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Preview - Ohio Epa 4496 Form

Co-Permittee Notice of Intent for Coverage Under

Ohio EPA Storm Water Construction General Permit

Submission of this NOI constitutes notice that the party identified in Section I of this form intends to be authorized by Ohio’s NPDES general permit for storm water associated with construction activity. Becoming a permittee obligates a discharger to comply with the terms and conditions of the permit. NOTE: All necessary information must be provided on this form. Read the accompanying instructions carefully before completing the form. Do not use correction fluid on this form. Forms transmitted by fax will not accepted. There is no fee associated with submitting this form.

I.Applicant Information/Mailing Address

Company (Applicant) Name:

Mailing (Applicant) Address:

__________________________________________________________________________________

City:

 

 

 

State:

 

 

Zip Code:

 

Contact Person:

 

 

Phone:

 

 

 

Fax:

 

Contact E-Mail Address:

 

 

 

 

 

 

 

 

 

 

 

II. Facility/Site Location Information

Existing Ohio EPA Facility Permit Number: ______________________________

 

 

 

 

 

 

Initial Permittee Name:

 

 

 

 

 

 

 

 

 

Phone:

 

 

Facility/Site Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City:

 

 

 

Township(s):

 

 

 

 

 

 

 

 

County(ies):

 

 

 

State:

 

Ohio

 

 

Zip Code:

 

 

Facility Contact Person:

 

 

 

Phone:

 

 

 

 

Fax:

 

 

Facility Contact E-Mail Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

III. Certification

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 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.

Applicant Name:

 

Title:

 

 

Applicant Signature:

 

 

 

Date:

 

 

EPA 4496 (Rev. 2/10)

CLICK TO CLEAR ALL ENTERED INFORMATION

Document Properties

Fact Name Description
Form Purpose The Ohio EPA 4496 form is used to notify the Ohio Environmental Protection Agency of a party's intent to be covered under the Storm Water Construction General Permit.
Governing Law This form is governed by the National Pollutant Discharge Elimination System (NPDES) regulations, which are part of the Clean Water Act.
Submission Requirements All necessary information must be completed on the form. It is important to read the accompanying instructions carefully before submission.
Prohibited Actions Correction fluid should not be used on the form, and submissions via fax are not accepted.
Fees There is no fee associated with the submission of the Ohio EPA 4496 form.
Certification Statement The form includes a certification statement, affirming that the information provided is true and complete, with penalties for false information.

Documents used along the form

The Ohio EPA 4496 form is essential for notifying the state of your intent to be covered under the Storm Water Construction General Permit. In addition to this form, several other documents may be required or beneficial during the permitting process. Below is a list of related forms and documents that you might encounter.

  • Ohio EPA 4506 Form: This form is used to request coverage under the Ohio EPA's National Pollutant Discharge Elimination System (NPDES) for stormwater discharges. It provides detailed information about the project and the potential environmental impacts.
  • Non-compete Agreement Form: To safeguard sensitive information after employment, utilize the necessary Non-compete Agreement guidelines for protecting your business interests.
  • Storm Water Pollution Prevention Plan (SWPPP): This document outlines the measures that will be taken to prevent stormwater pollution during construction activities. It includes site-specific practices and procedures to manage runoff effectively.
  • Notice of Termination (NOT): Once construction is complete, this form is filed to terminate coverage under the stormwater permit. It confirms that the project has ended and that all necessary steps have been taken to stabilize the site.
  • Site Inspection Reports: Regular inspection reports are often required to document compliance with the stormwater permit. These reports detail findings from site visits and any corrective actions taken to address issues.
  • Permit Compliance Certification: This document is submitted to confirm that all permit conditions have been met. It serves as an official statement of compliance with the environmental regulations associated with the project.

Understanding these additional documents will help ensure a smooth permitting process. Each form serves a specific purpose in maintaining compliance with environmental regulations and protecting water quality. If you have questions about any of these forms, consult with a qualified professional for assistance.

Guidelines on Filling in Ohio Epa 4496

Once you have gathered all necessary information, you can begin filling out the Ohio EPA 4496 form. Make sure to provide complete and accurate details to ensure a smooth submission process. Follow these steps carefully.

