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HomeMy WebLinkAboutDEEP Diversion of Water Application Connecticut Department of MAR 2 9 Z017 Energy & Environmental Protection Bureau of Water Protection & Land Reuse S"WINDWRKMMNGDE".. Water Planning & Management Division Request for Reauthorization under the General Permit for Diversion of Water for Consumptive Use Notice to Requesters: This form is only for those currently authorized CPPU USE ONLY under the following General Permits: • General Permit for Diversion of Water for Consumptive Use:Authorization Required Categories(DEP-IWRD-GP-012) issued March 29,2007; App#: • General Permit for Diversion of Water for Consumptive Use: Filing Only Categories(DEP-IWRD-GP-011)issued March 15, 2007; Doc#: • General Permit for Diversion of Water for Consumptive Use: Reauthorization Categories(DEP-IWRD-GP-01 R) issued March 15,2007. Check#: In order to use this form,the quantities requested in Part VI,#2 of this form must be equal to or less than previously approved quantities.Any increase of such quantities will result in the rejection of your request, Program: whereby your activity may be eligible for authorization under other consumptive diversion general permits or through an"individual"water GP IWRD Diversion for Consumptive Use diversion permit. Please complete this form in accordance with the instructions(DEEP-WPMD-INST-001)to ensure the proper handling of your request for reauthorization. Print or type unless otherwise noted.You must submit the total fee with this form. Those not currently authorized as such and seeking coverage under the General Permit for Diversion of Water for Consumptive Use must complete Form DEEP-WPMD-REQ-002 or DEEP-WPMD-REQ-003 depending on their eligibility category. Notice to Municipal Agencies:This is a request for reauthorization submitted to the Department of Energy and Environmental Protection(DEEP)pursuant to CGS section(s)22a-6 and 22a-378a. For any questions, call DEEP's Water Planning and Management Division at 860-424-3704. Part I: Existing Authorization 1. Application/Authorization Number: DIV-200701761GP Issue Date: 3/14/2008 If applicable, include, as Attachment A, a copy of your current approval under the General Permit for Diversion of Water for Consumptive Use:Authorization Required Categories(DEP-IWRD-GP-012)expiring March 29,2017. 2. Town where site is located: South Windsor 3. Brief Description of Authorized Diversion: The Permittee is authorized to divert the waters of the state by withdrawing a maximum of 0.150 million gallons of groundwater per day from a 212 foot bedrock well drilled in January 1968. DEEP-WPMD-REQ-001 Page 1 of 7 Rev.01/17/17 Part II: Eligible Diversion Activity Type and Fee Information Check the appropriate box to indicate the activity that is the subject of this request for reauthorization. Please complete one Request for Reauthorization for each current authorization you wish to reauthorize. For municipalities, a 50%discount applies.The request for reauthorization will not be processed without the fee.The fee shall be non-refundable and shall be paid by check or money order to the Department of Energy and Environmental Protection or by such other method as the commissioner may allow. Subject Activity fee[1082] ❑ Interconnection and Transfer of up to 1,000,000 gpd $2500.00 ❑ Withdrawal of up to 250,000 gpd—Surface Water/Stratified Drift Aquifer $2500.00 ® Withdrawal of up to 250,000 gpd—Bedrock Aquifer $2500.00 ❑ Backup Wells $2500.00 ❑ Small Supplemental Bedrock Well $2500.00 ❑ Small Water Supply System $2500.00 ❑ Large Tidally-Influenced Rivers $2500.00 ❑ Water Supply System Interconnection $2500.00 ❑ Unregistered Water Supply Systems $2500.00 ❑ Diversion of up to 250,000 gallons per day New Water $2500.00 ❑ Restoration of Lost Capacity $2500.00 Part III: Requester Information • If a requestor is a corporation, limited liability company, limited partnership, limited liability partnership, or a statutory trust, it must be registered with the Secretary of State. If applicable, requestor's name shall be stated exactly as it is registered with the Secretary of State. This information can be accessed at CONCORD. • If a requestor is an individual,provide the legal name(include suffix)in the following format:First Name;Middle Initial, Last Name;Suffix(Jr, Sr., 11, lll, etc.). If there are any changes or corrections to your company/facility or individual name, mailing or billing address or contact information, please complete and submit the Request to Chanqe Company/Individual Information to the address indicated on the form. For any other changes you must contact the specific program from which you hold a current DEEP license. If there is a change in ownership, please contact the Permit Assistance Office for questions concerning license transfers at 860-424- 3003. 