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Engineers 4847 Kaylee Avenue DATE I JOB NO 13 CL 3& (_I_ - ~§I Con~ulting LETTER OF TRANSMITTAL U Engineers 4847 Kaylee Avenue DATE I JOB NO. 07-22-14 1409003 Springdale, Arkansas 72762 P: (479) 872-7115 ATTENTION F: (479) 872-7118 RE: Sager Creek Vegetable Company Wastewater Improvements ITEMS SENT VIA: USPS TO: Arkansas Dept. of Environmental Quality 5301 Northshore Drive North Little Rock, AR 72118 WE ARE SENDING YOU: [8JAttached 0Shop Drawings 0Submittal 0Under Separate Cover Via __ 0Prints 0Change Order 0Pians [8JOther __ 0Specifications COPIES DESCRIPTION 1 NOI 1 Check in the amount of $200.00 THESE ARE TRANSMITTED AS CHECKED BELOW: [8JFor approval DNa exceptions taken 0Rejected - see remarks 0For your use DAmend and resubmit D_ DAs requested 0Make corrections noted REMARKS: SENDER: Ferdi Fourie, P.E. COPY TO: SIGNED:------------- Arkansas Department of Environmental Quality Permits Branch, Water Division 5301 Northshore Drive North Little Rock, AR 72118 (501) 682-0623 NOTICE OF INTENT FOR DISCHARGERS OF STORMWATER RUNOFF ASSOCIATED WITH LARGE CONSTRUCTION ACTIVITY AUTHORIZED UNDER NPDES GENERAL PERMIT ARR150000 Application Type: New mJ Renewal 0 (Permit Tracking Number ARRL_) I. PERMITTEE/OPERA. TOR INFORiVIA TION Sager Creek Vegetable Company Permittee (Legal Name): Operator Type: 305 E. Main Street Permittee Mailing Address: 0STATE 0 PARTNERSHIP PO Box 25o Permittee City: Siloam Springs 0 FEDERAL IK) CORPORATION* 72761 Pennittce State: Arkansas Zip: 0 SOLE PROPRIETORSHIP Permittee Telephone Number: 479-524-6431 0 PUBLIC 0 OTHER Pennittee Fax Number 479-524-9591 ---------------------------- DE Pennittee E-mail Address .,......,l,...m_u..,..s_h_~_·n-:-:sk___,i,...®..,.s-:-c-,v_e_g-:c-o_._c_o=-m----::-o *State of Incorporation: ________ • The legal name of the Permittee must be identical to the name listed with the Arkansas Secretary of State. II. Il'li'VOICE MAILING INFORMATION Laura Mushinski Siloam Springs Invoice Contact Person: --------------------------- City: Invoice Mailing Company: _s_a_g_e_r_c_r_e_e_k_v_e_g_e_t_a_b_l_e_c_o_. __ State: AR Zip: 72761 PO Box 250 Invoice Mailing Address: --------------- Telephone: _4_7_9_-_2_2_B_-_o_1_o_2______ _ III. FACILITY/PROJECT CONSTRUCTION SITE INFORMATION 1 acre = 43,560 square feet Sager Creek Vegetable Co Laura Mushinski Pr~ectName: Wastewater Improvements Contact Person: ------~~~----~~------14961 Readings Road Project County: _B_e_n_t_o_n_________ _ Project Physical Address: Directions to the Project: From US 4 12 north on Project City: Siloam Springs Zip: 72762 Fairmount. road -> east on Readings Rd. TelephoneNumber: 479-524-6431 Project Estimated Total amount of soil ~~~~~----------------to be disturbed . August 4,2014 15 00 Start Date: (estimate to nearest 112 acre): ---------------- Project Estimated Total Project Acreage October 30, 2014 15.00 End Date: (Estimate to nearest Y, acre): --------- 36 12 Project Latitude: degrees _____ minutes __3____ seconds 94 25 58 Project Longin;de: degrees ----- minutes ------- seconds Other: Buildings and pipeline Type of Project: Subdivision 0 School 0 Is the Project part of a larger common plan of development or sale? Yes 0 No Linear Project Starting Coordinates (if applicable): Linear Project Ending Coordinates (if applicable}: Latitude:~"~· 2. 57'• Longitude:2i._" ..e._· 57· 6·· Latitude: .2.§__• 11 ' __7 _,.Longitude: .1.!._• ~· _6_•· WATER DIVISION 5301 NORTHSHORE DRIVE /NORTH LITTLE ROCK, ARKANSAS 721 IS/PHONE 501-682-0623 i FAX 501-682-0910 www.adeq.state.ar.us Large Construction NOI I Revision date 1!10112011 Arkansas Department of Environmental Quality Permits Branch, Water Division 5301 Northshore Drive North Little Rock, AR 72118 (501) 682-0623 IV. DISCHARGE INFORMATION Name of Receiving Stream (i.e. an unnamed tributary of Mill Creek, thence into Mill Creek; thence into Arkansas River): Unnamed tributary of the Illinois River, thence Illinois River, thence Arkansas River Choose Your Ultimate Receiving Stream: Red River 0 Ouachita River 0 Arkansas River IX] White River 0 St. Francis River 0 Mississippi River D Name of Receiving Municipal Storm Sewer System (If applicable): V. FACILITY/SITE PERMIT INFORMATION NPDES Individual Permit Number (If Applicable): -=-=A::..R:..:.O..:.O ________________ NPDES General Permit Number (If Applicable): _A_R_G_______________ _ NPDES General Industrial Stormwater Permit Number (If Applicable): _A-=-RR=O..c.O_______________ _ NPDES General Construction Stormwater Permit Number (If Applicable): ....:..:A::.RR::..:..::l:..::5_______________ _ VI. OTHER INFORMATION: Location of SWPPP on the Mailbox at Country plant on Readings Road Construction Site: Consultant Company: USI Consulting Engineers, Inc. Consultant Contact Name: Ferdi Fourie, P.E. Consultant Email Address: ffourie®usi-ce.com 4847 Kaylee Ave City: Springdale State: AR 72762 Consultant Address: ------ Zip: --------- Consultant Fax 479-872-7115 479-872-7118 Consultant Phone Number: --------- Number: WATER DIVISION 5301 NORTHSHORE DRIVE I NORTH LITTLE ROCK, ARKANSAS 72118 I PHONE 501-682-0623 I FAX 501-682-0910 www.adeq.state.ar.us Large Construction NO! I Revision date 1110112011 Arkansas Department of Environmental Quality Permits Branch, Water Division 5301 Northshore Drive North Little Rock. AR 72118 (501) 682-0623 TIFICATIO:'II OF OPERATOR (Initial) "I certify that, if this facility is a corporation, it is registered with the Secretary of State of Arkansas. Please provide the full name of corporation if different than that listed in Section I above. " '"-'1R.--- (Initial) "I certify that as a whole the stormwater discharge(s), and the construction and implementation of Best Management Practices (BMP's) to control storm water runoff, are not likely to adversely affect species of critical habitat for a listed species." (Initial) "I certify that a stormwater pollution prevention plan has been prepared for this facility in accordance with Part ILA of this permit, which provides for, or will provide for, compliance with local sediment and erosion plans, local stormwater permits or stormwater management plans, in accordance with Part ILA.4.c of this permit." _ (Initial) "I certify that the cognizant official designated in Part VIII of this Notice of Intent is qualified to act as a duly authorized representative under the provisions of 40 CFR 122.22(b). If no cognizant official has been designated, I understand that the Department will accept reports signed by the applicant" "I certify under penalty of law that this document and all attachments such as Inspection Form were prepared under my direction or supervision in accordance with a system designed to ensure 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 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." Title: Chief Administrative O:"ficer Date: 7 / 18_ /.;_ -:1 -----1,~~~,~~~--------------------- VIII. COGNIZANT OFFICIAL FERDINAND FOURIE PROJECT MANAGER Cognizant Official Printed Name: Title: Cognizant Official Signature:~· ~· Telephone: 479-872-7115 IX. PERMIT REQUIREMENT VERIFICATION Please check the following to verify completion of permit requirements. Yes No* Submittal of Complete NOI? [] 0 Submittal of Required Permit Fcc? llJ 0 #5214 Check Number: Complete SWPPP? ~ 0 * If you answer No to any ofthe above questions, then a permit can not be issued! WATER DIVISION 530I NORTHSHORE DRIVE f ~ORTH LITTLE ROCK, ARKANSAS 72118! PHONE 501-682--0623/ FAX 501-682-0910 www.adeq.statc.ar.us Large Construction NOI I Revision date I !10 1120 I I r~li!!IT: KOUte Sheet I! I Facility Name I I I SC~t~e( P ; • ever I Permit Number ARR15~5 DL\ AFIN NO." 04~oot1?- Stream Segment: J~,J I Receiving Stream: Untla~Y\ecl mb. h I/(ino(S /Zi Vek" SoS Check 0 i 303(d) list 0 Yes 0 No I Google Earth coord to [email protected] .us 0 Assigned H\A c \\\\0\03 Activity Initials Date Complete/Entered Application Logged/ Assign Tracking Number/Place in red folder with Sect. N/A appropriate route sheet and filing w~ folders (1-day) Completeness and Technical Engineer Review/Enter permit information into sc_ ~\ C9\14 Database (3-days) 1\ AA (Max of 5 AFIN request (1-day) (o business days) .k\'(J'Y' ~ Enter AFIN and other information into I-- PDS and NPDES database prior to requesting invoice (same day) ~~/ ~·\0 Complete Invoice Request Form and v submit Invoice Request (same day) <~ ~\\p Prepare Authorization letter and attach appropriate permit, forms <\(7 (1-day) U\u Review/organize folder for scanning (1- Engineer L?J\(s) day) ~C Review all the documents/permits/ Engineer perform technical review for the Supervisor proposed project. (1-day) & 6/J Review the documents and sign the Assistant authorization letter or the permit. Chief (1-day) Enter Into PDS: Permit /7 Status/Effective Date. AA c Input effective date in access .cj, t'( database. (1-day) <ff-/ Mail original to applicant. Scan complete folder and place in appropriate E-drive Sect. folders. Update Zylab. Be sure to ~ -- include this permit in weekly report, due every Tuesday by 2:00P.M. ~w-~~ wt bl?~ ~~- f-f~ct REMARKS: evised 5/23/2012 .
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