MARYLAND DEPARTMENT OF THE ENVIRONMENT
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
INDIVIDUAL OR GENERAL PERMIT TO DISCHARGE STORMWATER
ASSOCIATED WITH CONSTRUCTION ACTIVITIES
CERTIFICATION OF EROSION AND SEDIMENT CONTROL PLAN APPROVAL
This form is required after an applicant submits an application form for an Individual or General
Permit for Stormwater Associated with Construction Activity, but before the Maryland
Department of the Environment (MDE) issues the permit.
Applicants for an Individual or General Permit for Stormwater Associated with Construction
Activity who have a document from the appropriate Approval Authority stating that the erosion
and sediment control plan has been approved may submit that document MDE in lieu of this
form. Otherwise, applicants must use this form to certify that the erosion and sediment control
plan has been approved by the appropriate Approval Authority.
Application
Information
Name of
site/project:
Phase (if
applicable):
Name of Owner
or Organization
Responsible for
site/project:
Certification
Information
Applicant Information
Permit number assigned by MDE:
Has the Approval Authority has approved the Erosion and Sediment
Control Plan for this project? Yes
Name of Approval Authority for Erosion and Sediment Control Plan:
Identifying Number for Erosion and Sediment Control Plan (if assigned by
Approval Authority):
Certification of
Permit Applicant
I certify under penalty of law that this document was completed under my
supervision and that the information contained herein is accurate and
truthful to the best of my knowledge.
Print or type name or person signing:
Title:
______________________________________________
(Signature of applicant)/(Date signed)
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Submit one signed original to:
Maryland Department of the Environment, Compliance Program
1800 Washington Blvd.
Suite 420
Baltimore Maryland 21230
FAX: (410) 537-3733
Maryland Department of the Environment, Compliance Program
Contact
1800 Washington Blvd.
Information for
Suite 420
Questions:
Baltimore Maryland 21230
Telephone: (410) 537-3510 Website: http://www.mde.state.md.us
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