HomeMy WebLinkAboutWPO201800001 Application 2018-01-04 Virginia Stormwater Management Program (VSMP)
Application for Albemarle County *001f
Project Name: Rivanna Community Church
(The name should be the same as it appears on plans)
Is this an amendment to an approved plan? Yes ❑ No IZ
Is this a revision or resubmission for review? Yes 0 No ll
County File Number: (to be provided by the County for new applications)
The following are required elements of new applications[from code section 17-404 For revisions or
amendments,please indicate which items are being amended. Signatures must be provided for any
submission.
WI A. Signature of the Property Owner for each parcel: (Required with every submission or revision, NOT
TO BE SIGNED BY AN AGENT OR CONSULTANT)
By signing this application as the owner,I hereby certify that all requirements of these plans and permits will be
complied with,and I have the authority to authorize the land distu sting activities and development on the subject
property. I hereby grant the County of Albemarle the right to ente p' ; i e property as required to ensure
compliance with the approved plans and permits. 4.
31-32 Steve & Kath Hood \',
Tax Map&Parcel Print Name of Property Owner Signatur- •f O 1r Date
cont. Trustees, Rivanna Community Church
Tax Map&Parcel Print Name of Property Owner Signature of Owner Date
Tax Map&Parcel Print Name of Property Owner Signature of Owner Date
Tax Map&Parcel Print Name of Property Owner Signature of Owner Date
Contact Information for the Owner(s)to receive correspondence:
Print Name Steve & Kathy Hood, Et.Als., Trustees Rivanna Community Church
Address 601 Earlysville Green
City Earlysville State VA Zip 22936
Daytime Phone(434) 975-0011 E-mail sknightrivanna@gmail.com
7/1/14,Revised:7/10/14,1/7/14 Page 1 of 2
121 B. All Fees [Code section 17-208]
For new or modified plans;Total acres proposed to be disturbed 0.8957
Acres to be Total Fee Fee Due with this Fee with Transfer or
disturbed Application modification of permit
Less than 1 $290 $145 $20
1 and less than 5 $2,700 $1,350 $200
5 and less than 10 $3,400 $1,700 $250
10 and less than 50 $4,500 $2,250 $300
50 and less than 100 $6,100 $3,050 $450
100 and more $9,600 $4,800 $700
For(minor)amendments to an approved plan;$200 per review
Variances;$150(per request)
Mitigation Plan;$150
® C. Registration Statement on the official DEQ form.
O D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
m E. Stormwater Management Plan satisfying the requirements of code section 17-403.
® F. Pollution Prevention Plan satisfying the requirements of code section 17-404.
m G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405.
❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
stream buffers. ,
❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408.
❑ J. Construction Record Drawings (as-builts)for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Provide 2 copies of all plans and any supporting documents. Professional seals must have original
signatures.
Additional information if not provided on plans and documents:
Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent)
Print Name Ed Blackwell
Address 566 East Market Street
City Harrisonburg State VA Zip 22801
Daytime Phone(540) 432-9555 E-mail ed@blackwellengineering.com
*When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months
from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's
signatures will not be considered valid.
FOR OFFICE USE ONLY WPO# f 1 l 41_
�
Fee Amount s`Date Paid G�� By who? N4 c pt#I I (�(@3Ck#_23_14_By: OS
7/1/14,Revised:7/10/14, 1/7/14 Page 2 of 2
Screening Form Number
_
4.40-vit,
COUNTY OF ALBEMARLE
Department of Community Development
401 McIntire Road,Room 227
Charlottesville,Virginia 22902-4596
Phone(434)296-5832 Fax(434)972-4126
LAND DISTURBANCE
EROSION AND SEDIMENT CONTROL SCREENING FORM
This form is intended to aid the Department in classifying a land disturbance. The form responses will be used to
determine whether a disturbance is subject to the County's Water Protection Ordinance. Failure to respond or to fully
complete the screening form within 72 hours may require the Department to stop all land disturbing activity. The Stop
Work Order will remain effective until the classification of the disturbance and/or obtainment of all required permits
associated with the disturbance.
