Illinois Environmental Protection Agency

Transcription

1 Bureau of Water 1021 N. Grand Avenue E. P.O. Box Springfield Illinois Division of Water Pollution Control ANNUAL FACILITY INSPECTION REPORT for NPDES Permit for Storm Water Discharges from Separate Storm Sewer Systems (MS4) This fillable form may be completed online, a copy saved locally, printed and signed before it is submitted to the Compliance Assurance Section at the above address. Complete each section of this report. Report Period: From March, 2017 To March,_2_01_8 MS4 OPERA TOR INFORMATION: (As it appears on the current permit) Name: Village of Bensenville Mailing Address 1: 12 S Center St I Permit No. ILR40 _05_0_ Mailing Address 2: County: DuPage = City: Bensenville State: IL Zip: Telephone: Contact Person: Joe Caracci (Person responsible fo-r~a-n-nu- a~i R~e- p-ort~) Address: jcaracci@bensenville.il.us Name(s) of governmental entity(ies) in which MS4 is located: (As it appears on the current permit) Village of Bensenville THE FOLLOWING ITEMS MUST BE ADDRESSED. A. Changes to best management practices (check appropriate BMP change(s) and attach information regarding change(s) to BMP and measurable goals.) 1. Public Education and Outreach D 4. Construction Site Runoff Control D 2. Public Participation/Involvement D 5. Post-Construction Runoff Control D 3. Illicit Discharge Detection & Elimination D 6. Pollution Prevention/Good Housekeeping D B. Attach the status of compliance with permit conditions, an assessment of the appropriateness of your identified best management practices and progress towards achieving the statutory goal of reducing the discharge of pollutants to the MEP, and your identified measurable goals for each of the minimum control measures. C. Attach results of information collected and analyzed, including monitoring data, if any during the reporting period. D. Attach a summary of the storm water activities you plan to undertake during the next reporting cycle ( including an implementation schedule.) E. Attach notice that you are relying on another government entity to satisfy some of your permit obligations (if applicable). F. Attach a list of construction projects that your entity has paid for during the reporting period. Any person who knowingly makes a false, fictitious, or fraudulent material statement, orally or in writing, to the Illinois EPA commits a Class 4 felony. A second or subsequent offense after conviction is a Class 3 felony. (415 ILCS 5/44(h)) ~7c~ Owner Signature: Printed Name: COMPLETED FORM TO: epa.ms4annualinsp@illinois.gov or Mail to: ILLINOIS ENVIRONMENTAL PROTECTION AGENCY WATER POLLUTION CONTROL COMPLIANCE ASSURANCE SECTION # NORTH GRAND AVENUE EAST POST OFFICE BOX SPRINGFIELD, ILLINOIS Z- -J,f" Date: This Agency is authorized to require this information under Section 4 and Title X of the Environmental Protection Act (415 ILCS 5/4, 5/39). Failure to disclose this information may result in: a civil penalty of not to exceed $ for the violation and an additional civil penalty of not to exceed $10,000 for each day during IL which the violation continues (415 ILCS 5/42) and may also prevent this form from being processed and could result in your application being denied. This form WPC 691 Rev 6/10 has been approved by the Forms Management Center. Title:

2 IB BENSENVILLE 12 S Center St. Bensenville. IL 60!06 Office fax VILLAGE BOARD President frank OeSimane Board of Trustees Rosa Carmona Ann Franz Agnieszka "Annie" Jaworska Mclane Loma, Nicholas Panicala Jr. Armando Perez Village Clerk Nancy Oumn Village Manager Evan K. Summers May 2, 2018 Ms. Mary Beth Falsey Water Quality Supervisor DuPage County Stormwater Management 421 N. County Farm Road Wheaton IL RE: NPDES Annual Report, Year 15 - Village of Bensenville Dear Ms. Falsey Enclosed please find the signed MS4 Form for the NPDES Phase II Annual Report, Permit Year 14. If you need additional information, please contact me at q~ Very Truly Yours, 77 C_,_~ Enclosures Cc: Mehul Patel, P.E., CFM - Assistant, Village of Bensenville (via )