1. Applicant/Requestor Name: Nuway Tobacco Company Mailing Address: 200 Sullivan Avenue City/Town:South Windsor State: CT Zip Code: 06074 Business Phone: 860-289-6414 ext.: Contact Person:Andrew Douglas Phone: 860-289-6414 ext. 215 *E-mail: adouglas@ethicalsolutions.net *By providing this e-mail address you are agreeing to receive official correspondence from the department,at this electronic address, concerning the subject registration.Please remember to check your security settings to be sure you can receive a-mails from"ct.gov" addresses.Also,please notify the department if your e-mail address changes. a) Requestor Type(check one): ❑ individual ® *business entity ❑ federal agency ❑ state agency ❑ municipality ❑ tribal *If a business entity: i) check type: E corporation ❑ limited liability company ❑ limited partnership ❑ limited liability partnership ❑ statutory trust ❑ Other: ii) provide Secretary of the State business ID#:0034354 This information can be accessed at CONCORD iii) ❑ Check here if you are NOT registered with the SOTS. ❑ Check here if any co-requestors. If so, attach additional sheet(s)with the required information as requested above. DEEP-WPMD-REQ-001 Page 2 of 7 Rev.01/17/17 x Part III: Requester Information (continued) b) Requestor's interest in property at which the proposed activity is to be located: ❑ site owner ❑ option holder ❑ lessee ❑ easement holder ® operator ❑ other(specify): 2. Billing contact, if different than the requestor. Name: Mailing Address: City/Town: State: Zip Code: Business Phone: ext.: Contact Person: Phone: ext. *E-mail: 3. Primary contact for departmental correspondence and inquiries, if different than the requestor. Name: Mailing Address: CityfTown: State: Zip Code: Business Phone: ext.: Contact Person: Phone: ext. *E-mail: 4. Attorney or other representative, if applicable. Firm Name: Mailing Address: CityfTown: State: Zip Code: Business Phone: ext.: Attorney: Phone: ext. *E-mail: 5. Owner of the property, if different than the requestor. Name:Charles Shepard Mailing Address: P.O. Box 415 City/Town: East Windsor Hill State: CT Zip Code: 06028 Business Phone: 860-289-6414 ext.: 240 Contact Person: Charles Shepard Phone: 860-289-6414 ext. 240 *E-mail: tshepard@ethicalsolutions.net 6. Owner of the facility, if different than the requestor. Name:Charles Shepard Mailing Address: P.O. Box 415 City/Town: East Windsor Hill State: CT Zip Code: 06028 Business Phone: 860-289-6414 ext.: 240 Contact Person: Charles Shepard Phone: 860-289-6414 ext.240 *E-mail: tshepard@ethicalsolutions.net DEEP-WPMD-REQ-001 Page 3 of 7 Rev.01/17/17 Part III: Requester Information (continued) 7. Consultant(s)employed or retained to assist in preparing the request for authorization or in designing or constructing the activity. ❑ Check here if additional sheets are necessary,and label and attach them to this sheet. Name: Mailing Address: CityfTown: State: Zip Code: Business Phone: ext.: Contact Person: Phone: ext. *E-mail: Service Provided: Part IV: Compliance and Enforcement History Complete and include an Applicant Compliance Information Form(DEEP-APP-002)as Attachment B. Have all requirements of your current authorization been met including special conditions, record keeping and reporting requirements? ®Yes ❑ No If no, explain: Note: Failure to meet requirements of your current authorization or a significant violation of environmental law may result in a denial of your request. Part V: Site Information Site Name and Location Name of Site(s) : Nuway Tobacco Company Street Address or Location Description: 200 Sullivan Avenue City/Town: South Windsor State: CT Zip Code: 06074 DEEP-WPMD-REQ-001 Page 4 of 7 Rev.01/17/17 Part VI: Project Summary 1. Regulated Activity Describe the diversion, which is the subject of this request for reauthorization including the reason for the diversion and the present use of the water diverted. Water withdrawn from this well is primarily used as industrial process water for the manufacture of reconstituted tobacco sheet. It is the primary liquid component for the tobacco product and is also used as boiler feed water, HVAC and process cooling water as well as for the cleaning and flushing of process equipment. The end use of the well water is essentially unchanged since the well was installed in 1968 and is expected to remain the same for the foreseeable future. ❑ Check if additional sheets are attached to this page. 2. Quantity, Rate, Frequency and Duration of Diversion Note: All quantity, rate, frequency and duration figures