Steve& Kathy Hood, Et. Als., Trustees Rivanna Community Church 434-975-0011
Owner/Agent Name (Print) Home Phone Office/Other Phone
601 Earlysville Green
Address
Earlysville VA 22936
City State Zip Code
1. Are there any streams on the property? Yes No ✓
2. If so,will land disturbing activity be within 100'
of the stream? Yes No ✓
3. Will the project require grading, excavating, clearing,
filling, or other land disturbing activity of any kind? Yes ✓ No
Purpose of land disturbing activity:
to add a new huilding nn the site
Directions to Property and Location of Activity:
miles on right.
Area to be disturbed: 0.8592 a res or 37424.8095 sq. ft.
Owner/Agent Signature Date
�- \ �.,
(FOR OFFICE USE ONLY)
Tax Map/Parcel:•• ^ :`;' ► -——-——Checked By Date
Remwires,an Erosion and Sediment Control Plan
-0Regt res;aia Agreement in Lieu of an Erosion and Sediment Control Plan
Exempt Activity
October 9,2006
Albemarle County Engineering
Erosion and Sediment Control Plan checklist for plan reviewers
Updated 1 Dec 2014
An erosion and sediment control plan is a document which illustrates the measures used to control erosion
and sedimentation during construction. All measures follow the Virginia Erosions and Sediment Control
Handbook.
Reference key;
[Square Brackets] are County Code references, {Curved Brackets} are policy references, and(regular
parenthesis) are explanatory. Links to reference documents are provided where possible.
Application information:
Completed WPO application and fees,with owners signature [County Code 18-32.4.3.2,
18-32.3.9, 17 Article II] Erosion Control plans require a Water Protection Ordinance
(WPO) application and original owner's signature. No review is provided without
application, owner signature and fees. This is true even for revisions. It is important that
the owner be aware of comments and re-submittals, and this is the county assurance.
Copies of federal and state permits for any wetland or stream disturbance. (Army Corps,
VDEQ, etc) [17-604, 18-32.1.2, 14-311]
VSNP:
V SWPPP,PPP, SWMP approvals obtained where necessary. In most cases, the erosion
control plan will not be submitted independently, but will be part of a Stormwater
Pollution Prevention Plan(SWPPP). Unless exempt, it will be approved with the
SWPPP.
Title information:
Project title. Titles should be appropriate. It should be an erosion control plan, not a
stormwater plan, or site plan, etc. In some cases a WPO package will contain a
stormwater plan and a mitigation plan, but they should be on separate sheets with keys
and page titles.
IProfessional seal, with original signature and date for professionally prepared plans.
V Content: The erosion control plan must not contain information regarding permanent
improvements that do not also appear on other plans. Erosion control plans are
temporary documents that are discarded after projects are complete.
Exipting conditions plan view information:
accurate current existing topography at the time of submittal, including all existing site
features, and any recent disturbances, all at a legible scale
date and source of the topographic information: All topography should be at least visually
field verified by the designer within the last year. Adequate erosion control cannot be
designed without accurate topography and drainage areas.
WPO buffer limits; 100' from stream or wetland bank, 200' from reservoirs, or
floodplain limit if greater.
NA No buffer disturbances without WPO Program Authority approval and a mitigation plan.
floodplain limits, including 100yr flood limits for any channel with a drainage area of
50+ acres.
Albemarle County
Engineering E&SC Plan Checklist
Page 2 of 4
NA Floodplain undisturbed. Disturbances require a Special Use Permit or Floodplain
Development Permit.
I' all existing easements (access, drainage, sight, sanitary easements, etc.)with deed book
/ references, locations and dimensions
all critical slopes (typically shaded)
ti A Zoning Ordinance buffers shown and protected undisturbed. Disturbances require
Planning approval of a waiver.
