Form Dhec 3559 PDF Details

Form Dhec 3559 is a document used to apply for or renew food service permits in the state of South Carolina. The form is relatively simple to fill out, and can be completed online or through the mail. Food service permits are required for any business that prepares and serves food to the public, so it's important to make sure your permit is up-to-date. For more information on Form Dhec 3559 and how to apply for or renew your food service permit, please visit our website. Thank you for choosing us as your resource for all things South Carolina!

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Form NameForm Dhec 3559
Form Length3 pages
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Fillable fields0
Avg. time to fill out45 sec
Other namesd 3559 noi form

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Notice of Intent (NOI)

NPDES General Permit for Discharges

Associated with Nonmetallic Mineral Mining Facilities

SCG730000

Submission of this Notice of Intent constitutes notice that the party identiied in this form intends to be authorized by a NPDES permit issued for Nonmetallic Mineral Mining discharges in a State location identiied in this form. Becoming a permittee obligates such a discharge to comply with all terms and conditions of the permit. ALL NECESSARY INFORMATION

MUST BE INCLUDED WITH THIS FORM. AN ANNUAL OPERATING FEE OF $100 IS REQUIRED FOR COVERAGE UNDER THIS PERMIT. See Instructions.

I.Site/Operator Information

Name of the Mining or Pit Site: Site Address:

Site City:

 

State:

Site County:

Site ZIP (if available):

 

 

 

 

 

 

 

 

 

 

 

 

Tax map # (list all):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Company/Operator Name:

 

 

 

 

 

 

Phone:

 

 

 

 

 

 

 

 

 

 

 

 

Company/Operator Physical Address (do not use PO Boxes):

 

 

 

 

 

 

 

Federal

STATE

City:

 

State:

ZIP:

Operator Status:

Public

Private

 

 

 

 

 

 

 

 

 

II. Site Contact Information

Contact Name:

 

 

 

 

 

 

Phone:

Contact Title:

 

 

 

 

 

 

 

 

 

 

Mailing and Billing Address:

 

 

 

 

 

 

 

 

City:

 

 

State:

 

ZIP:

 

Email (optional):________________________________

III. Site and Discharge Information

A.Materials to be Mined:

B.SIC or Activity Codes: Primary:

(if material is mined solely as ill dirt, write ill dirt in the blank, not “sand” or “clay”)

2nd:3rd:4th:

(The primary SIC codes for nonmetallic mining activities are in the 1400 series, for example ill dirt pits have the SIC code of 1499. Please list any other SIC codes that apply to this activity.)

C.Total number of acres to be affected by the mining activity:

D.Does the site currently have Nonmetallic Mineral Mining Discharge General Permit coverage?

IF Yes complete this permit number SCG73

 

 

; otherwise mark

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E. List any other NPDES or ND Permit numbers for the site: SC

 

 

 

SC

 

 

 

ND

 

 

 

 

 

 

 

 

 

 

 

 

F. Is this site exempt from the Mining Act?

Yes, Reason for exemption:

 

 

No, Mining Permit #:

 

 

G. Will this site discharge mine dewatering (see instructions for deinition)?

 

YES

NO

Will this site discharge a process-generated wastewater (see instructions for deinition)?

 

YES

NO

Will this site discharge mine equipment wash water (see instructions for deinition)?

 

YES

NO

Will this site discharge suction dredge water (see instructions for deinition)?

 

YES

NO

H.Provide the latitude and longitude (to the nearest 15 seconds) of the site, and the name of the nearest receiving water body (ex: to unnamed tributary to Saluda River). If any answer in G. above is “yes”, also list each outfall and the low (in gallons per day).

Outfall Number

or

Storm Water

Flow

(gallons per

day)

Latitude

Longitude

 

 

 

 

 

 

Deg

Min

Sec

Deg

Min

Sec

 

 

 

 

 

 

Receiving Waters

DHEC 3559 (01/2011)

SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL

I.Describe the discharge low path from the point it exits the system to the point it enters the receiving water (attach a separate sheet if more space is needed). Please note, if applicable, that easements have been obtained for any conveyances of the discharge not on property of the permittee, which are not waters of the State.

J.Locate the site and any discharges on a U.S. Geological Survey 7½ minute quad sheet. An 8½ x 11 copy of the portion of the map with the site and the discharge identiied should be submitted with this NOI.

USGS Map Quadrant Name:

K.Provide a map of the site that shows the following:

a.The property boundary and all areas that will be affected by mining activities (i.e. the pits or excavation areas, overburden areas, material stockpiles, etc.)

b.Location of planned access and haul roads on the area to be affected.

c.Location and name (if appropriate) of streams, lakes, wetlands and existing drainage ditches within the area to be permitted. Use arrows to indicate direction of water low in such streams and drainage ditches.

d.A legend showing the name of applicant, name of the proposed mine, north arrow, county, scale, date of preparation and name and title of the person who prepared the site map.

L.Describe all operations that contribute wastewater to the discharge and any treatment that is provided. Attach any existing data on the quality of the discharge.