entered below must be equal to or less than previously approved quantities under the General Permit for which you are currently authorized. Name of diversion structure(s) Nuway Well One Maximum daily withdrawal(mg) (i.e. the largest volume of water to be withdrawn in 0.150 mgd any 24 hourperiod) Maximum rate of withdrawal (cfs) 0.45 cfs Average day-maximum month withdrawal (mgd) 0.131 mgd Frequency of withdrawals 24 hours/day 365 days/year If the withdrawal is seasonal provide dates diversion will be used: Part VII: Supporting Documents Please check the box by the attachments being submitted as verification that all applicable attachments have been submitted with this Request for Reauthorization form.When submitting any supporting documents, label the documents as indicated in this part(e.g.,Attachment D, Location Map, etc.)and be sure to include the requester's name as indicated on this application form. Note that in addition to the supporting documents described in previous sections,your request for reauthorization must include a location map as Attachment D. ® Attachment A: Existing Authorization: If applicable, include,a copy of your current approval under the General Permit for Diversion of Water for Consumptive Use:Authorization Required Categories(DEP- IWRD-GP-012)issued March 29, 2007. ® Attachment B: Compliance and Enforcement History: a completed copy of the Applicant Compliance Information Form(DEEP-APP-002). Attachment C: Location Map:an 8.5"X 11"copy of the relevant portion of the most recent version of the United States Geological Survey topographic map at a(scale of 1:24,000)depicting the location of the subject withdrawal(s)and, if possible,the property boundaries wherein the subject withdrawal occurs. ❑ Attachment D: Additional Information: Include in this attachment any additional information not specifically requested which may assist the department in determining compliance with this general permit. DEEP-WPMD-REQ-001 Page 5 of 7 Rev.01/17/17 Part VIM: Copy of Request for Reauthorization to Municipal Agencies You must submit a complete copy of your request for reauthorization to the municipal inland wetlands agency, zoning commission, planning commission or combined planning and zoning commission, and conservation commission of each municipality that will or may be affected by the subject activity. Enter the names and addresses of the municipal agencies which were provided a complete copy of your request for reauthorization, including all of its attachments, the date such copy was submitted (Date of Service), and the Type of Service (check one). Inland Wetlands Agency: Name: Chairperson Inland Wetlands Agency/Conservation Commission Address: Town Hall 1540 Sullivan Avenue City/Town: South Windsor State: CT Zip Code: 06074 Date of Service: Type of Service: ® First class mail ❑ Certified mail ❑ Hand delivery Conservation Commission: Name: same as above Address: City/Town: State: Zip Code: Date of Service: Type of Service: ❑ First class mail ❑ Certified mail ❑ Hand delivery Planning Commission: Name: Address: City/Town: State: Zip Code: Date of Service: Type of Service: ❑ First class mail ❑ Certified mail ❑ Hand delivery Zoning Commission: Name: Address: City/Town: State: Zip Code: Date of Service: Type of Service: ❑ First class mail ❑ Certified mail ❑ Hand delivery Combined Planning and Zoning Commission: Name: Chairperson Planning and Zoning Commission Address: Town Hall 1540 Sullivan Avenue City/Town: South Windsor State: CT Zip Code: 06074 Date of Service: Type of Service: ® First class mail ❑ Certified mail ❑ Hand delivery ❑ Check this box if the agencies of another municipality were served a copy of this request for reauthorization and attach to this page additional sheets listing the agency names and addresses where a copy of the request was mailed or delivered,the date of such service and the type of service used. DEEP-WPMD-REQ-001 Page 6 of 7 Rev.01/17/17 Part IX: Requester Certification The requester and the individual(s) responsible for actually preparing the request for reauthorization must sign this part. A request for reauthorization will be considered incomplete unless all required signatures are provided. "I have personally examined and am familiar with the information submitted in this document and all attachments thereto, and I certify that based on reasonable investigation, including my inquiry of the individuals responsible for obtaining the information, the submitted information is true, accurate and complete to the best of my knowledge and belief. I certify that this request for reauthorization is on complete and accurate forms as prescribed by the commissioner without alteration of