Proposed plan view information:
Grading:
proposed topography at minimum 2' contour intervals—tied into existing contours, as
well as all proposed site features in later phases. (Sites with less than 6' of grade change
should consider using smaller contour intervals.) These should agree with other final
plans.
jproposed slopes are all 2:1 (horizontal:vertical) or flatter {Design Manual, section 8}
proposed slopes steeper than 3:1 have low maintenance (not grass) ground cover
/ specified on the plan {Design Manual, Section 8}existing critical slopes are not disturbed, unless a waiver or exemption has been granted ,
for the disturbance. [18-4.2, 14-304]
AlA Retaining Wall Plans approved. Any walls supporting roads or necessary infrastructure
require engineered plans (not generic manufacturer's details) and computations. {Design
Manual, section 8} This will also be required where walls are close to property lines and
there is the danger of affecting neighboring property, either during construction,with
/ later failures, or with pedestrian or vehicle safety. • '
final contour shapes and slopes ensure no un-drained pockets or stagnant pools
Narrative:
narrative and project title (Narratives are now optional, and not reviewed by the County,
other than noting whether they are not seriously in error, like a boilerplate with another
County's name on it.)
project description
existing site conditions description
adjacent areas description
off-site areas description including any off-site areas for borrow,waste or other
disturbance.
special use permit for cut greater than 50,000cy in RA zoning
soils descriptions •
County erosion control notes
stormwater runoff considerations: this can refer to the stormwater management ••
plan •
sediment basin design computations summary for each sediment basin
sediment trap design computation summary for each sediment trap
Erpsion and sediment control measures:
limits of clearing and grading encompassing all disturbances, entrances, staging and
parking areas, areas where sediment laden runoff will cross, or any construction related
activities. This must match any landscaping and conservation plans submitted with site
plans
Albemarle County
Engineering E&SC Plan Checklist
Page 3 of 4
✓ a construction entrance (CE) draining to a sediment trap or basin
NA dust control symbols (DC)
✓ temporary and permanent seeding symbols (TS, PS)
I existing drainage divides
✓ existing vegetation, with trees to be saved located by drip lines. This must match any
landscaping and conservation plans.
protection provided for all stages/phases of construction,from initial land clearing to
final grades and hardscapes. This is our most important item. Plans which show only,
inlet protection on proposed drainage systems,which are only possible to install upon
completion of grading, may be denied without further review.
Jno erosion control measures in the way of construction access or grading. Diversion
dikes or silt fence are not placed in the middle of the site, or through access or grading. •
Sediment traps are not under or on top of fill material or held up by retaining walls.
Construction entrances are not on fill, etc.If the concept for site protection is not
/ adequate in this regard,further review of the plan may not be possible.
N. existing soil boundaries are shown with labels. Areas already disturbed are indicated,
with constructed fill depth or cut noted.
critical erosion areas are identified; areas of constructed slopes, areas near property lines
A adjacent off-site disturbances are shown with erosion control facilities
A/ a stockpile location.
Ng where cut or fill balances have a 10,000 cubic yard deficit or more,plans should not be
approved without a waste area identified. This must be on-site, or on another approved
and permitted site. (Don't make the inspectors chase trucks to find the dump site
violation.)
✓t• a staging and parking area, or other construction related areas
/Y/ diversion dikes are used to direct drainage to traps and basins
✓ silt fence is not used across contours in place of diversion dikes.
1/ silt fence is limited to areas of sheet flow with 1/4 acre per 100ft of level on-grade silt
fence. Plans showing only silt fence,without sediment trapping measures, should not be
approved unless they meet this criteria and fill dirt is minimal.
/V'A all swales and low points at the perimeter of the site have a sediment trap or basin. Silt
fence in swales is typically not adequate. Check dams do not substitute for traps.