M.Use the space below to bring to the Department’s attention any additional information you feel should be considered in the permit decision. Attach an additional sheet if necessary.

IV. Certiication

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 qualiied personnel gather and evaluate the information submitted. Based on my inquiry of the person or persons who man- age 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 signiicant penalties for submitting false information including the possibility of ine and imprisonment for knowing violations.

Print Name:

Title:

 

 

 

 

 

Signature:

 

 

Date:

 

 

 

 

 

DHEC 3559 (01/2011)

INSTRUCTIONS

Notice Of Intent (NOI) For Nonmetallic Mineral Mining Discharges To Be Covered Under the NPDES General Permit SCG730000

Who Must File A Notice of Intent (NOI) Form.

Federal law at 40 CFR Part 122 prohibits point source discharges to a water body(ies) of the U.S. without a National Pollutant Discharge Elimination System (NPDES) permit. The operator of a site that has nonmetallic mineral mining discharges (including borrow pits) must submit a NOI to obtain coverage under the NPDES General Permit for Nonmetallic Mineral Mining Discharges. If you have questions about whether you need a permit under the NPDES Program, or if you need information as to whether a particular program is administered by EPA or a state agency, contact S.C. DHEC at (803) 898-4300.

Deinitions

Process-Generated Wastewater: is any wastewater used in the slurry transport of mined material, air emissions control (excluding water used for dust suppression on roads which is evaporated or absorbed by soils such that no runoff to a receiving stream occurs), or processing exclusive of mining. The term shall also include any other water, which becomes commingled with such wastewater in a pit, pond, lagoon, mine or other facility used for treatment of such wastewater.

Mine dewatering is any water that is impounded or that collects in the mine and is pumped, drained or otherwise removed from the mine through the efforts of the mine operator. This term shall also include wet pit overlows caused solely by direct rainfall and ground water seepage. However, if a mine is also used for treatment of mine process generated wastewater, discharges of commingled water from the mine shall be deemed discharges of mine process generated wastewater.

Mine Equipment Wash Water – means wastewater generated by washing mine equipment (including trucks) used in onsite mining operations. To qualify as mine equipment wash water under this general permit any soaps or detergents used for washing must be biodegradable and phosphate-free.

Suction Dredge Water – means wastewater generated from suction dredging in sand or gravel dredge mining operations conducted in surface waters classiied as Waters of the State and subsequently processed onshore to extract the sand or gravel. Suction dredge waters generated from dredging operations conducted in a mine pit are not included in this deinition.

Storm Water Associated with the Industrial Activity of Mining means storm water runoff, snow melt runoff, and surface runoff and drainage from facilities classiied as Standard Industrial Classiication 14 (non-metallic mineral industry) including active or inactive mining operations that discharge storm water contaminated by contact with or that has COME INTO CONTACT with, any overburden, raw material, intermediate products, inished products, byproducts or waste products located on the site of such operations. Inactive mining operations are mining sites that are not being actively mined, but which have an identiiable owner/operator; inactive mining sites do not include sites where mining claims are being maintained prior to disturbances associated with the extraction, beneiciation, or processing mined materials, nor sites where minimal activities are undertaken for the sole purpose of maintaining a mining claim.

Where To File NOI Form.

NOIs must be sent to the following address:

SC Department of Health & Environmental Control

Industrial Wastewater Permitting Section

2600 Bull Street

Columbia, SC 29201

Completing the Form

You must type or print all information. If you have any questions on this form, call S.C. DHEC at (803) 898-4300.

Revisions to a previously submitted NOI

If there are only changes in name, address, or site contact person, only Sections I, II and IV of the NOI are required to be completed. The entire NOI should be completed for changes in discharge(s) or discharge characteristics.

Fees

The annual NPDES administration fee of $100 is required to be submitted with the NOI for coverage of a new site. Make check payable to S.C. DHEC and attach to NOI.

Section I: Site/Operator Information.

Give the legal name and physical address of the site to be permitted, including city, state, zip and county. If the site lacks a street address, indicate the state or county highway number, the nearest town or city, or the quarter section, township, and range (to the nearest quarter section) of the approximate center of the site. Provide tax map numbers.

Give the legal name of the person, irm, public organization, or any other entity that operates the site described in this application. The name of the operator may or may not be the same name as the site. The operator of the site is the legal entity, which controls the site’s operation, rather than the property owner, or the plant or site manager. Do not use a colloquial name. Enter the physical address and telephone number of the home or regional ofice of the operator.

Operator Status: Indicate the legal ownership status of the operator: Federal, State, Public (other than federal or state), or Private

Section II: Site Contact Information

Enter the name, title and complete address and phone number of the person who is familiar with the operation of the site and with the facts reported in this NOI and to whom all permitting correspondence should be sent. If you would like to be contacted by email, you may enter your email address.

Section III: Site and Discharge Information.

A.List materials to be mined at the site. If sand and /or clay is mined solely for use as ill dirt list the material as “ill dirt”.

