HomeMy WebLinkAboutWPO202000035 VSMP - SWPPP 2020-10-01�h�os.arrJ COUNTY OF ALBEMARLE
Department of Community Development
tt 401 McIntire Road, North Wing
Charlottesville, Virginia 22902-45%
r Tel. (434) 296-5832 • Fax (434) 972-4126
Stormwater Pollution Prevention Plan (SWPPP)
Project Name:
Name'
Name
For Construction Activities At:
Address:
Prepared by:
Prepared for:
SWPPP Preparation Date:
(This document is to be made publicly available according to 9VAC25-880-70, Part II, section D)
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
CONTENTS: (from Albemarle County Code Sec. 17-405)
1. Registration statement
2. Notice of general permit coverage
3. Nature of activity
4. Erosion and Sediment Control Plan.
5. Stormwater Management Plan
6. Pollution Prevention Plan.
7. Discharges to impaired waters, surface waters within an applicable TMDL
wasteload allocation, and exceptional waters.
8. Qualified personnel
9. Signed Certification
10. Delegation of authority.
11. General permit copy
12. Inspection logs
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
Section 1. Registration statement
(Provide a signed completed copy of the DEQ registration statement)
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
VIRGINIA DEPARTMENT OF ENVIRONMENTAL QUALITY
GENERAL VPDES PERMIT FOR DISCHARGES OF STORMWATER FROM
CONSTRUCTION ACTIVITIES (VAR10)
REGISTRATION STATEMENT 2019
Application type. ❑ NEW PERMIT ISSUANCE
(CHOOSE ONE) ❑ MODIFICATION WITH ACREAGE INCREASE
❑ MODIFICATION WITHOUT ACREAGE INCREASE
❑ EXISTING PERMIT RE -ISSUANCE
Section I. Operator/Permittee Information.
PERMIT #:
PLAN/ID #:
TECHNICAL CRITERIA: 1113 ❑ IIC ❑
A. Construction Activity Operator (Permittee). The person or entity that is applying for permit coverage and will have
operational control over construction activities to ensure compliance with the general permit. A person with
signatory authority for this operator must sign the certification in Section VI. (per Part III. K. of the VAR10 Permit).
Operator Name:
Contact person: Garland Watkins
Address:
City, State Zip Code:
Phone Number:
Primary Email: earland.watkinst7a valvoline.com
CC Email:
B. Billing Information (leave blank if same as the Operator identified in Section I. A. above). This entity will receive
Annual Permit Maintenance and Permit Modification Fee invoices (if applicable).
Name:
Contact Person:
Address:
City, State Zip Code:
Phone Number:
Primary Email:
CC Email:
C. May we transmit correspondence electronically? You must choose YES and include a valid email in order to pay by
credit card and to receive your permit coverage approval lettervia email: YES ❑ NO ❑
Section II. Construction Activity Location Information. Project site information.
A. Include a site map showing the location of the existing or proposed land -disturbing activities, the limits of land
disturbance, construction entrances and all water bodies receiving stormwater discharges from the site.
B. Construction Activity Name:
Address:
City and/or County and Zip Code:
Latitude and Longitude
(6-digit, decimal degrees format):
C. Construction Activity Entrance Location
(description, street address and/or
latitude/longitude in decimal degrees):
Rev 01/2020 PAGE 1 1 6
CONSTRUCTION GENERAL PERMIT (VAR10) REGISTRATION STATEMENT 2019
Section III. Offsite Support Activity Location Information. List all offsite support activities to be included under this
permit registration. Enter additional areas on a separate page. Offsite areas not included on this registration will need
to obtain coverage under a separate VPDES permit.
A. Offsite Activity Name:
Address:
City and/or County and Zip Code:
Latitude and Longitude
(6-digit, decimal degrees format):
B. Offsite Activity Entrance Location
(description, street address and/or
latitude/longitude in decimal degrees):
Section IV. Site Information.
A. Property Owner Status:
B. Nature of the Construction Activity Description (i.e.
commercial, industrial, residential, agricultural,
environmental):
C. Municipal Separate Storm Sewer System (MS4)
name(s) (if the site is discharging to a MS4):
FEDERAL ❑ STATE ❑ PUBLIC ❑ PRIVATE ❑
D. Acreage totals for all land -disturbing activities to be included under this
permit coverage. Report to the nearest one -hundredth of an acre.