Diversions which travel more than 100ft, or go in and out of swales, are usually not
maintainable in the field. If the concept for site protection is not adequate in this regard,
further review of the plan may not be possible.
NA temporary slope drains (TSD) or diversions are provided to prevent discharge over
disturbed or fill slopes
inlet protection(IP) on all inlets
,/ culvert inlet protection(CIP) on all culvert inlets
J outlet protection(OP) on all outlets
IAA all watercourses are protected and encroachments minimized
NA stream crossing(USC,SC) and diversions are provided at all stream crossings.
NA adequate channels (MS-19)provided for each outfall (see Design Manual for minimum
content)
a all traps and basins are shown with proposed contours. Simple boxes or symbols are not
sufficient, in most cases, to determine layout or bond amounts.
For each trap;
NA drainage area is 3 acres or less
Albemarle County
Engineering E&SC Plan Checklist
Page 4 of 4
n/pr sized for total drainage area, including those for in-line upstream facilities
NA wet storage is 67cy or more
/V A dry storage is 67cy or more
(sj A wet storage is 4' deep or less
NA wet storage side slope is 1:1 or flatter
CIA dry storage side slope is 2:1 or flatter
iv A stone weir is 6ft per acre of drainage area
WA embankment and stone weir height is 5' maximum from outside toe
/VA embankment top width is adequate (see table 16 reference)
NA 2:1 length:width ratio for flow path
For each basin; (GB 3.14)
'4/.n sized for total drainage area, including those for in-line upstream facilities
V wet storage is 67cy or more
_ I dry storage is 67yr or more
wet storage side slope is 1:1 or flatter •
dry storage side slope is 2:1 or flatter
I embankment 15' high or less from downstream toe
if principle and emergency spillways sized per handbook requirements
,I embankment has 1' freeboard during 25yr storm with emergency spillway
.A' embankment has 2' freeboard during 25yr storm without emergency spillway
trash rack/anti-vortex device specified per handbook requirements
riser anchor size specified per floatation computation
dewatering device sized for 6+hr drawdown of dry storage: 3"dia. minimum
safety fence and signs stating"danger, quick sand, do not enter"provided if near any
residential properties, or public access
structures and embankment match permanent design for facilities to be converted to
permanent stormwater management facilities
embankment top width is adequate (see Design Manual reference details)
I 2:1 length:width ratio for flow path. Baffles specified only on temporary structures
(p.III-79). Baffles are a big hassle in construction, and should not substitute for properly
dimensioned design if at all possible.
Details:
__IVA a paved construction entrance detail (see Design Manual reference details) for projects in
the development areas over 10 acres
N A a typical section for each temporary channel or diversion, referenced from the plan
sheets. Existing ground should be shown at the maximum cross-slope on the plan.
NA details and copies of Program Authority permissions for any variances.
Mass or Early Grading:
N A mass grading Planning approval. (This is also called rough or early grading plans which
contain only approximate finished grades and culverts necessary to grade) Mass grading
can only be permitted within planned developments where a concept grading plan was
approved with the rezoning. The agent (Director of Planning)needs to formally
determine that the grading plan is in general conformity with the approved rezoning plan.
Otherwise, an initial site plan needs to be approved prior to issuance of a grading permit.
Issuance of a grading permit at the initial site plan stage, as apposed to after final plan
approval, requires specific approval from the County Engineer.
• Registration Statement
General WOES Permit for Discharges of Stormwater from Construction Activities(VAR10)
(Please Type or Print All Information)
1. Construction Activity Operator: (General permit coverage will be issued to this operator. The Certification in Item#12 must be
signed by the appropriate person associated with this operator.)