3 IB BENSENVILLE 12 S Center St. Bensenville. IL 60!06 Office fax www bensenville ii.us VILLAGE BOARD President frank OeSimone Board of Trustees Rosa Camrnna Ann Franz Agnieszka "Annie" Jaworska Mclane Lomax Nicholas Panicola Jr. Armando Perez Village Clerk Nancy Ouinn Village Manager Evan K. Summers May 2, 2018 Water Pollution Control Compliance Assurance Section # North Grand Avenue East, P.O. Box Springfield IL RE: NPDES Phase II MS4 General Permit Annual Report, Year 15 Dear Sir /Madam: Enclosed is the IEPA Annual Facility Inspection Report. Please consider this letter as the Village's notice that it is relying upon the actions of DuPage County to satisfy some of the permit obligations of the Village (letter attached). If you need additional information, please contact me at Very Truly Yours, Enclosures Cc: Mehul Patel, P.E., CFM - Assistant, Village of Bensenville (via )

4 Bureau of Water 1021 North Grand Avenue East P.O. Box Springfield Illinois Notice of Intent for Waiver of General Permit for Discharges from Small Municipal Separate Storm Sewer Systems - MS4's Part I General Information 1. MS4 Community Name: Village of Bensenville - ---= MS4 Mailing Address: Village of Bensenville Street: 12 S Center St City: Bensenville State: Illinois Zip Code: Contact Person: Joe Caracci, P.E Telephone: ( 630 ) - ( 350 ) - ( 3435 ) Part II MS4 Data Part Ill 5. Area of Land that drains to your MS4 in square miles: Population within municipal boundary: 18, Source: 0 Current U.S. Census D Other (Specify) The items listed below explain the criteria that must be met in order to be considered: a. If your community serves a population of less than 1,000 the following criteria must be met: i. The MS4 system is not contributing substantially to the pollutant loadings of a physically interconnected MS4 that is regulated by the NPDES storm water program. ii. If the MS4 system, requesting a waiver, discharges any pollutant(s) that have been identified as a cause of impairment of any water body to which you discharge and it has been determined that storm water controls are not needed based on waste load allocations that are part of an EPA approved or established "total maximum daily load" (TMDL) that addresses the pollutants(s) of concern. b. If your community serves a population greater than but less than 1 o 000 the following criteria must be met: i. The permitting agency has evaluated all waters of the U.S., including small streams, tributaries, lakes, and ponds, that receive a discharge from your MS4. ii. It has been determined that storm water controls are not needed based on waste load allocations that are part of an EPA approved or established TMDL that addresses the pollutant(s) of concern or, if a TMDL has not been developed or approved, an equivalent analysis that determines sources and allocations for the pollutant(s) of concern: Page 1 of 4

5 iii. The pollutant(s) of concern include biochemical oxygen demand (BOD), sediment or a parameter that addresses sediment (such as total suspended solids, turbidity, or siltation), pathogens, oil and grease, and any pollutant that has been identified as a cause of impairment of any water body that will receive a discharge from the MS4. iv. The IEPA has determined that future discharges from the MS4 do not have the potential to result in exceedances of water quality standards, including impairment of designated uses, or other significant water quality impacts, including habitat and biological impacts. 7. Please document either in the space below or with attached information how the MS4 meets the specified criteria (with the exception of B(iv) for communities greater than 1,000 but less than 10,000) Village of Bensenville will be a permit partner under DuPage County's NPDES Permit No. ILR Page2 of4

6 8. List the names of known receiving waters for the MS4: (use additional sheets if necessary) View 303d List Name of Receiving Water a. Addison Creek b. Silver Creek c. Willow Creek d. e. f. g. h. i. j. k. I. Impairment listed on 303d list or has TMDL? Yes Yes Yes 9. Name of person responsible for the submission of the MS4 General Permit Waiver Request: Name: Title: Phone: Page 3 of4

7 Part IV: 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 gathered and evaluated 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, it is to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for knowingly submitting false information, including the possibility of fines and imprisonment. Any person who knowingly makes false, fictitious, or fraudulent material statement, orally or in writing, to the Illinois EPA commits a Class 4 felony. A second or subsequent offence after conviction is a Class 3 felony (415 ILCS 5/44 (h)) Authorized Representative Name: Title: Date: May 2, 2018 Authorized Representative Signature: You may complete this form online and save a copy locally before printing and signing the form. Bureau of Water Division of Water Pollution Control Attn: Permit Section #15 P.O. Box North Grand Avenue East Springfield IL Page4 of 4