HomeMy WebLinkAboutColorado Discharge Permit ApplicationCOLORADO
Department of Public
Health Ft Environment
Dedicated to protecting and improving the
health and environment of the people of Colorado
For Agency Use Only
Permit Number Assigned
RWAIVER -
Date Received / /
Month Day Year
COLORADO DISCHARGE PERMIT SYSTEM (CDPS)
RAINFALL EROSIVITY WAIVER FOR EXCLUSION FROM CDPS STORMWATER PERMITTING
FOR SMALL CONSTRUCTION PROJECTS (LESS THAN FIVE ACRES)
PHOTO COPIES, FAXED COPIES, PDF COPIES OR EMAILS WILL NOT BE ACCEPTED.
Please print or type. Original signatures are required. All items must be completed accurately and in their entirety for the application
to be deemed complete. Incomplete applications will not be processed until all information is received which will ultimately delay the
issuance of a permit. If more space is required to answer any question, please attach additional sheets to the application form.
Applications must be submitted by mail or hand delivered to:
Colorado Department of Public Health and Environment
Water Quality Control Division
4300 Cherry Creek Drive South
WQCD-P-B2
Denver, Colorado 80246-1530
This Rainfall Erosivity Waiver Form is for use by all Small Construction Projects regulated under the Stormwater Program where the
project "R" Factor is less than 5, as determined using the State approved method. This includes sites otherwise required to apply for, or
maintain, coverage under CDPS general permit COR -030000, but only if they meet the definition of Small Constructions Projects given
below.
Small construction projects are projects that result in land disturbance of equal to or greater than one acre and less than five acres.
Small construction activity also includes the disturbance of any area less than five acres of total land area that is part of a larger common
plan of development or sale, if the larger common plan will ultimately disturb equal to or greater than one and less than five acres.
Response by the Water Quality Control Division ("Division") indicating acceptance of a Rainfall Erosivity Waiver request constitutes notice
that the facility does not require authorization for its stormwater discharges associated with construction activities. This waiver does
not relieve the operator of the following requirements:
1) The operator or owner must comply with the requirements of local agencies, such as meeting local stormwater quality
requirements.
2) The operator or owner must obtain authorization to discharge stormwater related with other industrial activities and materials,
including but not limited to, asphalt and concrete batch plants and sand and gravel mining operations.
3 The operator or owner must obtain authorization to discharge any process water, including but not limited to, groundwater
dewatering, washing activities, and discharges related to utility installation (hydrostatic test water, super chlorinated
water, etc.)
RWAIVER APPLICANT INFORMATION
Applicant is: ❑ Property Ownerl' Contractor/Operator
A. CONTACT INFORMATION - NOT ALL CONTACT TYPES MAY APPLY * indicates required
*PERMITTEE (If more than one please add additional pa es)
*ORGANIZATION FORMAL NAME: 144/ Cpdfv Mdvti C .
1) *PERMITTEE the person authorized tb sign and certify the permit application. This person receives all permit
correspondences and is legally responsible for compliance with the permit.
Responsible Position (Title): f. Pfb :u P ytiangi'lr
Currently Held By (Person): t Cly ('f4,5 ,-
Telephone No: -! 78- 1i71 - (. i7g 5 email address rreiVSd re NGy r.+ v,(.
Mailing Address: t/Paj K. trfr f low hlt ear+ I
City: State: a Zip: ,�/ 46'2
This form must be signed by the Permittee to be considered complete. See page 4 (signature requirements)
Page 1 of 6 revised April 2015
4300 Cherry Creek Drive S., Denver, CO 80246-1530 P 303-692-2000 www.colorado.gov/cdphe/wqcd
John W. Hickenlooper, Governor Larry Wolk, MD, MSPH, Executive Director and Chief Medical Officer