Total land area of development (including the entire
area to be disturbed as approved in the Stormwater
Management Plan):
Primary estimated area to be disturbed (portions with
Erosion and Sediment Control Plan approval only):
Offsite estimated area to be disturbed (if applicable):
E. Estimated Project Dates
(M M/DD/YYYY)
Start date:
Completion date:
F. Is this construction activity part of a common plan of development or sale? YES ❑ NO ❑
G. 6`" Order Hydrologic Unit Code (HUC) and Receiving Water Name(s). Attach a separate list if needed.
HUC RECEIVING WATERBODY(S)
Section V. Other Information.
A. 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 the Registration
Statement. By signing the Registration Statement, the operator is certifying that the SWPPP has been prepared.
B. Has an Erosion and Sediment Control Plan been submitted to the VESC Authority for review? YES ❑ NO ❑
C.
Erosion and Sediment Control Plan Approval Date (for estimated area to be disturbed).:
Has land disturbance has commenced? YES ❑ NO ❑
D. Annual Standards and Specifications. If this project is utilizing approved Annual Standards and Specifications (AS&S),
attach the completed AS&S Entity Form.
AS&S Entity Name (if different from the Operator identified in Section II. A.):
Rev 01/2020 PAGE 2 16
CONSTRUCTION GENERAL PERMIT (VAR10) REGISTRATION STATEMENT 2019
Section VI. Certification. A person representing the operator as identified in Section I. A. and meeting the requirements
of 9VAC25-880-70. Part III. K must physically sign this certification. A typed signature is not acceptable. Please note that
operator is defined in 9VAC25-870-10 as follows:
"Operator" means the owner or operator of any facility or activity subject to the Act and this chapter. In the context of stormwater
associated with a large or small construction activity, operator means any person associated with a construction project that meets
either of the following two criteria: (i) the person has direct operational control over construction plans and specifications, including
the ability to make modifications to those plans and specifications or (ii) the person has day-to-day operational control of those
activities at a project that are necessary to ensure compliance with a stormwater pollution prevention plan for the site or other state
permit or VSMP authority permit conditions (i.e., they are authorized to direct workers at a site to carry out activities required by the
stormwater pollution prevention plan or comply with other permit conditions). In the context of stormwater discharges from
Municipal Separate Storm Sewer Systems (MS4s), operator means the operator of the regulated MS4 system.
9VAC25-880-70. Part III. K. Signatory Requirements. Registration Statement. All Registration Statements shall be signed as follows:
a. For a corporation: by a responsible corporate officer. For the purpose of this chapter, 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 gather complete and accurate information for state permit application requirements; and where authority
to sign documents has been assigned or delegated to the manager in accordance with corporate procedures,•
b. For a partnership or sole proprietorship: by a general partner or the proprietor, respectively; or
c. For a municipality, state, federal, or other public agency: by either a principal executive officer or ranking elected official.
For purposes of this chapter, a principal executive officer of a public agency includes: (i) the chief executive officer of the
agency or (ii) a senior executive officer having responsibility for the overall operations of a principal geographic unit of the
agency.
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:
Signature (signed in ink): 5wyi Watkiki
Date Signed: 09-29-20
Section VII. Submittal Instructions. Submit this form to the VSMP Authority. If the locality is the VSMP Authority,
please send your Registration Statement submittal directly to the locality; do NOT send this form to DEQ. A list of local
VSMP Authorities is available here: VSMP Authorities.
If DEQ is the VSMP Authority, please send to: If the locality is the VSMP Authority, please send to:
Department of Environmental Quality
Office of Stormwater Management Suite 1400
PO Box 1105
Richmond VA 23218
constructiongp@deg.vi rein ia.gov
Rev 01/2020 PAGE 3 16
Section 2. Notice of general permit coverage
(This notice is to be posted near the main entrance according to 9VAC25-880-70, Part II, section
C.) (Provide a copy of the DEQ coverage letter when obtained)
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
Section 3. Nature of activity
(Provide a detailed narrative of the construction activities. Include or reference a construction schedule and
sequence. Include any phasing.)
