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The Ohio EPA 4496 form, known as the Co-Permittee Notice of Intent for Coverage Under the Ohio EPA Storm Water Construction General Permit, plays a crucial role for parties involved in construction activities. By submitting this form, a party signals its intention to be covered by Ohio’s National Pollutant Discharge Elimination System (NPDES) general permit, which governs storm water discharges associated with construction. This coverage comes with responsibilities, as becoming a permittee means that the discharger must adhere to the terms and conditions set forth in the permit. It is essential to complete the form accurately, providing all required information, as incomplete submissions can lead to delays or rejections. Careful attention to the accompanying instructions is necessary to avoid mistakes, such as using correction fluid or sending the form via fax, both of which are not accepted. Importantly, there is no fee for submitting the form, making it accessible for all applicants. The form requires detailed information about the applicant, including the company name, mailing address, and contact details. Additionally, it asks for specifics about the facility or site location, including existing permit numbers and contact information for the facility. Lastly, a certification section emphasizes the importance of truthful submissions, highlighting the legal implications of providing false information. Understanding these aspects of the Ohio EPA 4496 form is vital for compliance and successful permit acquisition.

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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)

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Form Specifications

Fact Name Description
Form Purpose The Ohio EPA 4496 form serves as a Notice of Intent for coverage under the Ohio EPA Storm Water Construction General Permit.
Governing Law This form is governed by the National Pollutant Discharge Elimination System (NPDES) regulations.
Submission Requirement Submitting this form indicates the party intends to be authorized under the general permit for storm water related to construction activities.
Compliance Obligation Once authorized, a permittee must comply with all terms and conditions outlined in the permit.
Information Accuracy All necessary information must be accurately provided on the form, and correction fluid is prohibited.
Submission Method Forms transmitted by fax will not be accepted; only original submissions are valid.
Fees There is no fee associated with submitting the Ohio EPA 4496 form.
Certification Requirement The form requires a certification statement confirming the accuracy of the information provided.
Penalties for False Information Submitting false information may result in significant penalties, including fines and imprisonment.

Ohio Epa 4496: Usage Guidelines

Filling out the Ohio EPA 4496 form is a straightforward process. This form is essential for notifying the Ohio EPA of your intent to obtain coverage under the storm water construction general permit. Make sure to provide all required information accurately, as incomplete submissions may lead to delays. Follow these steps to complete the form correctly.

  1. Section I: Applicant Information
    • Enter the company name in the designated field.
    • Fill in the mailing address, including street, city, state, and zip code.
    • Provide the contact person's name, phone number, fax number, and email address.
  2. Section II: Facility/Site Location Information
    • Input the existing Ohio EPA facility permit number, if applicable.
    • Enter the initial permittee's name and phone number.
    • Fill in the facility or site name, along with the city, township(s), county(ies), and state.
    • Provide the zip code for the facility/site.
    • List the facility contact person's name, phone number, fax number, and email address.
  3. Section III: Certification
    • Print the applicant's name and title.
    • Sign and date the form to certify the information provided is accurate.

Once you have completed the form, review all entries for accuracy. Ensure no correction fluid is used, and remember that faxed submissions will not be accepted. You are now ready to submit the form to the Ohio EPA for processing.

Your Questions, Answered

What is the purpose of the Ohio EPA 4496 form?

The Ohio EPA 4496 form serves as a Notice of Intent (NOI) for parties seeking coverage under Ohio's National Pollutant Discharge Elimination System (NPDES) general permit for storm water associated with construction activities. By submitting this form, the applicant indicates their intention to comply with the terms and conditions of the permit, which is essential for managing storm water runoff from construction sites.

Who needs to submit the Ohio EPA 4496 form?

What information is required on the Ohio EPA 4496 form?

The form requires several key pieces of information, including the applicant's name and mailing address, the facility or site location details, and contact information for both the applicant and the facility. Additionally, the form includes a certification section where the applicant must affirm the accuracy and completeness of the information provided. It is important to fill out all sections completely to avoid delays in processing.

Are there any fees associated with submitting the Ohio EPA 4496 form?

No, there is no fee required for submitting the Ohio EPA 4496 form. This means that applicants can proceed with their submission without worrying about additional costs, making it more accessible for those involved in construction activities.

Can I use correction fluid on the Ohio EPA 4496 form?

No, correction fluid should not be used on the Ohio EPA 4496 form. If an error is made, it is advisable to cross out the incorrect information and write the correct details next to it. This ensures that the form remains clear and legible, which is essential for processing.