the text. I certify that a complete copy of this request for reauthorization, including all documents attached thereto, was sent by regular or certified mail or was hand delivered to the municipal wetlands agency, zoning commission, planning commission or combined planning and zoning commission, and conservation commission of each municipality which is or may be affected by the subject activity. I understand that a false statement in the submitted information may be punishable as a criminal offense, in accordance with section 22a-6 of the General Statutes, pursuant to section 53a-157b of the General Statutes, and in accordance with any other applicable statute." Signature of Reques er Date Andrew Douglas Chemical Engineer Printed Name of Requester Title(if applicable) Signature of Prepare r Date Andrew Douglas Chemical Engineer Printed Name of Preparer Title (if applicable) ❑ Check here if additional signatures are required. If so, please reproduce this sheet and attach signed copies to this sheet. Note: Please submit the fee, the original of your Request for Reauthorization form and all supporting documents to: CENTRAL PERMIT PROCESSING UNIT DEPARTMENT OF ENERGY AND ENVIRONMENTAL PROTECTION 79 ELM STREET HARTFORD, CT 06106-5127 One complete copy of your Request for Reauthorization Form and all supporting documents must also be submitted to each municipal agency listed in Part Vlli of this form. IMPORTANT: A diversion is authorized under the General Permit for Diversion of Water for Consumptive Use—Reauthorization(DEEP-WPMD-GP-001) upon receipt, by the commissioner, of a complete,sufficient Request for Reauthorization and appropriate fee, in accordance with Section 4 of that general permit. The filing deadline to submit this completed form is ninety(90) days after the effective date of the subject general permit. Otherwise you must complete forms DEEP-WPMD-REQ-002 or DEEP-WPMD-REQ-003 depending on the eligibility category. DEEP-WPMD-REQ-001 Page 7 of 7 Rev.01/17/17 Attachment A Existing Authorization: General Permit for Diversion of Water for Consumptive Use: Authorization Required Categories issued March 29, 2007 STATE OF CONNECTICUT DEPARTMENT OF ENVIRONMENTAL PROTECTION r�Ares °ur NuWay Tobacco Company P.O.Box 415 East Windsor Hill,CT 06028 Attn: Brian Hart: Re: Authorization Under the General Permit for Diversion of Water for Consumptive Use: Authorization Required Categories Authorization No.: 1)IV-200701761 GP Eligible Category: Withdrawal of up to 250,000 gpd Bedrock Aquifer Town: South Windsor,CT Waters: ground water Dear Mr.Hart: Your Request for Authorization Under the General Permit for Diversion of Water for Consumptive Use dated June 26,2007 and filed with this department on June 28,2007 is hereby approved. The purpose of the diversion is manufacture reconstituted tobacco sheet. Your request for authorization is approved pursuant to the provisions of the General Permit for Diversion of Water for Consumptive Use:Authorization Required Categories(DEP-IWRD-GP-012)("the General Permit")issued March 29,2007 pursuant to Section 22a-378a of the General Statutes. Please be advised that Section 22a-379 of the General Statutes requires the holder of a water diversion permit authorizing a consumptive use of waters of the state to pay an annual fee to the Commissioner of Environmental Protection. The annual fee requirement applies to holders of individual permits and general permit authorizations. Currently,the annual fee established by Special Session Public Act No.03-6 for such permits is$750. Each year,the department mails an invoice for payment to each permit holder. Payment of the invoice is due by July 1". If you have not already done so,you should contact your local Inland Wetlands Agency and the U.S. Army Corps of Engineers to determine local and federal permit requirements on your project,if any. Write the Corps'New England District,Regulatory Branch,696 Virginia Road,Concord,MA 01742-2751 or call(978)318-8335. If you have any questions concerning this authorization,please contact staff in the Inland Water Resources Division at(860)424-3019. Authorized Activity: NuWay Tobacco(the"permittee")is authorized to divert the waters of the state by withdrawing a maximum of 0.150 million gallons of groundwater per day from a 212 foot bedrock well drilled in January, 1968,in accordance with plans entitled"Nuway Tobacco Company Site Plan Waste Water Permit",dated July 2001,revised through.June 22,2007,prepared by Fuss&ONeil,and other (Printed on Recycled Paper) 79 Elm Street • Hartford, CT 06106-5127 An Equal Opportunity Employer t DIV-20070176IGP NuWay Tobacco Page 2 of S documentation submitted as a part of the request for