425-431-7167 Cell Phone (Optional): Fax (Optional): Mailing Address: 20420 68ih Avenue West City: State: Zip + 4: 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 permiltee. The Property Owner information will be used for ememency contact purposes.] _ Name: Edmonds School District No.15 Company (if applicable): N/A Business Phone: Ext. Unified Business Identifier (UBI): done 425-431-7167 Cell Phone (Optional): Fax (Optional): (01 is a nine -digit number used to identity a business entity. "none" Write if you do not have a UBI number.) E-mail:finchm@edmonds.wednet.edu Mailing Address: City: State: Zip + 4: 2 042 0 68th Avenue West Lynnwood WA 98036 III. On -site Contact Person TT icall the Certified Erosion & Sediment Control Lead or O erator/Pemintee Name: Company: To be determined - publicly bid project Business Phone: Ext. Mailing Address: City: State: Zip + 4: Cell Phone (Optional) Fax (Optional): E-mai#: 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 a new site, go to www.ec .wa. ov/ ra ramslw 1 ermitsl ar#s/ ortal.htmi. 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 WOWebPortal@ecy.wa.gov or 800-633-6193 or 360-407-7097 (local). ECY 020-85 (Rev. 12114) G� 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 speck location. For example, Intersection of Highway 61 and 34.) 23200100th Avenue 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_ Z Other (specifftgrading City (or nearest city): Edmonds Zip Code: County: Snohomish 98020 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 you 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? 2 5 7yd3 (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 Estimated project start-up date (mm/dd/yy): 05/25/2015 Record the latitude and longitude of the main entrance to the site or the approximate center of site. Latitude: 47.78643 ON VI. Existing Site Conditions Longitude:-122.37080 °W 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 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 soillgroundwater 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 VII. Stormwater Pollution Prevention Plan (SWPPP) 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) I Vill. Best Management Practices (BMPs) I 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 13MP 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.goylorograms/wQ/stormwater/constructionicontacts.liiml (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 eq uivolent BMP no less than 60 days before the intended use of the equivalent BMP. Ix Water Information Indicate whether your site's stormwater and/or dewatering water could enter surface waters, directly and/or indirectly: Y❑ 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, 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 1-4 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 Ti I A Deer Creek 47.791520 N -122.377900 W I °N I °W 1f your site discharges to a waterbody that is on the impaired waterbodies list (e.g., 303 fdj list) for turbid* tine 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 on tin at: ht0,11www.ecv.wa.p4y/pi ara►nslwa1303dlindex.html . 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 NOI 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: uvww. ec , wa. ovl rfl ramslsealse ale -review, html. 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 Al. 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 (360407-6426) 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/_$o /15 Second notice: D5/QZ /15 (Begins 30-day public comment period.) For exam le: First notice: Friday 01/01/14 Second notice: Frida D1/08/14 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 68m 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 Multi u ose Sports Fields is located at 2.320010011, Avenue West I in the City of Edmonds in Snohomish County This project involves 5.92 acres of soil disturbance for gradinra, sys�tletic turf field resudacin avin and Stormwater improvements construction activities. �— (List all construction activities, for example, residential, commercial, industrial, highway, utility). The receiving water(s) Is/are Deer Creels (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 underpenalty 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 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." Matt Finch / Edmonds School District No. 15 Design & Construction Manager Printed Name / Company Title ;460t, _ 04/29/2015 Signature of OperatorlPerm ittee 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 C20-85 (Rev. 12114) 5 DEPARTMENT OF ECOLOGY Transfer of Coverage JUL 17 2015 Construction Stormwater General Permit WATER QUALM PROGRAM DEPARTMENT OF This form transfers permit coverage for all, or a portion Permit # WAR--303159 ECOLOGY of a site to one or more new operators, — - - Sule of N4ihinglon Type of permit transfer (check one): ❑ Partial transfer ® Complete transfer Specific date that permit responsibility, coverage, and liability, is transferred to new operator. 071a_5[t 5 Please see instructions for details on type of transfer. Current Operator/Permittee Information For partial transfer;: *List total size of pro]ectlsite remaining under your operational control following transfer: 6.92 acres. ■Ust total area of salt disturbance remaining under your operational control following transfer: 6.92 acres. *Submitting this form meets the requirement to submit an updated NOl (General Permit Condition G9) Stewart Mh re Edmonds School District Business Phone: Ext: Mailing Address: 429-431.7000 20420- 68th Avenue West Cell Phone; I Fax 166finnall. Email: mhyres@Icdmonds.wedncecdu City: State: Zip-4: Z nnwood WA 98036-7 Signature" (see signatory retiulrements in section vni): Title: Executive Director, Business Operations Date:` -[ New OperatorlPermittee Information I. New OperatoriPermittee (Party with operational control over plans and specifications or day-to-day operational control of activities which 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: Gre Welsbrich - Corr an : FielftTurfUSA Business Phone: Ext; Unified Business identifier (UBI): 602 048132 425.246,8087 (UB1 is a nine -digit number used to identify a business entity. Write "none" If you do not have a UBl number. Cell P#�one (Optional):Fax (gpUona}): E-mail: Ming Address: City: State: 7jp+4: 2804 269th Avenue NE Redmond WA 98053-2928 11. Property Owner (The party listed on the County Assessors records as owner and taxpayer of the parcels] for which permit coverage Is requested. Ecology will nQ send correspondence and permit fee invoices to the Property Owner. The Property Owner information will be used for emergency contact purposes.) Name: Stewart "h Cam an : Edmonds School District Business Phone: 6rt Untied Business Identi6er(USI). 