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NOTICE OF INTENT TO COMPLY WITH MAINE GENERAL PERMIT FOR THE DISCHARGE OF STORMWATER FROM MUNICIPAL SEPARATE STORM SEWER SYSTEMS DEPLW0916 Maine Department of Environmental Protection 5/29/2008 PLEASE TYPE OR PRINT IN BLACK INK ONLY Municipality: City of Lewiston Mailing Address: 27 Pine Street Town/City: Lewiston State: Maine Zip Code: 04243 Name and title of chief elected official or principal executive officer: James A Bennett City Administrator Mailing Address: 27 Pine Street Town/City: Lewiston State: Maine Zip Code: 04243 Name of primary contact person responsible for MS4 stormwater management program: Janice E Patterson Mailing Address: P O Box 479 103 Adams AVe Town/City: Lewiston State: Maine Zip Code: 04243 Daytime phone: (with area code) [PHONE REDACTED] Email if available: [EMAIL REDACTED] Estimate of the area in square miles of the Urbanized Area: 35 Prior DEP Permit Number(if applicable): MER04112 Name of stream(s), wetland(s) or waterbody(ies) to which the regulated Small MS4 discharges and a list of impaired waterbody(s) which receive stormwater from the Regulated Small MS4 (attach additional sheets as necessary): See attached sheet I have personally examined and am familiar with the information submitted in this document and all attachments thereto, and I certity 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 knowingly made in the submitted information may be punishable as a criminal offense, in accordance with Maine General Statutes. I certify that this permit registration is on complete and accurate forms as prescribed by the Department without alteration of the text. I also certify under penalty of law that I have read and understand all requirements of the General Permit. I certify that all requirements for authorization under the general permit are met and that a system is in place to ensure that all terms and conditions of this general permit will continue to be met for all discharges authorized by this general permit for the municipality. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowingly making false statements. Signature of chief elected official or principal executive officer: Date: This NOI registration form must be filed with the Department at the following address: Stormwater Coordinator Maine Department of Environmental Protection Bureau of Land & Water Quality 17 State House Station Augusta ME 04333-0017 OFFICE USE ONLY Ck.# Staff Staff NOI # FP Date Acc. Date Def. Date After Photos ---PAGE BREAK--- NOTICE OF INTENT TO COMPLY WITH MAINE GENERAL PERMIT FOR THE DISCHARGE OF STORMWATER FROM MUNICIPAL SEPARATE STORM SEWER SYSTEMS DEPLW0916 Maine Department of Environmental Protection 5/29/2008 Receiving Streams: Androscoggin River **Hart/Dill Brook **Jepson Brook Un-named tributary to No Name Brook Un-named stream north of Mitchell Road Moody Brook No Name Brook Salmon Brook Stetson Brook Receiving Waterbodies: Lake Andrews Gulf Island Pond No Name Pond Un-named pond near Grove Street and Randall Road Un-named Pond near Mitchell Road and Webster Street Un-named pond adjacent to Old Lisbon Road Garcelon Bog Receiving Watersheds: Androscoggin River **Urban Impaired Streams