authorization. This authorization is subject to the conditions described below. Permittee's failure to comply with the terms and conditions of this authorization and those of the general permit shall subject permittee and permittee's contractor(s)to enforcement actions and penalties as provided by law. Any permittee authorized for a diversion of water under this general permit shall assure that activities authorized by the general permit are conducted in accordance with the following conditions: A.SPECIAL CONDITIONS None. B.OPERATING CONDITIONS (1) Diversion Metering The permittee shall install a flow meter(s)to measure the total volume of diversion authorized herein,and shall for the duration of the authorization continuously operate and maintain such meter(s)in good working order. In the event of meter malfunction or breakage,the permittee shall repair or replace such meter within 72 hours. (2) Meter Calibration The permittee shall test each meter referenced in condition B(1)above every other year,and calibrate to within two percent accuracy as shown through a post-calibration test. The permittee shall maintain a record of the accuracy and calibration tests along with supporting documentation and certifications. The permittee shall make a copy of said records available to the commissioner or the commissioner's designee immediately upon request. (3) Inspections The permittee shall conduct routine inspections of all equipment associated with the diversion(s)authorized by the general permit. Inspections shall be conducted as necessary to insure proper operation of all equipment. A log shall be maintained on-site documenting the date of inspection,inspector's name,verification of operation or critical equipment,and a summary of any work or change in equipment associated with the diversions authorized by the general permit. (4) Daily Diversion Recording The permittee shall record on a daily basis the quantity of water that is diverted or transferred,and is metered,pursuant to the general permit. Water diversions shall be recorded and reported in gallons or thousands of gallons.The daily record shall include all other pertinent data such as but not limited to the volume of water diverted,exact hours of operation],the time each day that the meter was read and recorded,and denotation and DIV-20070176IGP NuWay Tobacco Page 3 of 8 explanation of any instances in which the diversion of water exceeded the authorized withdrawal limitation(s)specified above. Such record shall be on a form as prescribed by the commissioner.A copy of the daily.record of withdrawals shall be included in the Annual Report to the commissioner as required in condition C(3)below. (5) Long-range Water Conservation Plan Each permittee that is a water company,as defined in section 25-32a of the Connecticut General Statutes,and is required by section 25-32d of the Connecticut General Statutes to submit a water supply plan to the Commissioner of Public Health,shall implement its water conservation.component of said plan and any subsequent amendments or updates as approved by section 25-32d of the Connecticut General Statutes. The permittee shall maintain a summary of all actions taken each year pursuant to the Long-range Water Conservation Plan and,where practical,a description of the estimated or actual water savings achieved. A copy of this summary shall be included in the Annual Report to the commissioner as required in condition C(3)below. (6) Water Audit Each water company authorized to divert or transfer herein shall triennially conduct a water audit of their water distribution system. The water audit shall follow standards and criteria contained within American Water Works Association's(AWWA)Manual M36 as may be amended or revised. A copy of all actions taken pursuant to the water audit shall be included in the Annual Report to the commissioner as required by condition C(3)below. (7) Leak Detection Each permittee that is a water company,at any time that the unaccounted-for water,as calculated pursuant to condition B(6)remains above 15%of total system input,the permittee shall,in the subsequent year conduct a system-wide,comprehensive leak detection survey of the water distribution system and repair any leaks found. The leak detection survey shall follow standards and criteria contained within the AWWA Manual M36 as may be amended or revised. The permittee shall maintain a record of all actions taken pursuant to the leak detection survey,including the number of miles of water main surveyed,the survey techniques and methodology utilized,the number of leaks detected,and the actual repairs made. A copy of this record shall be included in the Annual.Report to