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(If the site lacks a street address, list its specific location. For example, Intersection of Highway 61 and 34.) <br />Parcel ID#: (optional) <br />Type of Construction Activity (check all that apply): <br />❑ Residential <br />❑ Commercial <br />❑ Industrial <br />❑ Highway or Road (city, county, state) <br />❑ Utilities <br />❑ Other (specify): <br />Site Acreage <br />Total size of your site/project (that you own/control): acres. <br />Total area of soil disturbance for your site/project over the life of the project: acres. <br />Including grading, equipment staging, excavation, borrow pit, material storage areas, dump areas, haul roads, <br />side -cast areas, off -site construction support areas, and all other soil disturbance acreage associated with the <br />project. (Note: 1 acre=43,560 sq. ft.) <br />Estimated project start-up date (mm/dd/yy): <br />Estimated project completion date (mm/dd/yy): <br />Record the latitude and longitude of the main entrance to the site or the approximate center of site: <br />Latitude: <br />V. Existing Site Conditions <br />Longitude: <br />1. Are you aware of contaminated soils present on the site? ❑ Yes ❑ No <br />2. Are you aware of groundwater contamination located within the site boundary? ❑ Yes ❑ No <br />3. If you answered yes to questions 1 or 2, will any contaminated soils be disturbed, or will any <br />contaminated groundwater be discharged due to the proposed construction activity? ❑ Yes ❑ No <br />("Contaminated" and "contamination" here mean containing any hazardous substance (as defined in WAC <br />173-340-200) that does not occur naturally or occurs at greater than natural background levels.) <br />If you answered yes to Question 3, please provide detailed information with the NOI (as known and readily <br />available) on the nature and extent of the contamination (concentrations, locations, and depth), as well as <br />pollution prevention and/or treatment Best Management Practices (BMPs) proposed to control the discharge <br />of soil and/or groundwater contaminants in stormwater. This should include information that would be <br />included in related portions of the Stormwater Pollution Prevention Plan (SWPPP) that describe how <br />contaminated and potentially contaminated construction stormwater and dewatering water will be managed. <br />ECY 020-87a (10/2025) <br />