Name: Rivanna Community Church
Contact Scott Knight
Mailing Address: 601 Earlysville Green
City: Earlysville State: VA Zip: 22936 Phone:
Email address(if available):
Indicate if DEQ may transmit general permit correspondence electronically: Yes❑ No El
2. Existing General Permit Registration Number(for renewals only): N/A
3. Name and Location of the Construction Activity:
Name: Rivanna Community Church
Address(if available): 601 Earlysville Green
City: Earlysville State: VA Zip: 22936
County(if not located within a City): Albemarle
Latitude(decimal degrees): 38.151 Longitude(decimal degrees): -78.478
Name and Location of all Off-site Support Activities to be covered under the general permit
Name: N/A
Address(if available):
City: State: Zip:
County(if not located within a City):
Latitude(decimal degrees): Longitude(decimal degrees):
4. Status of the Construction Activity(check only one): Federal❑ State❑ Public❑ Private X❑
5. Nature of the Construction Activity(e.g.,commercial,industrial,residential,agricultural,oil and gas,etc.):
Church
6. Name of the Receiving Water(s)and Hydrologic Unit Code(HUC):
Name: Jacobs Run Name:
HUC: JR11 HUC:
7. If the discharge is through a Municipal Separate Storm Sewer System(MS4),the name of the MS4 operator:
N/A
8. Estimated Project Start and Completion Date:
Start Date(mm/dd/yyyy): 12/15/2017 Completion Date(mm/dd/yyyy): 12/15/2019
9. Total Land Area of Development(to the nearest one-hundredth acre): 4.15
Estimated Area to be Disturbed(to the nearest one-hundredth acre): 0.859
10. Is the area to be disturbed part of a larger common plan of development or sale? Yes❑ Nolli
11. A stormwater pollution prevention plan (SWPPP)must be prepared in accordance with the requirements of the General
VPDES Permit for Discharges of Stormwater from Construction Activities prior to submitting this Registration Statement.
By signing this Registration Statement the operator is certifying that the SWPPP has been prepared:
12. Certification: "I certify under penalty of law that I have read and understand this Registration Statement and that this document
and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and
evaluated the information submitted. Based on my inquiry of the person or persons who manage the system or those persons
directly responsible for gathering the information, the information submitted is to the best of my knowledge and belief true,
accurate, and complete. I am aware that there are significant penalties for submitting false information including the possibility of
fine and imprisonment for knowing violations."
Printed Name: Sri f KLA-l .�{- Title: u •
Signature: Date: / 4-/ /063
(Please sign in INK. This Certification must be signed by the appropriate person associated wit the operator identified in
Item#1.)
01/2014 Page 1 of 1
Instructions for Completing the Registration Statement
General VPDES Permit for Discharges of Stormwater from Construction Activities(VAR10)
GENERAL stormwater pollution prevention plan or comply with other permit
conditions).
A.Coverage Under this General Permit.
The entities that are considered operators will commonly consist of the
Any operator applying for coverage under this general permit who is owner or developer of a project(the party with control of project plans
required to submit a Registration Statement (see Section B below) and specifications)or the general contractor(the party with day to day
must submit a complete Registration Statement to the Department. operational control of the activities at the project site which are
The Registration Statement serves as a Notice of Intent for coverage necessary to ensure compliance with the general permit).
under the General VPDES Permit for Discharges of Stormwater from
Construction Activities(VAR10). Provide the legal name(do not use a colloquial name),contact,mailing
address, telephone number, and email address (if available) of the
B.Single-family Residences, construction activity operator;general permit coverage will be issued to
this operator. Indicate if the Department may transmit general permit
Operators with an existing stormwater discharge or proposing a new correspondence electronically.
stormwater discharge associated with the construction of a single-
family residence separately built, disturbing less than one acre and item 2:Existing General Permit Registration Number.
part of a larger common plan of development or sale is not required to
submit a Registration Statement, provided that the stormwater For reapplications only,provide the existing general permit registration
management plan for the larger common plan of development provides number for the construction activity. This item does not need to be
permanent control measures (i.e., stormwater management facilities) completed for new construction activities applying for general permit
encompassing the single family residence. coverage.
Operators of these types of discharges are authorized to discharge item 3: Name and Location of the Construction Activity
under this general permit immediately upon the general permit's information.
effective date of July 1,2014.