the commissioner as required by condition C(3)below. (8) Seasonal Irrigation Restrictions Irrigation withdrawals authorized under this general permit are restricted to the period of April 15 through October 31,inclusive. (9) Pollution Prevention/Best Management Practices The permittee shall not cause or allow the authorized diversion,including any construction associated therewith,to result in pollution or other environmental damage and shall employ DIV-20070176I GP NuWay Tobacco Page 4 of 8 best management practices to prevent such damage.The permittee shall,in addition to employing any other best management practices necessary to prevent such damage,do the following: (A) Control Erosion The permittee shall install and maintain in optimal condition erosion and sedimentation controls to prevent erosion and discharge of material into any waters of the state,including wetlands,as a result such diversion or any construction associated therewith. Such controls shall be installed and maintained in conformity with the Connecticut Guidelines for Soil Erosion and Sediment Control,as amended,published by the Connecticut Council on Soil and Water Conservation pursuant to section 22a-328 of the General Statutes. (B) Golf Courses For diversions authorized under the general.permit,involving the irrigation of golf courses, the permittee shall,where applicable,conform with the document entitled Best Management Practices for Golf Course Water Use,as amended,available from the Department at ho://www.ct.gov/deL). (C) Dispose of Excess Material Properly All excess material and solid waste generated during any construction associated with such diversion shall be disposed of in accordance with applicable federal,state and local law. (10) Alteration of Authorized Diversion In operating the authorized.diversion,the permittee shall not make any alteration,except a de minimis alteration,to such diversion and shall not make any de minimis alteration without first obtaining the written approval from the commissioner of such alteration.For the purposes of the general permit,a de minimis alteration means a change in the design or operation of the authorized diversion that does not increase its adverse environmental or other impacts and does not significantly change the quantity or location of water withdrawn. (11) Contractor Notification If the authorized diversion will be constructed by a person(s)under contract to the permittee, the permittee shall(A)give a copy of this general permit and of permittee's approval of authorization hereunder to such contractor(s)prior to the start of construction,and(B)retain a written receipt for such copy,signed and dated by such contractor(s). (12) Notice to Commissioner of Any Changes in Permittee Contact Information The permittee shall give written notice of any changes in permittee contact information to the commissioner within two weeks of any such change or modification. DIV-200701761 GP NuWay Tobacco Page 5 of 8 (13) Notice to Commissioner upon Permanent Discontinuance of Diversion Within two weeks after permanently discontinuing the authorized diversion,the permittee shall give written notice of same to the commissioner. (14) Initiation of Diversion If the permittee does not initiate the authorized diversion within three years after the date of the applicable approval of authorization,said approval shall be null and void. (15) Restrictions The DEP shall have the right to restrict the diversion authorized in this permit at any time the commissioner determines: (A) a declared local,regional or state-wide drought advisory,watch,warning or emergency necessitates curtailment of non-essential water uses,or (B) the continuation of the diversion would have an adverse effect on wetlands and watercourses,water quality,fisheries resources,aquatic habitat,or any public or private water supply well. C.REPORTING AND RECORD KEEPING REQUIREMENTS Except as provided in condition C(3)below,or as otherwise specified in writing by the commissioner,all information required under the general permit shall be retained by the permittee and be readily available on request. (1) The permittee shall maintain a copy of the general permit authorization on site at all times. (2) The permittee shall retain copies of all records and reports required by the general permit, and records of all data used to compile these reports for a period of at least fifteen years from the date such data was generated or report was created whichever is later. (3) Annual Report The permittee shall submit by January 30 of each year,for the duration of their authorization, an Annual Report for the preceding calendar year. Such report shall be certified in accordance