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
Section 4. Erosion and Sediment Control Plan.
(Provide a reduced, 11x17 copy of the latest Erosion and Sediment Control Plan. Do not reference only.)
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
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(Provide a reduced 11x17 copy of the latest stormwater management plan. Do not reference only.)
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
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STORM WATER COMPLIANCE
THIS CEYFLM4NM MEET$ $TORMWALFA REQUIREMENTS MR OUALItt AND CVNTTY
THROUGH APPROVED WPO201WOU BIOFILTTA AND VEND IMENCMENTM TO WAD 2006 W50.
APPROVED ADDITIONAL IMPERVIOUS COVER'. IB.@5 BE
FROPOSEDADOITI0NALIMFEINIOU8CWEN UlJWBFROP 3,09SEXIM-17.W1SF
ME IB ANALYSIS PERFORMEDATC1YM MEAMOUTFALLSMOSUREWNEG TVEIMPACTS
FROM LAND DISTURBING ACTIVATES AND THAT FACILITIES ME ADEQUATE MR ORW03ED
DISGkWES.(REFER TO WRD PLAN FOR EC ION AND SEDIMENT CONTROL CLEM)
CESOr
EAST VS IMPOSED MANAGE OBER AND RUNOFF -IS&DOLOR STORM)
[kalna-
iobI Area
2-"BU.II
]DYa
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Pma Runts
Pre RumX
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630
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D.50
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0.50
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"I=9/IR .D-B 4 D. Ef o[RII b VCOT JGWRI MomN APE
STORM SEWER PIPE TABLE
PIPERUN
SIZE&WPE
LENGTH
SLOPE
INV. UP
II DOWN
STOd
16KP
TI.1'
0Po%
HS2w
152.00
d TO3
15'RCP
HIS
0EN
9IN
451.55
3TO2
15'WP
33.0
0Po%
6512E
41A5
2T01
I 15'RCP
47.5'
100%
91.I9
450.71
LAND COVER & RUNOFF COEFFICIENT (C) SUMMARY
RUNOFF
DRAINAGE
AREA
AREA
LEGEND
DESCRIPTION
COVER
C
AREA
(SQ. FT.)
(ACRES)
(C)
(C)
+
GLENELGLOAM
LAWNS
0
0.000
+ + + + +
HYDROLOGIC SOIL GROUP B
IMFERVI01}SAREA
PAYEDANO ROOFIAFAS
THE
OXUS
3
TOTAL AREA
I'm
0.03E
COMPORTED
OAS
+ + +
GLENELGLOAM
LAWNS
1�
I'm
+ + + + +
HYDROLOGIC SOIL GROUPS
IMPERVI USAREA
PAVEDANDR00FAREAR
Lm
B.ar
roiu AREA
LBSB
B.az
COMPOETEC
0w
GLEN LOAMI
TIMING
1, 07
0 W2
+ + + +
HYDBMWICSOLGWUPB
IMFEAVIOLLSAREA
PAVEDANDRCLi AREAS
72M
0.1W
TOTAL AREA
0610
0.1Po
WMFQSITEC
ROBS
CESOr W➢S. DR
xTllavNAUA A n:vEI`H„aLOWa4 -
-
MOR
IN
MIN
NAMN
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CESQ
rrr.ew�lu.u■
757280
AS NOTED
NET
TJV
P
r
03.06.20
°aApi°`
DIq WLN000
S BEFORE O
N,
TORIYEIGHT
THE S SHAIB
N WMMEWE THE camACiORS SHALL
THE FOLLOWING AGENCIES:
NOTME
PROPOSED
DRAINAGE PLAN
C AND ALL
R 2MIGH AND ALL
AGENCIAT
OTHER S WHICH
OTHER AGENCIES WELCH MIGHT HAVE
UNDERGROUND UTILITIES INVOLVING THIS
C=005FOR CCMER,"GOI
AND ME
PWIECT AND ME NONMEMBERS OF VIWINIA
pmyU lq
C5.1
TEVELOPMENNU PEAVWi CNEGLL.