  1. Begin with Section I: Applicant Information. Enter the Company Name in the designated space.
  2. Fill in the Mailing Address, including the street address, city, state, and zip code.
  3. Provide the Contact Person's Name, along with their phone number, fax number, and email address.
  4. Proceed to Section II: Facility/Site Location Information. Input the Existing Ohio EPA Facility Permit Number if applicable.
  5. Enter the Initial Permittee Name and their contact phone number.
  6. Complete the Facility/Site Name, followed by the city, township(s), county(ies), and state.
  7. Fill in the Zip Code for the facility/site.
  8. Provide the Facility Contact Person's Name, along with their phone number, fax number, and email address.
  9. Move to Section III: Certification. Read the certification statement carefully.
  10. Print the Applicant Name and their title.
  11. Sign and date the form in the designated areas.
  12. Before submission, double-check all entries for accuracy. Remember, do not use correction fluid on the form.

After completing the form, ensure that it is submitted according to the guidelines. Forms sent by fax will not be accepted. There is no fee for submission, so make sure to send it promptly to avoid any delays.

Common mistakes

Filling out the Ohio EPA 4496 form can seem straightforward, but many people make common mistakes that can delay the process or even lead to penalties. One frequent error is neglecting to provide all necessary information. Each section of the form requires specific details, and incomplete submissions can result in rejection. Always double-check that every field is filled out correctly.

Another common mistake is using correction fluid to amend errors. This practice is strictly prohibited on the Ohio EPA 4496 form. Instead, if a mistake is made, it’s best to simply cross out the incorrect information and write the correct details next to it. This keeps the form clear and compliant with submission guidelines.

Many applicants also fail to read the accompanying instructions thoroughly. The instructions provide essential guidance on how to fill out the form accurately. Skipping this step can lead to misunderstandings about what information is required, causing unnecessary complications.

Providing outdated contact information is another pitfall. Ensure that the contact person’s phone number and email address are current. This information is crucial for the Ohio EPA to reach you if they have questions or need further clarification regarding your application.

Some individuals forget to include the facility’s existing Ohio EPA facility permit number. This number is vital for processing the application and linking it to the correct facility. Without it, the form may be considered incomplete.

Failing to certify the application properly is another mistake that can have serious consequences. The certification section must be signed and dated by the applicant. This signature confirms that the information provided is accurate and truthful, and without it, the application may be deemed invalid.

Another common error involves submitting the form via fax. The Ohio EPA does not accept faxed submissions, so it’s important to send the form through the correct channels, whether by mail or electronically, as specified in the instructions.

Lastly, people often overlook the importance of keeping a copy of the submitted form for their records. This can be helpful for future reference or in case any issues arise regarding the application. Having a copy ensures that you have the necessary information on hand if you need to follow up.

By being aware of these common mistakes, applicants can navigate the Ohio EPA 4496 form more effectively, ensuring a smoother process and compliance with all requirements.

FAQ

  1. What is the Ohio EPA 4496 form?

    The Ohio EPA 4496 form is a Notice of Intent (NOI) for coverage under Ohio’s National Pollutant Discharge Elimination System (NPDES) general permit for storm water associated with construction activity. By submitting this form, the applicant notifies the Ohio EPA of their intention to be authorized under this permit.

  2. Who needs to submit the Ohio EPA 4496 form?

    Any party involved in construction activities that may result in storm water discharges must submit this form. This includes contractors, developers, and landowners. It is essential for those who wish to comply with Ohio’s regulations regarding storm water management.

  3. What information is required on the form?

    The form requires several key pieces of information, including:

    • Applicant's company name and mailing address
    • Contact person's name, phone number, and email address
    • Facility or site location details, including existing Ohio EPA facility permit number
    • Certification statement confirming the accuracy of the information
  4. Are there any fees associated with submitting the Ohio EPA 4496 form?

    No, there are no fees required for submitting the Ohio EPA 4496 form. This allows applicants to notify the Ohio EPA without incurring additional costs.

  5. What should I do if I make a mistake on the form?

    It is important not to use correction fluid on the form. Instead, you should correct the error by clearly marking the incorrect information and providing the correct details. Ensure that all necessary information is legible and accurate before submission.

  6. Can I submit the Ohio EPA 4496 form by fax?

    No, forms transmitted by fax will not be accepted. All submissions must be sent in their original format, ensuring that all information is complete and accurate.

  7. What are the penalties for submitting false information?

    Submitting false information on the Ohio EPA 4496 form can result in significant penalties. These may include fines and potential imprisonment for knowing violations. It is crucial to ensure that all submitted information is true, accurate, and complete.

  8. How can I ensure compliance after submitting the form?

    After submitting the Ohio EPA 4496 form, it is essential to comply with the terms and conditions of the NPDES general permit. This includes implementing appropriate storm water management practices and maintaining accurate records of all activities related to the construction project.