Provide the official name,street address(if available),city or county(if
C.To Apply for Permit Coverage. not located within a City)of the construction activity. Also,provide the
latitude and longitude in decimal degrees of the approximate center of
1. New Construction Activities. Any operator proposing a new the construction activity(e.g.,N 37.5000,W 77.5000).
stormwater discharge from construction activities shall submit a
complete Registration Statement to the Department prior to the Name and Location of Off-site Support Activity information.
commencement of land disturbance,unless exempted by Section B
above. My operator proposing a new stormwater discharge from This general permit also authorizes stormwater discharges from
construction activities in response to a public emergency where the support activities (e.g., concrete or asphalt batch plants, equipment
related work requires immediate authorization to avoid imminent staging yards, material storage areas, excavated material disposal
endangerment to human health or the environment is immediately areas, borrow areas) located on-site or off-site provided that (i) the
authorized to discharge under this general permit and must submit a support activity is directly related to a construction activity that is
complete Registration Statement to the Department no later than 30 required to have general permit coverage;(ii)the support activity is not
days after commencing land disturbance; documentation to a commercial operation, nor does it serve multiple unrelated
substantiate the occurrence of the public emergency must construction activities by different operators; (iii)the support activity
accompany the Registration Statement. does not operate beyond the completion of the construction activity it
supports; (iv) the support activity is identified in the registration
2. Existing Construction Activities. Any operator that was statement at the time of general permit coverage; (v) appropriate
authorized,to discharge under the general permit issued in 2009, control measures are Identified in a SWPPP and implemented to
and who intends to continue,coverage under this general permit, address the discharges from the support activity areas; and (vi) all ,
shall submit a complete Registration Statement to the Department applicable state, federal, and local approvals are obtained for the
on or before June 1,2014,unless exempted by Section B above. support activity.
D.Where to Submit Registration Statements. Provide the official name,street address(if available),City and County
(if not located within a City) of all off-site support activities to be
All Registration Statements should be submitted to: covered under this general Permit. Also, provide the latitude and
longitude in decimal degrees of the approximate center of the off-site
Department of Environmental Quality support activities (e.g., N 37.5000, W 77.5000). Also, if an off-site
Office of Stormwater Management,10th Floor support activity is going to be covered under this general permit the
P.O.Box 1105 total land area of the off-site support activity and the estimated area to
Richmond,VA 23218 be disturbed by the off-site support activity need to be included in Item
#9:
LINE-BY-LINE INSTRUCTIONS
item 4:Status of the Construction Activity.
Item 1:Construction Activity Operator information.
Indicate the appropriate status(Federal, State, Public, or Private) of
"Operator' means the owner or operator of any facility or activity the construction activity.
subject to the Stormwater Management.Act and regulations. In the
context of stormwater associated with a large or small construction Item 5:Nature of the Construction Activity.
activity, operator means any person associated with a construction
project that meets either of the following two criteria:(i)the person has Provide a brief description of the construction activity, such as
direct operational control over construction plans and specifications, commercial,residential,agricultural,oil and gas,etc.This list is not all
including the ability to make modifications to those plans and inclusive.
specifications or(ii)the person has day-to-day operational control Of
those activities at a project that are necessary to ensure compliance Item 6:Receiving Waters(s)and HUC information.
with a stormwater pollution prevention plan for the site or other state
permit or VSMP authority permit conditions(i.e.,they are authorized to Provide the name of the receiving water(s)and corresponding HUC for
direct workers at a site to carry out activities required by the all stormwater discharges including any stormwater discharges from
off-site support activities to be covered under this general permit.
01/2014 Page 1 of 2
Hydrologic Unit Code or HUC is a watershed unit established in the gather complete and accurate information for permit application
most recent version of Virginia's 6'order national watershed boundary requirements; and where authority to sign documents has been
dataset. assigned or delegated to the manager in accordance with
corporate procedures.
