
) Leave Blank DNR Use Only FIN Number FID Number File Date WPDES Permit Number Notice: This form is authorized by s. 283.37, Wis. Stats. Submittal of a completed form to the Department is mandatory for any owner or operator of a storm water discharge who must apply for a permit in accordance with 40 CFR Part 122 or Chapter 283, Wis. Stats. Failure to submit a completed form to the Department on time may result in forfeitures of up to $10,000 per day, pursuant to s. 283.91, Wis. Stats. Pe.
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How to fill out the WI DNR 3400-163 online
The WI DNR 3400-163 form, known as the Notice of Intent for the Industrial Storm Water Discharge General Permit, is a critical document required for owners or operators seeking coverage for storm water discharges. This guide provides a clear, step-by-step approach to filling out the form online, ensuring you have all necessary information ready for submission.
Follow the steps to complete the WI DNR 3400-163 form online
- Press the ‘Get Form’ button to access the WI DNR 3400-163 form and open it in the editor.
- In Section I, Input the applicant's contact information, including the applicant's name, the contact person's name, mailing address, city, email address, phone number, state, zip code, and alternate phone number.
- In Section II, Fill in the details of the facility or site location, including the county, facility/site name, municipality type and name, and full site location description including PLSS information (township, range, section, quarter, latitude, and longitude).
- In Section III, Indicate whether the facility is new or existing and provide the Standard Industrial Classification (SIC) code. Specify if the Storm Water Pollution Prevention Plan (SWPPP) has been developed and submitted.
- In Section IV, Provide a brief description of the industrial activities and land use occurring at the facility.
- In Section V, Answer questions about storm water discharges, including past contaminations, material handling exposed to rain, and documents confirming analyses of storm water runoff.
- In Section VI, Respond to whether there are discharges other than storm water included in the storm water outfall and describe any non-storm water discharges.
- In Section VII, Ensure the form is signed by the appropriate representative as outlined (corporations, government entities, partnerships, sole proprietors, or LLC managers). Include the date signed and printed name.
- After completing all sections, save your changes. Users may also choose to download, print, or share the form as needed.
Begin filling out your WI DNR 3400-163 form online today!
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