IPAIWWEANNUAL
Section 6. Pollution Prevention Plan.
(reference County Code 17-404 and State Regulation 9VAC25-880-70 part II section A.4)
A. Plan showing pollution activities and prevention practices
(Provide a reduced I Ix17 copy of a site plan on which all of the following activity locations are clearly
marked. Keep this plan up-to-date with ongoing site changes and inspections.)
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
\ // PHASE2
\LEASSE P.O.B. �? / SEQUENCE OF CONSTRUCTION.
PLwSFR3 aPWI SF t 1R051 A' / 1. NOTIFY INSPECTOR BEFORE COMMENCING IMAGE 2.
/N{ / pA✓, / �' •/- C09t 4659.E VM32 !d/MO!?AE84AlW — e
/ / I PMCEL/MSpO M M 1116p ( Ox J/ 2 INSTALL NEXTSTALLIDDQUENC PHV5E2TEMPOMRYEROSION CONTROL MEASURES, 0.55HWM.INSPECTOR MUST APPROVE ALL EROSION CONTROL MEASURES PRIOR TO
/ xExT 91EPIry 9EWWCE.
y. I• \ � 3. BEGIN MUCH GRADINGME SHE, WKIINGWRETHATEROBIONWNTROLMEP511R MEMWINGPMPERLYTHNWGHMT IINGCfEflPTIWs.
\ l LYAEHHR / q. PFRTTFMFGWLYSEWING.
llWFM&GF STRICTURES
OFNLSLgiMSEl4flVAN0 UNDERGROUND UTILITIES. INSTALL INLET PROTECTION CONCURRENT WITH CONSTRUCTONOFPROPOSED SNRM
SIRUCNRES.
$ FINE CAAOIxG,$UBGRACE PREPARAMGN ADD SITE MING. CONCRETE WASHOUT SHALL BE INSTALLED PRIM TOM CONCRETE WORK.
\ J
k / /fie / CW T. CWSTflWiBUILDING.
g 8. BEGIN CONSTRUCTION OFPARKING LOT, DRIVES, SIOEWALKs.AND CONCRETE FU1WgMAND WR85.
/ Jp 3Q, // 9. AREAS EIPLY$EW REAWNDEROFPERJIOUSMFAS. PEWNNEXi$EOUING$IWIBEIN$iADF➢WITIINm MY$OF WMRETION C£FIWLLGRO➢ING IN UNPAVED
fL' y0 PRFAsPERINA.
yL0
4 O °'
}�
/ \
p
10. NMI SOIL STABILIZATION BWIKETAS SHOWN AND ANY OVER PLACES AS REWIRED.
//
/
b
11. REIA'JVETFLPC YMOSIWCCMNCLMFISURESAFTER$REACHIE4E$'FINAL MILIIATION'MDAP%VOVALOFIN$PECTOR.
flEFEfl TOLPNDSCMEPUN FOR9EFOING.
IP
/
'COMACTORSHAIL MODIFY THE SEQUENCE OF CONSTRUCTION BASED ON SITE CONDITIONS SUBJECT TO APPROVAL FROM AIBEMPLE COUNTY. CONTRACTOR TO
NOTIFY PROJECTMUNNEER PRICK TO CHANGING SEQUENCE OF CONSTRUCTION.
Inv/s- an
vIW w
GwosaDRWE
2,060SR H='X'41'
/
MS-19 ANALYSIS
/ v
GL a0
FRET COLD LEAF VHO iflll`. CO
REx BZL <&5B 32ZusTs[
PAMIDO 500—W—oo—III(
DISCHARGE
POINT
DRAINAGE
AREA
QCAPACn
C2
C1D
v10
MS-19ANALYSIS
THEDEVELOPMENT RUNOFF RATE IS MAINTAINED BY METHODS OTHER THAN METE
El WIFALL
affix0d2CFS
0S, CPS
DETEMICN FOR THE GO(HATURAM AND 010 DANME) STORM EVENTS
DISCHAAGINGINTOAN ADEQUATENAT MLORMAJIMADECCNVEYANCESYSTW
PRE DEVELOPMENT RUNOFF HATE IS MAINTAINED BY METHODS OTHER THAN W$HE
E2 OUTFALL
aRAC
OOBCFB
OUNCES
DETEMIWFORTHEWLHATLEW AND 010 DEANNME) STORM EVENTS
DISCHARGINGINTOAN ADEQUATENANMLORMAJIMADECCNVEYANCESYSTW
PROPOSEDI5'
STORM SEWER
OA3 AC
6t6CFB
227CFS
364 FEE
TEN YEAR STOW, 010, WILL BE CONTAINED IN THE STORM SEWER.
