2017 Construction General Permit – Appendix K

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2017 Construction General Permit (CGP)

Appendix K - Notice of Termination (NOT) Form and Instructions
Part 8.3 requires you to use the NPDES eReporting Tool, or “NeT” system, to prepare and submit
your NOT electronically. However, if you are given a waiver by the EPA Regional Office to use a
paper NOT form, and you elect to use it, you must complete and submit the following form.

Page K -1 of 4

UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
WASHINGTON, DC 20460
NOTICE OF TERMINATION (NOT) FOR THE 2017 NPDES CONSTRUCTION GENERAL PERMIT

NPDES
FORM
3510-13

Form
Approved.
OMB No.
2040-0004

Submission of this Notice of Termination constitutes notice that the operator identified in Section III of this form is no longer authorized discharge pursuant to
the NPDES Construction General Permit (CGP) from the site identified in Section IV of this form. All necessary information must be included on this form. Refer
to the instructions at the end of this form.

I. Approval to Use Paper NOT Form
Have you been granted a waiver from electronic reporting from the Regional Office *?

YES

NO

If yes, check which waiver you have been granted, the name of the EPA Regional Office staff person who granted the waiver, and the date of
approval:
Waiver granted:

The owner/operator’s headquarters is physically located in a geographic area (i.e., ZIP code or census tract) that is
identified as under-served for broadband Internet access in the most recent report from the Federal Communications
Commission.
The owner/operator has issues regarding available computer access or computer capability.

Name of EPA staff person that granted the waiver:
/

Date approval obtained:

/

* Note: You must have been given approval by the Regional Office prior to using this paper NOT form. If you have not obtained a waiver, you must file this
form electronically using the NDPES eReporting Tool (NeT).

II. Permit Information
NPDES ID:
Reason for Termination (Check only one):
You have completed all construction activities at your site, and you have met all other requirements in Part 8.2.1.
Another operator has assumed control over all areas of the site and that operator has submitted an NOI and obtained coverage under the CGP.
You have obtained coverage under an individual permit or another general NPDES permit addressing stormwater discharges from the
construction site.

III. Operator Information
Operator Name:
Mailing Address:
Street:
City:

State:

ZIP Code:

-

State:

ZIP Code:

-

County or Similar Government Division:
Phone:

-

-

Ext.

E-mail:

IV. Project/Site Information
Project/Site Name:
Project/Site Address:
Street/Location:
City:
County or Similar Government Division:

EPA Form 3510-13

Page 2 of 4

V. Certification Information
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, 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.
First Name, Middle
Initial, Last Name:
Title:

Signature:

Date:

/

/

Email:

EPA Form 3510-13

Page 3 of 4

Instructions for Completing EPA Form 3510-13
Notice of Termination for the 2017 NPDES
Construction General Permit
NPDES Form Date (2/17)

This Form Replaces Form 3510-13 (02/12)

Who May File an NOT Form
Permittees who are presently covered under the EPA-issued 2017
Construction General Permit (CGP) for Stormwater Discharges
Associated with Construction Activity may submit an NOT form
when: (1) earth-disturbing activities at the site are completed and
the conditions in Parts 8.2.1.a through 8.2.1.b are met; or (2) the
permittee has transferred all areas under its control to another
operator, and that operator has submitted and obtained
coverage under this permit; or (3) the permittee has obtained
coverage under a different NPDES permit for the same discharges.
Completing the Form
Type or print, using uppercase letters, in the appropriate areas
only. Please place each character between the marks.
Abbreviate if necessary to stay within the number of characters
allowed for each item. Use only one space for breaks between
words, but not for punctuation marks unless they are needed to
clarify your response. If you have any questions about this form,
refer to https://www.epa.gov/npdes/stormwater-dischargesconstruction-activities#cgp or telephone EPA’s NOI Processing
Center at (866) 352-7755. Please submit original document with
signature in ink - do not send a photocopied signature.
Section I. Approval to Use Paper NOT Form
You must indicate whether you have been granted a waiver from
electronic reporting from the EPA Regional Office. Note that you
are not authorized to use this paper NOT form unless the EPA
Regional Office has approved its use. Where you have obtained
approval to use this form, indicate the waiver that you have been
granted, the name of the EPA staff person who granted the
waiver, and the date that approval was provided.
Seehttps://www.epa.gov/npdes/contact-us-stormwater#regional
for a list of EPA Regional Office contacts.
Section II. Permit Information
Enter the existing NPDES ID assigned to the project . If you do not
know the permit tracking number, or contact EPA’s NOI Processing
Center at (866) 352-7755.
Indicate your reason for submitting this Notice of Termination by
checking the appropriate box. Check only one.
Section III. Operator Information
Provide the legal name of the person, firm, public organization, or
any other entity that operates the project described in this NOT
and is covered by the NPDES ID identified in Section II. Enter the
complete mailing address, telephone number, and email address
of the operator.
Section IV. Project/Site Information
Enter the official or legal name and complete street address,
including city, state, ZIP code, and county or similar government
subdivision of the project or site. If the project or site lacks a street
address, indicate the general location of the site (e.g., Intersection
of State Highways 61 and 34). Complete site information must be
provided for termination of permit coverage to be valid.
Section V. Certification Information
The NOT, must be signed as follows:
For a corporation: By a responsible corporate officer. For the
purpose of this Part, a responsible corporate officer means: (i) a
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 for the
corporation, or (ii) the manager of one or more manufacturing,

EPA Form 3510-13

Form Approved OMB No. 2040-0004

production, or operating facilities, provided, the manager is
authorized to make management decisions which govern the
operation of the regulated facility including having the explicit or
implicit
duty
of
making
major
capital
investment
recommendations,
and
initiating
and
directing
other
comprehensive measures to assure long-term environmental
compliance with environmental laws and regulations; the
manager can ensure that the necessary systems are established or
actions taken to gather complete and accurate information for
permit application requirements; and where 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, respectively; or
For a municipality, state, federal, or other public agency: By either
a principal executive officer or ranking elected official. For
purposes of this Part, a principal executive officer of a federal
agency includes (i) the chief executive officer of the agency, or
(ii) a senior executive officer having responsibility for the overall
operations of a principal geographic unit of the agency (e.g.,
Regional Administrator of EPA).
Include the name, title, and email address of the person signing
the form and the date of signing. An unsigned or undated NOT
form will not be considered valid termination of permit coverage.
Paperwork Reduction Act Notice
Public reporting burden for this NOT is estimated to average 0.5
hours per notice, including time for reviewing instructions,
searching existing data sources, gathering and maintaining the
data needed, and completing and reviewing the collection of
information. An agency may not conduct or sponsor, and a person
is not required to respond to, a collection of information unless it
displays a currently valid OMB control number. 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: Chief,
Information Policy Branch, 2136, U.S. Environmental Protection
Agency, 1200 Pennsylvania Avenue, NW, Washington, DC 20460.
Include the OMB number on any correspondence. Do not send
the completed form to this address.
Submitting Your Form:
Submit your NOT form by mail to one of the following addresses:
For Regular U.S. Mail Delivery:
Stormwater Notice Processing Center
Mail Code 4203M, ATTN: 2017 CGP
U.S. EPA
1200 Pennsylvania Avenue, NW
Washington, DC 20460
For Overnight/Express Mail Delivery:
Stormwater Notice Processing Center
William Jefferson Clinton East Building - Room 7420
ATTN: 2017 CGP
U.S. EPA
1201 Constitution Avenue, NW
Washington, DC 20004
Visit this website for instructions on how to submit electronically:
https://www.epa.gov/npdes/stormwater-dischargesconstruction-activities#ereporting

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