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VI CGP FEE PAYMENT 1 DEPARTMENT OF PLANNING AND NATURAL RESOURCES DIVISION OF ENVIRONMENTAL PROTECTION WATER CONTROL PROGRAM USVI Territorial Pollution Discharge Elimination System (TPDES) Construction General Permit (VI CGP) Application Fees and Annual Discharge Fees for Stormwater Discharges Associated with Construction Activity This form is used when paying application or annual discharge fees for a construction general TPDES permit. 12 VIRR § 184-35(b) requires permit applicants and permittees to pay: ▪ an application fee when applying for a new or renewed TPDES permit; • an annual discharge fee each year (or partial year) in which the permit is in effect; and • a special fee when applying for certain modifications to an existing permit I. FEE PAYMENT: After you have completed section V below (Determining Your Fee Payment) complete this section to indicate the type of fee you are paying and the amount. I am paying (check one): ☐ an application fee because I am applying for new or renewed coverage under the CGP ☐ an annual discharge fee ☐ a special application fee to modify coverage under the CGP The amount of my fee is [enter number determined below in section V, Determining Your Fee Payment]. $_______________ Submit the fee payment and this form, in person or by mail, to one of the addresses below. For application fees, submit your payment and form with your NOI or permit application. DPNR-DEP DPNR-DEP ATTN: WPC Program ATTN: WPC Program Charles W. Turnbull Regional Public Library #45 Mars Hill 4607 Tutu Park Mall Frederiksted, VI 00840 St. Thomas, VI 00802 Make checks payable to: Department of Planning and Natural Resources DPNR will send receipts for payments submitted by mail. II. PERMIT TRACKING TPDES Permit Tracking Number (if known) III. OPERATOR/PERMITTEE INFORMATION Operator Name IRS Employer Identification Number (EIN) Phone VI CGP FEE PAYMENT 2 Email Contact Name IV. PROJECT/SITE INFORMATION Project/Site Name Project/Site Location V. DETERMINING YOUR FEE PAYMENT: Check the box for the type of fee you are paying (new permit or permit renewal, special application fee for permit modification, or annual discharge fee) and then follow the directions in that section to determine your fee. Check the appropriate fee and enter the information requested. ☐ APPLICATION FEE FOR NEW PERMIT OR PERMIT RENEWAL: Due when you submit your Notice of Intent. Your application fee is based on the total cleared acreage for your project/site. This is the number entered in section III.4. of your Notice of Intent as “estimated area to be disturbed.” ☐ My total cleared acreage is more than five acres. This is your Application Fee. Enter this amount in Section I above. $500.00 ☐ My total cleared acreage is between one and five acres. This is your Application Fee. Enter this amount in Section I above. $150.00 ☐ I am a private school, municipality, or church or other religious organization and my total cleared acreage is more than five acres. This is your Application Fee. Enter this amount in Section I above. $75.00 ☐ I am a private school, municipality, or church or other religious organization and my total cleared acreage is between one and five acres. This is your Application Fee. Enter this amount in Section I above. $22.50 ☐ I am a public school. Enter $0 in Section I above. $0.00 ☐ ANNUAL DISCHARGE FEE: Effective and due on October 1, 2020, an annual discharge fee is required for each permittee. Each year after, the annual discharge fee is due on March 31. For the first year you are covered by a permit, if the coverage starts after February 1, the annual fee is due 60 days after the date coverage starts. Enter your total cleared acreage here (this is the number you entered in section III.4. ……..of your Notice of Intent as “estimated area to be disturbed”). ☐ Full year fee (I will be covered by the CGP for each month during the current calendar year). If the number to the right does not fill in automatically, enter the number that is $100 times your total cleared acreage. This is your Annual Discharge Fee. Enter this amount in Section I above. ☐ Partial year fee (I will be covered by the CGP for only months during the current calendar year). If the number to the right does not fill in automatically, enter the amount that is $100 times your total cleared acreage, divide that number by 12, then multiply by the number of months this calendar year for which you will be covered by the CGP. This is your Annual Discharge Fee. Enter this amount in Section I above. 