OUTFAIL
,) 'SEE SHEETS C50,C51,6 C52 FOR DRAINAGE AREA WIFE AND CALCULATIONS
.11
S6fi9'
4
ANALYSIS �WLTA GFCc
)EXlsnNG N D ITLL 1 \ Vn-TRNIr� 'L oP g (CURBEl TiFALL s
BIa
MSIBANPLYSI$ UNN
OPOE PDSTOR BRL RnER BIRC�������L2��5 IP
e^/®�///
//// %�/ -�1 � S Jg 0-J,p I \
�• /( J^F°1S1%
PARCEL
�F J x/F 1AL v
NR6T GCIO L F 1 TvxsT // l \ vLnP INN RCRGL uc Er N'OCi,/ iW /
PMCEL0600-00-00-11c0 PMfiFUOAPN-m-m-uwv
49546.9 1.14 AC. TINE BuNINC DISTANCE
f Ll P N JP33'19' E I6.56'
� 1
LEGEND
ENSTING
REFER TO EX. CONOITIWS AND
AT CEAICLITION
PUN SHEET FOR EXISTING LEGEND DBMS
PROPOSED
4 I: LIMITS OF DISTURBANCE —N —s`— SILENCE
'< •� THEE PROTECTION .0000000000000000. STMWWATTLE
IP ® INLETPROTECTIW O TFNPCRARYSEE➢ING
OEMTEMPMARYSTOCKPIIE O FEAMpNFNTSEEDING
CCNSTiUCTION ENTRANCE
CE ® ALBEMARIE COUNTY FAMED WASH Q® CWCRETEWASHOT
FAGG
SL STAGINGUYOGNNAREA OP OULTETPROTECTIW
cRA»IIcsGALEpx FEET)
CESQ
rrr.ew�lu.u■
1, 757M I
TJV
03.IRS 20
DIRwm000
D.A9T6.
FCRTY£IGHT (AS) HORS BEFORE DIGGING 2
TO COMMENCE. THE coNTRACIORS SHA
EROSION& SEDIMENT
NOTIFY ME FOULOWING AGENCIES'. VIflGINIA
CONTROL-PHASE2
ONE CALL AT 811 OR (S'A) 55I 1f01 AND All
OTHER AGENCIES WHICH MIGHT HAVE
UNDERGROUND UTILITIES INVOLVING THIS
PROJECT AND ARE NONMEMBERS OF VIgGINIq
ONECPIL.
piµylq
C6.1
B. Sources of Pollutants, locations, and prevention practices
Pollutant, or Pollutant
Location on site
Prevention Practices,
Generating Activity
Control Measures
C. Sources of Pollutants, continued. Common activities and minimum control and prevention
ractices
Pollutant, or Pollutant
Location on site
Prevention Practices,
Generating Activity
Control Measures
Follow Erosion and Sediment Control
Clearing, grading, excavating, and un-
Land disturbance area
Plan. Dispose of clearing debris at
stabilized areas
acceptable disposal sites. Seed and mulch,
or sod within 7 da s of land clearing
Cover storm drain inlets and use drip
Paving operations
Roads and driveways
pans and absorbent/oil dry for all paving
machines to limit leaks and spills
Direct concrete wash water into a leak -
Concrete washout
Current location and detail shown
proof container or leak -proof settling
and cement waste
on plan
basin that is designed so that no overflows
can occur
Enclose or cover material storage areas.
Mix paint indoors in a containment area or
Structure construction, stucco,
Structures
in a flat unpaved area. Prevent the
painting, and cleaning
discharge of soaps, solvents, detergents
and wash water, paint, form release oils
and curing compounds.