How should I submit the Ohio EPA 4496 form?

The form must be submitted in a physical format, as faxed submissions are not accepted. It is recommended to mail the completed form to the appropriate Ohio EPA office, ensuring that it is sent well in advance of any construction activities to allow for processing time.

What are the consequences of submitting false information on the Ohio EPA 4496 form?

Submitting false information on the Ohio EPA 4496 form can lead to significant penalties, including fines and potential imprisonment for knowing violations. The certification section of the form emphasizes the importance of providing true and accurate information, as it is a legal declaration that the applicant is responsible for the contents of the submission.

What should I do if I have questions about completing the Ohio EPA 4496 form?

If you have questions about the Ohio EPA 4496 form or need assistance with completing it, it is advisable to consult the accompanying instructions that come with the form. Additionally, reaching out to the Ohio EPA directly can provide clarification and guidance to ensure that your submission meets all requirements.

Common mistakes

  1. Failing to read the accompanying instructions thoroughly. Understanding the requirements is crucial for accurate completion.

  2. Omitting necessary information in any section of the form. All fields must be filled out completely to avoid delays.

  3. Using correction fluid on the form. This can lead to the form being rejected.

  4. Submitting the form via fax. Only original forms are accepted, so it is essential to mail or deliver it in person.

  5. Not including the correct contact information. Ensure that the phone number and email address are accurate for any follow-up communications.

  6. Neglecting to certify the information. The certification section must be signed and dated to validate the submission.

  7. Providing outdated or incorrect facility information. This includes the facility name, address, and permit number.

  8. Forgetting to include the contact person’s details. This is important for communication regarding the application.

  9. Failing to check for completeness before submission. A final review can help catch any missing information.

  10. Ignoring the penalties for submitting false information. Understanding the seriousness of this can motivate careful completion.

Documents used along the form

The Ohio EPA 4496 form is essential for notifying the state about a party's intention to comply with storm water regulations during construction activities. However, several other forms and documents often accompany this submission to ensure comprehensive compliance with environmental regulations. Below is a list of these important documents, each serving a unique purpose in the permitting process.

  • Ohio EPA 4501 Form: This form is used for the application of a National Pollutant Discharge Elimination System (NPDES) permit for storm water discharges. It provides detailed information about the construction site and its potential impact on local water bodies.
  • Storm Water Pollution Prevention Plan (SWPPP): A critical document that outlines the measures a construction site will implement to prevent pollution from storm water runoff. It includes best management practices tailored to the specific site.
  • Site Map: This visual representation of the construction site indicates the layout, drainage patterns, and locations of erosion and sediment control measures. It helps regulators understand potential pollution sources.
  • Notice of Termination (NOT): Once construction is complete, this form is submitted to terminate the coverage under the storm water permit. It certifies that all necessary measures have been taken to stabilize the site.
  • Annual Report: Required for certain permits, this document summarizes the storm water management practices implemented over the year. It assesses the effectiveness of these practices and outlines any necessary adjustments.
  • Inspection Reports: These documents record findings from routine inspections of the construction site. They ensure compliance with the SWPPP and identify any issues that need addressing.
  • Certification of Compliance: This form certifies that the construction site adheres to all environmental regulations and the conditions of the NPDES permit. It is often required for annual reporting.
  • Public Involvement Plan: In some cases, this document outlines how the construction project will engage with the community and address public concerns related to storm water management and environmental impact.

Each of these documents plays a vital role in ensuring that construction activities comply with environmental standards, protecting water quality, and promoting responsible management of storm water. Understanding their functions helps stakeholders navigate the regulatory landscape effectively.

Similar forms

The Ohio EPA 4496 form is essential for notifying authorities about stormwater construction activities. Several other documents serve similar purposes in environmental compliance and permitting. Here’s a list of those documents and how they relate to the Ohio EPA 4496 form:

  • NPDES Permit Application: This application is required for facilities discharging pollutants into waters of the United States. Like the Ohio EPA 4496, it establishes the need for compliance with environmental regulations.
  • Storm Water Pollution Prevention Plan (SWPPP): This plan outlines measures to prevent stormwater pollution during construction. It complements the Ohio EPA 4496 by detailing how compliance will be achieved on-site.
  • General Permit Registration Form: This form is used to register for general permits related to stormwater. Similar to the Ohio EPA 4496, it signals intent to comply with specific permit requirements.
  • Notice of Termination (NOT): This document notifies the EPA when construction activities are complete and permits can be terminated. It is a follow-up to the Ohio EPA 4496, indicating the end of the permit coverage.
  • Environmental Impact Statement (EIS): An EIS assesses the potential environmental effects of a proposed project. While broader in scope, it shares the Ohio EPA 4496's goal of ensuring responsible environmental management.
  • Site Assessment Report: This report evaluates potential environmental impacts of a project site. It is similar to the Ohio EPA 4496 in its focus on compliance and environmental stewardship.
  • Construction General Permit (CGP): This permit specifically addresses stormwater discharges from construction sites. Like the Ohio EPA 4496, it sets forth the obligations of permittees to minimize environmental impact.

Dos and Don'ts

When filling out the Ohio EPA 4496 form, it's important to follow certain guidelines to ensure your submission is successful. Here’s a list of things you should and shouldn’t do:

  • Do read the instructions carefully. Understanding the requirements will help you provide all necessary information.
  • Do ensure all information is accurate. Double-check names, addresses, and contact details to avoid any mistakes.
  • Do sign and date the form. Your signature certifies the accuracy of the information provided.
  • Do keep a copy for your records. Having a copy can be helpful for future reference or if any issues arise.
  • Do submit the form on time. Timely submission is crucial for compliance with the permit requirements.
  • Don't use correction fluid. This can make the form look unprofessional and may lead to rejection.
  • Don't fax the form. Faxed submissions are not accepted, so use mail or electronic submission as required.
  • Don't leave any sections blank. Incomplete forms can delay processing and may require resubmission.
  • Don't ignore the penalties for false information. Providing inaccurate details can lead to serious consequences.
  • Don't forget to include all required attachments. Missing documents can hinder your application process.

Misconceptions

Understanding the Ohio EPA 4496 form is crucial for compliance with storm water regulations. However, several misconceptions exist regarding its purpose and requirements. Here are seven common misconceptions:

  • Misconception 1: The form requires a fee for submission.

    • This is false. There is no fee associated with submitting the Ohio EPA 4496 form.

  • Misconception 2: Correction fluid can be used to amend errors on the form.

    • Correction fluid is not permitted. All corrections must be made clearly, without the use of correction fluid.

  • Misconception 3: Faxed submissions of the form are acceptable.

    • Faxed forms will not be accepted. The form must be submitted in its original format.

  • Misconception 4: Only the primary applicant needs to sign the form.

    • All parties identified in the application must comply with the certification requirements, ensuring accuracy and truthfulness.

  • Misconception 5: The form can be submitted without complete information.

    • All necessary information must be provided. Incomplete submissions may lead to delays or denials of coverage.

  • Misconception 6: The form is only for new construction projects.

    • The form applies to any construction activity that falls under the jurisdiction of the Ohio EPA's storm water regulations, regardless of the project's status.

  • Misconception 7: The Ohio EPA 4496 form is optional.

    • Submission of the form is mandatory for obtaining coverage under Ohio’s NPDES general permit for storm water associated with construction activities.

Key takeaways

When filling out and using the Ohio EPA 4496 form, it is essential to follow specific guidelines to ensure compliance and avoid delays. Here are some key takeaways:

  • Understand the Purpose: This form serves as a Notice of Intent for coverage under the Ohio EPA Storm Water Construction General Permit.
  • Complete All Sections: Ensure that all necessary information is provided in the designated sections. Incomplete forms may lead to rejection.
  • Read Instructions Carefully: Before starting, take the time to read the accompanying instructions thoroughly. They provide crucial information on how to fill out the form correctly.
  • Avoid Correction Fluid: Do not use correction fluid on the form. If you make a mistake, simply cross it out and write the correct information.
  • No Fax Submissions: Forms transmitted by fax will not be accepted. Make sure to submit the form through the appropriate channels.
  • No Fees Required: There is no fee associated with submitting the Ohio EPA 4496 form, which makes the process more accessible.
  • Provide Accurate Contact Information: Include complete and accurate contact details for both the applicant and the facility to facilitate communication.
  • Certification is Crucial: The form includes a certification section where the applicant must attest to the accuracy of the information provided. This carries legal implications.
  • Be Aware of Penalties: Understand that submitting false information can result in significant penalties, including fines and imprisonment.

By following these guidelines, you can ensure that your submission of the Ohio EPA 4496 form is accurate and compliant with regulatory requirements.