319009065 425,431.7000 (U81 is a nine-digrt number used to Eden* a business entity. Write "none" It Vou do not have a M number.)_ Cell Phone (Optional): Fax (Optionaq: E-mail: mhyres@edmo ndS.wedilet. edu Mailing Address: -- City: State: 20420 - 68th Avenue West IlaXnnwood WA 9$fl3S-7400 ECY 02"7a (Rev. 12114) T Form Pagel 111. On•Slte Contact Person(s) (Typically the Certified Erosion and Sediment Control Lead or Operator/Permittee) (dame: Ryan Wolter - Business Phone: 360.668-8989 Cell Phone: 425.405.2543 Email: rvanOfhaw.c IV. Site/Project Information Site or Project Name Former Woodwav HS Fiel uor A jn Fiet ffu Ext: - - Mailing Address: 1-280413130 93rd Fax(Optional)- Street Address or Location Description (lithe stte lacks a street address, list ifs specific localkin. For example, Intersection of Highway 61 and 34.) 23200 -100th Avenue West, Edmonds, WA Parcell0#: (Optional) Type of Construction Activity (check all that apply): [] Residential ❑ Commercial ❑ Industrial ❑ Highway or Road (city ,county, state) ® Utllities(specify): Drainage ® Other(sperafy):; ynt�tic' u 1 City (or nearest cdy): Edmonds H City: State: Zi ty +4: p Snohomish WA 98296 Site Acreage ^--�-- ---- -- -- ---_.------__._-- Total size of your siWproject (that you own/control): 5.92acres. (Note: f acre = 43,5601P.) Total area of soil disturbance (grading and/or excavating) for XW siWpmject over the life of the project: 5.92acres. Concrete I En0eered Soils How many yards of concrete will be poured? 260yd3 estimate How many yards of recycled concrete will be used? OOyd3 estimate Will any engineered soils be used? (For example. cement treated base, cement kiln dust, etc.) ] Yes ® No Estimated project startup date (mmlddlyy): 06/08/15 County.Snohomish 98020 Estimated ro p �cicompletion date (mm/ddlyy):10/01/15G Record the latitude and longitude of the main entrance to the she or the appro)imale center of site. Latitude: 47o4T I In —ON Longitude: f220'15" °W For assistance with latitude and longitude, refer to any of the following wabslfes: www.oetlatlon.com or httg:tAvww.woddatlas.camlaatlasAmageo.htm. Please convert all latitude and kingNude coordinates into decimal degrees format. For help with this process, go to: htI Y fcc avlm audWbkke=MMSS-dLdLnal.hJmI V. Existing Site Conditions ECY 020-87a ( Rev. 12114) Form Page 2 1. Are you aware of contaminated soils present on the site? []Yes ® No 2. Are you aware of groundwater contamination located wilhln 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 explain below or on a separate panr In detail the locations, contaminants, and concentrations, and pollution prevention and/or treatment SMPs proposed to control the discharge of soiligroundwater contaminants. Ecology may request a copy of your SWPPP. VI. WQWebDMR (Electronic Discharge Monitoring Reporting) Yowmust submit monthly dischargetnonitorling reports using Ecology's WQWeb DMR system. To sign up for-WQWebDMR. or. to register a new site, go to m .ecyma-govlstormwater, and click on the'Constnmion Stormwater" lints. You va11 find information on WQWebDM R under the *WQWebDMR and PARIS' link on the right-hand 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 Internet aocess. Only a permlttee 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 yourtransfer of coverage I form. If you have questions on this process, contact Ecology's WQWebDMR staff at WebDMR-Stgrmwgie[ ecY.wa gpv or 360.407- 1 7097. VII. Discharge/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 (thiough 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 sealer system, provide the name of the operator of the storm sewer system: (e.g., City of Tacoma): C0ity of EOrnonds (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 vrrll discharge to ground with 100% infiltration, with no potential to reach surface waters under any conditions, If your project irtcludes dewatering, you must include dewatering plans and discharge locations in your site Stonnwater Pollution 'Prevention Plan. - - Location of Outfall into Enter the outfa0 identifier code, waterbody name, and latitudeAongitude of the point(s) where the site has the potential to discharge into a waterbody (the outfall). 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 fimited 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. E 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 symbols. (Maximum of 4 characters). Surface Waterbody Name at the Outfall EC 020.87a (Rev. 12114) Form Page 3 Latitude Longitude Decimal Degrees Decimal Degrees 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 269s' 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 Improvements Location: 232001000 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 (DMRs) electronically using Ecology's secure online system, WQWebDMR. To sign up for WQWebDMR go to: www.ecy.wa.gov/programs/wq/permits/pads/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. colt Greg Waisbrich August 27, 2015 Page 2 Ecology Field Inspector Assistance If you have questions regarding stonnwater 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.er.y.wa-gov/programs/wq/stornlwdcr/construction/. If you have questions about the construction stormwater general permit, please contact Charles Gilman at chades.gilman@ ecy.wa.gov, or (360) 407-6437. Sincerely, Bill Moore, P.E., Manager Program Development Services Section Water Quality Program Enclosure