Water shall be filtered, settled or similarly
Dewatenng operations
Dewatenng sites shown on plan
treated prior to discharge as shown on
plan.
Designated areas for material delivery
Material delivery and storage
Designated area shown on plan
and storage. Placed near construction
entrances, away from waterways and
drainage paths
Material use during building process
Building areas
Follow manufacturer's instructions
. MSDS's attached.
waste collection area will not receive a
substantial amount of runoff from upland
Solid waste disposal
Current designated container areas
areas and does not drain directly to a
on plan
waterway. Containers have lids covered
before periods of rain, or are in a covered
area. Scheduled collection to prevent
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
Pollutant, or Pollutant
Location on site
Prevention Practices,
Generating Activity
Control Measures
overfilling. MATERIALS NOT TO BE
BURIED ONSTTE
Convenient and well -maintained
portable sanitary facilities will be
Sanitary waste
Current locations shown on plan
provided, and located away from
waterways or inlets. Such facilities shall
be regularly maintained.
Apply fertilizers in accordance with
Landscaping operations
Landscape areas shown on plan
manufacturer's recommendations and
not during rainfall events
To be treated in a sediment basin or
Wash Waters
Wash areas shown on plan
better control as specified on plan.
Minimize the discharge of pollutants
from equipment and vehicle washing
Vehicle and equipment washing
Designated areas and details shown on
Provide containment and filtering for all
plan
wash waters per the plan
Minimization of exposure to precipitation and stormwater. Minimize the exposure of building materials, building products,
construction wastes, trash, landscape materials, fertilizers, pesticides, herbicides, detergents, sanitary waste, and other materials
present on the site to precipitation and to stormwater.
(Identify all non-stormwater discharges to occur on your site. Keep this plan up-to-date with ongoing site
changes and inspections. See CGP, 9VAC25-880-70 section E for examples of non-stormwater discharges.)
0
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
E. Persons responsible for pollution prevention practices
(Provide the names and contact information for all persons responsible for prevention practices as listed above.)
F. Response and reporting practices
Minimize discharges from spills and leaks. Minimize the discharge of pollutants from spills and leaks and implement chemical
spill and leak prevention and response procedures as follows.
Respond to all spills, leaks and discharges as follows,
Report all spills, leaks and discharges as follows,
(Provide detailed response and reporting practices according to 9VAC25-880-70, Part II, section AA.e.)
G. Pollution Prevention Awareness
(Describe training and procedures to provide awareness and compliance for all measures in this
document; waste management, wash waters, prevention measures, etc.)
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
Section 7. Discharges to impaired waters, surface waters within an applicable TMDL
wasteload allocation, and exceptional waters.
(Provide detailed measures for any applicable TMDL)
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
Section 8. Qualified personnel
The following personnel are responsible for inspections;
(Provide the name, telephone number, and qualifications of the qualified personnel conducting inspections.)
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
Section 9. Signed Certification
(Provide certification according to 9VAC25-870-370)
CERTIFICATION
"I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate 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."
Operator Name:
Company:
Title:
Signature: G"4i kveki4s
Date:
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
Section 10. Delegation of authority.
(Provide the persons or positions with authority to sign inspection reports or to modify the stormwater pollution
prevention plan. A formal, signed delegation of authority is needed.)
Delegation of Authority
I, (name), hereby designate the person or specifically described position below to be a duly authorized
representative for the purpose of overseeing compliance with environmental requirements, including the Construction General Permit,
at the construction site. The designee is authorized to sign any reports, stormwater
pollution prevention plans and all other documents required by the permit.
(name of person or position)
(company)
(address)
(city, state, zip)
(phone)
By signing this authorization, I confirm that I meet the requirements to make such a designation as set forth in the Construction
General Permit (CGP), and that the designee above meets the definition of a "duly authorized representative".
Operator Name:
Company:
Title:
Signature:
Date:
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
Section 11. General permit copy
(Provide a copy of the construction general permit, 9VAC25-880)
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
Section 12. Inspection logs
(Provide templates for your inspections. Requirements are listed in 9VAC25-880-70, Part II, section B and F.)
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County