Item 7:MS4 Information.
b. For a partnership or sole proprietorship: by a general partner or
If stormwater is discharged through a municipal separate storm sewer the proprietor,respectively.
system(MS4),provide the name of the MS4 operator.The name of the
MS4 operator is generally the Town, City,County,Institute or Federal c.For a municipality,state,federal,or other public agency:by either
facility where the construction activity is located. a principal executive officer or ranking elected official.For purposes
of this part,a principal executive officer of a public agency includes:
Item 8: Construction Activity Start and Completion Date
information. (i)The chief executive officer of the agency,or
Provide the estimated start date(month/day/year)of the construction (ii)A senior executive officer having responsibility for the overall
activity. Provide the estimated completion date (month/day/year) of operations of a principal geographic unit of the agency.
the construction activity.
Item 9:Construction Activity Area information.
Provide the total area (to the nearest one-hundredth acre) of the
development (i.e.., the total acreage of the larger common plan of
development or sale). Include the total acreage of any off-site support
activity to be covered under this general permit.
Provide the estimated area(to the nearest one-hundredth acre)to be
disturbed by the construction activity. Include the estimated area of
land disturbance that will occur at any off-'site support activity to be
covered under this general permit.
Item 10:Common Plan of Development or Sale information.
Indicate if the area to be disturbed by the construction activity is part of
a larger common plan of development or sale.Larger common plan of
development or sale is defined as a contiguous area where separate
and distinct construction may be taking place at different times on
different schedules. Plan is broadly defined as any announcement or
documentation,including a sign, public notice or hearing,sales pitch,
advertisement, drawing, permit application, zoning request, etc., or
physical demarcation such as boundary signs, lot stakes,or surveyor
markings indicating that construction activities may occur.
Item 11:Stormwater Pollution Prevention Plan(SWPPP).
A Stormwater Pollution Prevention Plan(SWPPP)must be prepared in
accordance with the requirements of the General VPDES Permit for
Discharges of Stormwater from Construction Activities(VAR10)prior to
submitting this Registration Statement. By signing this Registration
Statement the operator is certifying that the SWPPP has been
prepared.
Item 12:Certification.
A properly authorized individual associated with the operator Identified
in Item 1 of the Registration Statement is responsible for certifying and
signing the Registration Statement. Please sign the Registration
Statement in INK.
State statutes provide for severe penalties for submitting false
information on the Registration Statement. State regulations require
that the Registration Statement be signed as follows:
a. For a corporation: by a responsible corporate officer. For the
purpose of this part,a responsible corporate officer means:
(i) A president, secretary, treasurer, or vice-president of the
corporation in charge of a principal business function,or any other
person who performs similar policy-making or decision-making
functions for the corporation,or
(ii) the manager of one or more manufacturing, production, or
operating facilities, provided the manager is authorized to make
management decisions that govern the operation of the regulated
facility including having the explicit or Implicit duty of making major
capital investment recommendations, and initiating and directing
other comprehensive measures to assure long-term compliance
with environmental laws and regulations;the manager can ensure
that the necessary systems are established or actions taken to
01/2014 Page 2 of 2
When to Report an Oil Spill
en_ SPILL
S THE
SPILL TO
NAVIGABLE WATERS YES
OR ADJ01NING
SHORELINES?
i.
No
COULD `
WATER QUALITY
STANDARDS BE
. 1OLATED?,
Ahre OF NO I
G THE REPORTING BST
EXEMPT! ��
ii THE FILL
APPLY?
COU LD
HE SPILL CADS YES
A FILM, •SHEEN,• OR YES
■I SOOLORATI ONE id..1
N ,
COULD
THE SPILL CAUSE YES
A SLUDGE OR
EMULSION? I
No NEED TO
NO REPORT THE SPILL
•
IA.
1 ii' UMMOO
1i iMrr.) iR'\ C!