USVI Public Records

Document text

VI MSGP FEE PAYMENT 1 DEPARTMENT OF PLANNING AND NATURAL RESOURCES DIVISION OF ENVIRONMENTAL PROTECTION WATER CONTROL PROGRAM USVI Territorial Pollution Discharge Elimination System (TPDES) Multi-Sector General Permit (VI MSGP) Application Fees and Annual Discharge Fees for Stormwater Discharges Associated with Industrial Activity This form is to be used when paying application and annual discharge fees for a multi-sector 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 MSGP ☐ an annual discharge fee ☐ a special application fee to modify my coverage under the MSGP The amount of my fee is [enter number determined below in section V, Determining Your Fee Payment]. $_______________ Submit your fee payment and this completed form by either hand delivering them to DPNR-DEP before going to the DPNR Cashier's office OR by mailing them to one of the following addresses: DPNR-DEP DPNR-DEP ATTN: WPC Program ATTN: WPC Program CW Turnbull 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) VI MSGP FEE PAYMENT 2 III. OPERATOR INFORMATION Operator Point of Contact Information First Name, MI, Last Name Title Phone Email Preparer Name IV. FACILITY INFORMATION Facility Name Facility Physical Address V. DETERMINING YOUR FEE PAYMENT: Check the box for the type of fee you are paying (new permit or permit renewal, annual discharge fee, or special application fee for permit modification) 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. Enter your total exposed acreage for your facility (this is the number entered in your Notice of Intent in section D.4. as “estimated area at your site exposed to stormwater”). ☐ My total exposed acreage is five acres or less. This is your Application Fee. Enter this amount in Section I above. $150.00 ☐ My total exposed acreage is more than five acres. This is your Application Fee. Enter this amount in Section I above. $500.00 ☐ I am filing a No Exposure Certification. This is your Application Fee. Enter this amount in Section I above. $250.00 ☐ I am a private school, municipality, or church or other religious organization and my total exposed acreage is less than five acres. This is your Application Fee. Enter this amount in Section I above. $22.50 ☐ I am a private school, municipality, or church or other religious organization and my total exposed 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 I am filing a No Exposure Certification. This is your Application Fee. Enter this amount in Section I above. $37.50 ☐ I am a public school. This is your Application Fee. Enter this amount in Section I above. $0. VI MSGP FEE PAYMENT 3 ☐ 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 exposed acreage for your facility (this is the number you entered in your Notice of Intent in section D.4. as “estimated area at your site exposed to stormwater”) ☐ Full Year Discharge Fee – I will be covered by the MSGP at this facility for each month during the current calendar year and . . . ☐ my total exposed acreage is five acres or less. This is your Annual Discharge Fee. Enter this amount in Section I above. $500.00 ☐ my total exposed acreage is more than five acres. This is your Annual Discharge Fee. Enter this amount in Section I above. $1,000.00 ☐ I am a private school, municipality or church or other religious organization and my total exposed acreage is five acres or less. This is your Annual Discharge 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 exposed acreage is more than five acres. This is your Annual Discharge Fee. Enter this amount in Section I above. $150.00 ☐ I am a public school. Enter $0 in Section I above. $0 ☐ Partial Year Discharge Fee -- I will be covered by the MSGP at this facility for only months during the current calendar year and . . . ☐ my total exposed acreage is five acres or less. If the number to the right does not fill in automatically, enter the number that is $500 divided by 12 times the number of months the permit will be in effect this calendar year. This is your Annual Discharge Fee. Enter this amount in Section I above. ☐ my total exposed acreage is more than five acres. If the number to the right does not fill in automatically, enter the number that is $1,000 divided by 12 times the number of months the permit will be in effect this calendar year. 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 my total exposed acreage is five acres or less. If the number to the right does not fill in automatically, enter the number that is $75 divided by 12 times the number of months the permit will be in effect this calendar year. 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 my total exposed acreage is more than five acres. If the number to the right does not fill in automatically, enter the number that is $150 divided by 12 times the number of months the permit will be in effect this calendar year. This is your Annual Discharge Fee. Enter this amount in Section I above. ☐ I have a No Exposure Certification. Enter $0 in Section I above. $0 ☐ I am a public school. Enter $0 in Section I above. $0 $0.00 $0.00 $0.00 $0.00 Select VI MSGP FEE PAYMENT 4 ☐ SPECIAL APPLICATION FEE FOR PERMIT MODIFICATIONS: Due when you apply to modify your permit at any time other than during permit renewal ☐ I am making a minor modification (as set forth in 12 VIRR 184-75, see below). This is your Special Application Fee. Enter this amount in Section I above. $0 ☐ I am requesting a modification to my permit that will increase my total exposed acreage (total exposed acreage is the number entered in the Notice of Intent in section D.4. as “estimated area to be disturbed”) and ☐ my total exposed acreage will remain at or below 5 acres. This is your Special Application Fee. Enter this amount in Section I above. $150.00 ☐ my total exposed acreage will be above 5 acres. This is your Special Application Fee. Enter this amount in Section I above. $500.00 ☐ I am a private school, municipality, or church or other religious organization; my total exposed 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 a private school, municipality, or church or other religious organization; my total exposed acreage will be above five acres. This is your Special Application Fee. Enter this amount in Section I above. $75.00 ☐ I am requesting a modification to my permit that is not a minor modification (as set forth in 12 VIRR 184-75, reprinted below), it will not increase my total exposed acreage, and . . . ☐ My total exposed acreage is at or below 5 acres. This is your Special Application Fee. Enter this amount in Section I above. $75.00 ☐ My total exposed acreage is above 5 acres. This is your Special Application Fee. Enter this amount in Section I above. $250.00 ☐ I am a private school, municipality, or church or other religious organization; my total exposed acreage is at or below five acres. This is your Special Application Fee. Enter this amount in Section I above. $11.25 ☐ I am a private school, municipality, or church or other religious organization; my total exposed acreage is above five acres. This is your Special Application Fee. Enter this amount in Section I above. $37.50 ☐ I am a public school. Enter $0 in Section I above. $0 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 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 VI MSGP FEE PAYMENT 5 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.