0 - $0.00 VI CGP FEE PAYMENT 3 ☐ I am a private school, municipality or church or other religious organization and I will be covered by the CGP for each month during the current calendar year. If the number to the right does not fill in automatically, enter the number that is $15 times your total cleared acreage. This is your Annual Discharge Fee. Enter this amount in Section I above. ☐ I am a private school, municipality or church or other religious organization and I will be covered by the CGP for only months during the current calendar year. If the number to the right does not fill in automatically, enter the amount that is $15 times your total cleared acreage, divide that number by 12, then multiply by the number of months this calendar year for which you will be covered by the CGP. This is your Annual Discharge Fee. Enter this amount in Section I above. ☐ I am a public school. Enter $0 in Section I above. $0 ☐ SPECIAL APPLICATION FEE FOR PERMIT MODIFICATIONS: Due when you apply to modify your coverage under the CGP at any time other than during permit renewal. ☐ I am making a minor modification as set forth in 12 VIRR 184-75 (see the bottom of this form). No fee. Enter $0 in Section I above. $0 ☐ I am increasing my total cleared acreage (the number entered in section III.4. of the Notice of Intent as “estimated area to be disturbed”) and ☐ My total cleared acreage will be above five acres. This is your Special Application Fee. Enter this amount in Section I above. $500.00 ☐ My total cleared acreage will remain at or below five acres. This is your Special Application Fee. Enter this amount in Section I above. $150.00 ☐ I am a private school, municipality, or church or other religious organization; my total cleared acreage will be above five acres. This is your Special Application Fee. Enter this amount in Section I above. $75.00 ☐ I am a private school, municipality, or church or other religious organization; my total cleared acreage will remain at or below five acres. This is your Special Application Fee. Enter this amount in Section I above. $22.50 ☐ I am modifying my permit coverage. The modification is not a minor modification (as set forth in 12 VIRR 184-75, see below) and will not increase my total cleared acreage and ☐ My total cleared acreage will be above five acres. This is your Special Application Fee. Enter this amount in Section I above. $250.00 ☐ My total cleared acreage will remain at or below 5 acres. This is your Special Application Fee. Enter this amount in Section I above. $75.00 ☐ I am a private school, municipality, or church or other religious organization; my total cleared acreage will be above five acres. This is your Special Application Fee. Enter this amount in Section I above. $37.50 ☐ I am a private school, municipality, or church or other religious organization; my total cleared acreage will remain at or below five acres. This is your Special Application Fee. Enter this amount in Section I above. $11.25 VI. CERTIFICATION I certify under penalty of law that this document and all attachments (if any) 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, the information $0.00 $0.00 - VI CGP FEE PAYMENT 4 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. Name Title Signature Date Email FOR INTERNAL DPNR USE ONLY: Payment received by: ☐ mail ☐ in person ☐ Payment of $__________ sent to Cashier’s Office by ______________________ on ____________ ☐ Receipt sent to permittee by _______________________________ on ______________ ☐ Fee determination verified by ______________________________ on ______________ ☐ Fee payment recorded in data base by _______________________ on ______________ ☐ Form filed by ____________________________________________ on __________________ __ Minor modifications are defined in 12 VIRR §184-75 as modifications that only: (a) Correct typographical errors; (b) Require more frequent monitoring or reporting by the permittee; (c) Change an interim compliance date in a schedule of compliance, provided the new date is not more than 120 days after the date specified in the existing permit and does not interfere with attainment of the final compliance date requirement; or (d) Allow for a change in ownership or operational control of a facility where the Director determines that no other change in the permit is necessary, provided that a written agreement containing a specific date for transfer of permit responsibility, coverage, and liability between the current and new permittees has been submitted to the Director. (e) Delete a point source outfall when the discharge from that outfall is terminated and does not result in discharge of pollutants from other outfalls except in accordance with permit limits. (f) Incorporate conditions of a POTW pretreatment program that has been approved in accordance with the procedures in 40 CFR 403.11 (or a modification thereto that has been approved in accordance with the procedures in 40 CFR 403.18) as enforceable conditions of the POTW's permits.