with condition E(4)below and shall contain the following: (A) A copy of the withdrawal records of daily withdrawals and daily transfers as required by condition B(4); (B) A copy of any violation report as required in section D below. DIV-20070176IGP NuWay Tobacco Page 6 of 8 D.RECORDING AND REPORTING VIOLATIONS Immediately upon learning of a violation.of a condition of this authorization or of any of the requirements for authorization of Section 3(b)of the general permit,the permittee shall immediately take all reasonable action to determine the cause of such violation,correct such violation and mitigate its results,prevent further such violation,and report in writing such violation and such corrective action to the commissioner within five(5)calendar days of the permittee learning of such violation. Such report shall include but not be limited to the following information: (1) the provision(s)of this authorization that has been violated; (2) the date and time the violation(s)was first discovered and by whom; (3) the cause of the violation(s),if known; (4) if the violation(s)has ceased,the duration of the violation(s)and the exact date(s)and time(s) it was corrected; (5) if the violation(s)has not ceased,the anticipated date when it will be corrected; (6) steps taken and steps planned to prevent a reoccurrence of the violation(s)and the date(s) such steps were implemented or will be implemented; (7) the signatures and signed certification statements of the permittee and of the individual(s) responsible for actually preparing such report. A copy of this report shall be included in the Annual Report required above. E.GENERAL CONDITIONS (1) Reliance on Request for Reauthorization In evaluating the request for reauthorization,the commissioner has relied on information provided by the requester.If such information proves to be false or incomplete,the authorization issued under the general permit may be suspended or revoked in accordance with law,and the commissioner may take any other legal action provided bylaw. (2) Duty to Correct and Report Violations Upon learning of a violation of a condition of this authorization,a permittee shall immediately take all reasonable action to determine the cause of such violation,convect such violation and mitigate its results,prevent further such violation,and report in writing such violation and such corrective action to the commissioner within five(5)days of the permittee's learning of such violation,as required by section C above. Such report shall be certified in accordance with condition E(4)below. DIV-20070176IGP NuWay Tobacco Page 7 of 8 (3) Duty to Provide Information If the commissioner requests any information pertinent to the authorized activity or to determine compliance with the general permit,the permittee shall provide such information in writing within thirty(30)days of such request.Such information shall be certified in accordance with condition E(4)below. (4) Certification of Documents Any document,including but not limited to any notice,which is submitted to the commissioner under the general permit shall be signed by,as applicable,the registrant or the permittee in accordance with section 22a-430-3(b)(2)of the Regulations of Connecticut State Agencies,and by the individual or individuals responsible for actually preparing such document,each of whom shall certify in writing as follows: "I have personally examined and am familiar with the information submitted in this document and all attachments thereto,and I certify that,based on reasonable investigation, including my inquiry of those individuals responsible for obtaining the information,the submitted information is true,accurate and complete to the best of my knowledge and belief I understand that a false statement made in the submitted information may be punishable as a criminal offense,in accordance with section 22a-6 of the General Statutes,pursuant to section 53a-I57b of the General Statutes,and in accordance with any other applicable statute" (5) Date of Filing For purposes of the general permit the date of filing with the commissioner or with any municipal agency or commission of any document is the date such document is received by the commissioner,municipal agency or commission,respectively.The word"day"as used in the general permit means the calendar day;if any date specified in the general permit falls on a.Saturday,Sunday,or legal holiday,such deadline shall be the next business day thereafter. (6) False Statements Any false statement in any information submitted pursuant to the general permit may be punishable as a criminal offense,in accordance with section 22a-6 of the General Statutes, pursuant to section 