B.List the four 4-digit standard industrial classiication (SIC) codes that best describes the principal services provided at the site identiied in Section I. For the purposes of this permit a mining code in the 1400 series should be listed as the primary, a construction or excavation code (e.g. 1794) may be listed as one of the other codes.

C.Indicate the total number of acres to be affected by the mining activity.

D.Indicate whether the site is currently covered by the Nonmetallic Mineral Mining Discharge General Permit and give the permit number, if applicable. This section is used for updates to or transfers of existing permitted sites.

E.List any other NPDES or ND (land application) permits issued for the site, if applicable.

F.Indicate whether the site is required to obtain a Mine Operation Permit or whether the Mining Act exempts it. If the site is exempt, state the reason for the exemption (for example a SCDOT borrow pit).

G.Indicate whether the site has a discharge of mine dewatering, process generated wastewater, mine equipment wash water, or suction dredge water. Otherwise the site will be covered for stormwater only.

H.If there is a discharge of mine dewatering or process wastewater, mine equipment wash water, or suction dredge water, list the discharges for which coverage is sought. Actual or estimated low data should be included for the discharge. If coverage is sought for more than one discharge of the same type, please list each discharge separately. If more space is needed, attach a separate sheet. If there will only be stormwater covered by this permit, “stormwater” should be indicated.

Give the latitude and longitude (to the nearest 15 seconds) for each discharge and the name of the receiving waters. Name all waters to which discharge is made and which low into signiicant receiving waters. For example, if the discharge is made to a ditch, which lows into an unnamed tributary, which in turn lows into a named river, you should provide the name or description (if no name is available) of the ditch, the tributary and the river.

I.Describe any discharge low paths.

J.Provide an 8½ x 11 copy of the applicable portion of a US Geological Survey 7½ minute quad map. The map must show the outline of the site affected by mining and the location of any discharge point(s). The quad sheet name must be provided with the map.

K.Provide a detailed site map of the mining activity.

L.Provide additional information about the quality of the discharge.

M.Provide any other relevant information.

Section IV: Certiication

Please print the name and title of the authorized person and sign and date in accordance with the following:

Federal statutes provide for severe penalties for submitting false information on this application form. Federal regulations require this application to be signed as follows:

For a corporation: by a responsible corporate oficer, which means: (i) president, secretary, treasurer, or vice-president of the corporation in charge of a principal business function, or any other person who performs similar policy or decision making functions, or (ii) the manager of one or more manufacturing, production, or operating facilities employing more than 250 persons or having gross annual sales or expenditures exceeding $25 million (in second-quarter 1980), if authority to sign documents has been assigned or delegated to the manager in accordance with corporate procedures:

For a partnership or sole proprietorship: by a general partner or the proprietor; or

For a municipality, State, Federal, or other public facility: by either a principal executive oficer or ranking elected oficial.

Paperwork Reduction Act Notice

Public reporting burden for this application is estimated to average 1.5 hours per application, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate, any other aspect of the collection of information, or suggestions for improving this form, including any suggestions which may increase or reduce this burden to: Manager, Industrial Wastewater Permitting Section, Bureau of Water, S.C. Dept. of Health & Environmental Control, 2600 Bull Street, Columbia, SC 29201-1797.

DHEC 3559 (01/2011)

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This document will need specific data to be filled out, so be sure you take the time to provide exactly what is expected:

1. When completing the Form Dhec 3559, make sure to incorporate all needed blanks within its corresponding form section. This will help to expedite the work, which allows your details to be handled efficiently and properly.

Filling out part 1 of Form Dhec 3559

2. Once your current task is complete, take the next step – fill out all of these fields - Mailing and Billing Address, City III Site and Discharge, State ZIP, Email optional, A Materials to be Mined, B SIC or Activity Codes Primary, if material is mined solely as ill, rd th, The primary SIC codes for, C Total number of acres to be, D Does the site currently have, If Yes complete this permit number, E List any other NPDES or ND, F Is this site exempt from the, and Yes Reason for exemption with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Filling in part 2 in Form Dhec 3559

3. This next part will be focused on DHEC, and SOUTH CAROLINA DEPARTMENT OF - complete each of these blanks.

Simple tips to fill in Form Dhec 3559 stage 3

4. It is time to fill in this next form section! In this case you will get all these I Describe the discharge low path, J Locate the site and any, and the discharge identiied should, USGS Map Quadrant Name, K Provide a map of the site that, a The property boundary and all, stockpiles etc, b Location of planned access and, indicate direction of water low in, d A legend showing the name of, the person who prepared the site, L Describe all operations that, and the discharge form blanks to do.

the person who prepared the site, a The property boundary and all, and d A legend showing the name of in Form Dhec 3559

Be very mindful while filling in the person who prepared the site and a The property boundary and all, because this is the part where many people make errors.

5. This document must be finished by filling in this section. Here there is a detailed listing of form fields that require correct details for your document usage to be faultless: an additional sheet if necessary, IV Certiication I certify under, Print Name, Signature, Title, and Date.

Form Dhec 3559 writing process outlined (step 5)

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