039-041 23 Atwood EPA NOIPage 1 of 4
Submission of this Notice of Intent (NOI) constitutes notice that the operator identified in Section III of this form requests authorization to discharge pursuant to the
NPDES Construction General Permit (CGP) permit number identified in Section II of this form. Submission of this NOI also constitutes notice that the operator identified
in Section III of this form meets the eligibility requirements of Part 1.1 CGP for the project identified in Section IV of this form. Permit coverage is required prior to
commencement of construction activity until you are eligible to terminate coverage as detailed in Part 8 of the CGP. To obtain authorization, you must submit a
complete and accurate NOI form. Discharges are not authorized if your NOI is incomplete or inaccurate or if you were never eligible for permit coverage. Refer to the
instructions at the end of this form.
Permit Information
Operator Information
Operator Information
Mailing Address:
NPDES
FORM
3510-9
UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
WASHINGTON, DC 20460
NOTICE OF INTENT (NOI) FOR THE 2017 NPDES
CONSTRUCTION PERMIT
FORM
Approved OMB No.
2040-0004
NPDES ID:MAR1000WM
State where your construction site is
located:
MA
Is your construction site located on Indian Country Lands? YES NO
Are you requesting coverage under this NOI as a "Federal Operator" as defined in Appendix A (https://www.epa.gov/sites/production/files/2017-
02/documents/2017_cgp_final_appendix_a_-_definitions_508.pdf)?
YES NO
Have stormwater discharges from your current construction site been covered previously under an NPDES permit? YES NO
Will you use polymers, flocculants, or other treatment chemicals at your construction site? YES NO
Has a Stormwater Pollution Prevention Plan (SWPPP) been prepared in advance of filling this NOI, as required? YES NO
Are you able to demonstrate that you meet one of the criteria listed in Appendix D (https://www.epa.gov/sites/production/files/2017-
02/documents/2017_cgp_final_appendix_d_-_endangered_species_reqs_508.pdf) with respect to protection of threatened or endangered species listed
under the Endangered Species Act (ESA) and federally designated critical habitat?
YES NO
Have you completed the screening process in Appendix E (https://www.epa.gov/sites/production/files/2017-
02/documents/2017_cgp_final_appendix_e_-_historic_properties_reqs_508.pdf) relating to the protection of historic properties?
YES NO
Indicating "Yes" below, I confirm that I understand that CGP only authorized the allowable stormwater discharges in Part 1.2.1 and the allowable
non-stormwater discharges listed in Part 1.2.2. Any discharges not expressly authorized in this permit cannot become authorized or shielded from
liability under CWA section 402(k) by disclosure to EPA, state or local authorities after issuance of this permit via any means, Including the Notice of
Intent (NOI) to be covered by the permit, the Stormwater Pollution Prevention Plan (SWPPP), during an Inspection, etc. If any discharges requiring
NPDES permit coverage other than the allowable stormwater and non-stormwater discharges listed in Parts 1.2.1 and 1.2.2 will be discharged, they
must be covered under another NPDES permit.
YES NO
Operator Name:R.P. Masiello, Inc.
Street/Location:38 Main Street
City:Boylston State:MA Zip Code:01505
Page 2 of 4
First Name, Middle Initial, LastName:Robert Egan
Operator Point of Contact Information
Project/Site Information
Project/Site Address
Discharge Information
County or Similar Government Subdivision:WORCESTER
Title:Project Manager
Phone:774-696-6809 Ext.
Email:began@rpmasiello.com
Project/Site Name:Northwood Development
Street/Location:0 Atwood Drive
City:Northampton State:MA Zip Code:01060
County or Similar Government Subdivision:HAMPSHIRE
Latitude/Longitude:42.3038°N, 72.624°W
Latitude/Longitude Data Source:Map Horizontal Reference Datum:WGS 84
Project Start Date:09/22/2017 Project End Date:12/31/2018 Estimated Area to be Disturbed:5.5
Types of Construction Sites:
Commercial
Will there be demolition of any structure built or renovated before January 1, 1980? YES NO
Was the pre-development land use used for agriculture? YES NO
Have earth-disturbing activities commenced on your project/site? YES NO
Is your project located on a property of religious or cultural significance to an Indian tribe? YES NO
Does your project/site discharge stormwater into a Municipal Separate Storm Sewer System (MS4)? YES NO
Are there any waters of the U.S. within 50 feet of your project's earth disturbances? YES NO
Are any of the waters of the U.S. to which you discharge designated by the state or tribal authority under its antidegradation policy as a Tier 2 (or
Tier 2.5) water (water quality exceeds levels necessary to support propagation of fish, shellfish, and wildlife and recreation in and on the water) or as
a Tier 3 water (Outstanding National Resource Water)? See Appendix F (https://www.epa.gov/sites/production/files/2017-
02/documents/2017_cgp_final_appendix_f_-_tier_3_tier_2_and_tier_2.5_waters_508.pdf)
YES NO
001: Unnamed Wetland
Tier Designation:N/A
Is this receiving water impaired (on the CWA 303(d) list)? YES NO
Page 3 of 4
First Name, Middle Initial, LastName:Robert Egan
Stormwater Pollution Prevention Plan (SWPPP)
Endangered Species Protection
Historic Preservation
Certification Information
Has a TMDL been completed for this receiving waterbody? YES NO
002: Northampton Oxbow Cutoff
Tier Designation:N/A
Is this receiving water impaired (on the CWA 303(d) list)? YES NO
Has a TMDL been completed for this receiving waterbody? YES NO
Title:Project Manager
Phone:774-696-6809 Ext.
Email:began@rpmasiello.com
Using the Instructions in Appendix D of the CGP, under which criterion listed in Appendix D are you eligible for coverage under this permit?
Criterion A
Provide a brief summary of the basis for criterion selection listed above (the necessary content for a supportive basis statement is provided under
the criterion you selected.):
Massachusetts Department of Geographic Information mapping indicates no federally-listed rare or
endangered species within the action area.
Are you installing any stormwater controls as described in Appendix E (https://www.epa.gov/sites/production/files/2017-
02/documents/2017_cgp_final_appendix_e_-_historic_properties_reqs_508.pdf) that require subsurface earth disturbances? (Appendix E
(https://www.epa.gov/sites/production/files/2017-02/documents/2017_cgp_final_appendix_e_-_historic_properties_reqs_508.pdf), Step 1)
YES NO
Have prior surveys or evaluations conducted on the site already determined historic properties do not exist, or that prior disturbances have
precluded the existence of historic properties? (Appendix E (https://www.epa.gov/sites/production/files/2017-
02/documents/2017_cgp_final_appendix_e_-_historic_properties_reqs_508.pdf), Step 2):
YES NO
Certified By: Robert Egan (RPMASIELLO)
Certified On: 09/18/2017 9:23 AM
Page 4 of 4
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 have no personal knowledge that the information submitted is other than 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. Signing an electronic document on behalf of another
person is subject to criminal, civil, administrative, or other lawful action.