53a-157b of the General Statutes,and in accordance with any other applicable statute. (7) Correction of Inaccuracies Within fifteen(15)days after the date a permittee becomes aware of a change in any of the information submitted pursuant to the.general permit,becomes aware that any such information is inaccurate or misleading;or that any relevant information has been omitted, such permittee shall correct the inaccurate or misleading information or supply the omitted information in writing to the commissioner. Such information shall be certified in accordance DIV-20070176IGP NuWay Tobacco Page 8 of 8 with condition E(4)above.The provisions of this subsection shall apply both while a request for authorization is pending and after the commissioner has approved such request. (8) Transfer of Authorization An authorization under the general permit is transferable only in accordance with the provisions of section 22a-6o of the General Statutes and upon payment of a transfer fee of $750. A transfer of authorization shall not be deemed authorized unless the transfer fee has been paid in full. (9) Other Applicable Law Nothing in the general permit shall relieve the permittee of the obligation to comply with any other applicable federal,state and local law,including the obligation to obtain any other lawfully required authorization to construct or maintain the authorized diversion. (10) Other Rights The general permit is subject to and does not derogate any present or future rights or powers of the State of Connecticut and conveys no rights in real or personal property nor any exclusive privileges,and is subject to all public and private rights and to any federal,state, and local laws pertinent to the property or activity affected by such general permit.In conducting any activity authorized hereunder,the permittee may not cause pollution, impairment,or destruction of the air,water,or other natural resources of this state.The issuance of the general permit shall not create any presumption that the general permit should or will be renewed. This authorization shall expire on March 29,2017. Dati enise Ruz Director Inland Water Resources Division Attachment B Compliance and Enforcement History: Applicant Compliance Information Form • Connecticut Department of Energy & Environmental Protection DEEP ONLY App,No. Applicant Compliance Information CoAnd.No. Applicant Name: Nuway Tobacco Company Mailing Address: 200 Sullivan Avenue City/Town: South Windsor State: CT Zip Code: 06074 Business Phone: 860-289-6414 ext.: Contact Person: Andrew Douglas Phone: 860-289-6414 ext. 215 *E-mail: adouglas@ethicalsolutions.net If you answer yes to any of the questions below, you must complete the Table of Enforcement Actions on the reverse side of this sheet as directed in the instructions for your permit application. A. During the five years immediately preceding submission of this application, has the applicant been convicted in any jurisdiction of a criminal violation of any environmental law? ❑ Yes ® No B. During the five years immediately preceding submission of this application, has a civil penalty been imposed upon the applicant in any state, including Connecticut, or federal judicial proceeding for any violation of an environmental law? ❑ Yes ® No C. During the five years immediately preceding submission of this application, has a civil penalty exceeding five thousand dollars been imposed on the applicant in any state, including Connecticut, or federal administrative proceeding for any violation of an environmental law? ❑ Yes ® No D. During the five years immediately preceding submission of this application, has any state, including Connecticut, or federal court issued any order or entered any judgement to the applicant concerning a violation of any environmental law? ❑ Yes ® No E. During the five years immediately preceding submission of this application, has any state, including Connecticut, or federal administrative agency issued any order to the applicant concerning a violation of any environmental law? ❑ Yes ® No DEEP-APP-002 1 of 2 Rev.08/08/11 Table of Enforcement Actions (�) (2a) (2b) (3) (4) (6) Type of Action ate Date Case/Docket/ Yp D Jurisdiction Description of Violation Commenced Terminated Order No. ❑ Check the box if additional sheets are attached. Copies of this form may be duplicated for additional space. DEEP-AAP-002 2 of 2 Rev.08/08/11 k by Ago 040 AVOW t I ate '. r -0i 1 f� t b f,., f p -p7v wm J Njum 4! :_ � �.: 14\,/—.. ..��s � �!F� i��. fit, `�al'' •_. �.,��� of "Al �,1/tYSDl3'�t�➢ aY � �;� kt. FA LIK Nis N a � /2�'Jd Sao'rx ,/, + I 1-71 %. ♦�^''� � i�z✓//,�-.�_ �_"".a" ._���w.3. j � "-tom � ol Ail Ile Alt ,. a • �,�1y Il q� i