HomeMy WebLinkAboutWPO201800064 Other 2018-08-17ON TIEg4 " 3. (from Albemarle County Code See. 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.
S. Qualified personnel
9. Signed Certification
10. Delegation of authority.
11. General permit copy
12. Inspection logs
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Issued—10/2014 Stormwater Pollution Prevention Plan (S WPPP) Albemarle County
(Provide a signed completed copy of the DEQ registration statement)
Issued—10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
t��Sas'�,�Tiari 3saxer�lel��
Canarei WOES Parmit Y'ov 01schiorges of Stormwatter from Constrtactlon € ckivities
(Piease'ryoe or PrinI' All .aforr!i'o!a)
I. Construction Activity Operator: (General permit coverage will be issued to this operator. The Certification in Item #12 must be
signed by the a propriate person associated with this operator.)
Mailing
Email address (if available):
Indicate if DEQ may transmit general permit correspondence electronically: Yes &�r No ❑
2. Existing General Permit Registration Number (for renewals
3. Name and Location of
Address (if available): 1 15 U KnnU y4po i
City: C z State: UA Zip. '�Q9331
County (if not located within a City): t^l� haMadp-
Latitude (decimal degrees):_- �'rT�% Longitude (decimal degrees):
Name and Location of all Off -site Support Activities to be covered under the general permit:
Name: !1 G
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 L�
5. Nature of the Construction Activity (e.g., commercial, industrial, residential, agricultural, oil and gas, etc.):
6. Name onf �th'e- Receiving Waters and Hydrologic Unit Code (HUC):
Name:t�:9rlaa4 . Mcc4Obfdllt5 y;rvt2—SiGc�%✓� CYce
HUC: 0309,MD!+ /D 1 JRd / HUC:
7. If the discharge is through a Municipal Separate Storm Sewer System (MS4), the name of the MS4 operator:
8. Estimated Project Start and Comp etion Data:
Start Date (mm/dd/yyyy): Id i5I (8 Completion at (mm/dd/yyyy): 1.I9711�
9. Total Land Area of Development (to the nearest one -hundredth acre):
Estimated Area to be Disturbed (to the nearest one -hundredth acre): 494?
10. Is the area to be disturbed part of a larger common plan of development or sale? Yes I/ No ❑
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 imprison�%�nri for knowing violation �s." ` /'n [ I _ . _'
Printed Name: V V (��1(�ry i D. UQIA _ Title: I/r' (DT hLL i0
Signature: - Date 81151le>
(Please sign in INK. This Certification must be signed by the appropriate person associated with the operator identified in
Item #1.)
07/2014 Page 1 of 1
ifisvmt ;4Ons for Coi-ripieting the Reyfs'd..t'iior; Statement
aane;ai WDES Perraft for Cisctiargas ofSto.wwaterfrom Construction Activities (V.r RIO)
GENERAL
A. Coverage Under this General Permit.
Any operator applying for coverage under this general permit who is
required to submit a Registration Statement (see Section B below)
must submit a complete Registration Statement to the Department.
The Registration Statement serves as a Notice of Intent for coverage
under the General VPDES Permit for Discharges of Stormwater from
Construction Activities (VAR10).
B. Single-family Detached Residential Structures.
Operators with an existing stormwater discharge or proposing a new
stormwater discharge associated with the construction of a single-
family detached residential structure are not required to submit a
Registration Statement or the Department of Environmental Quality
(DEQ) portion of the general permit fee.
Operators of these types of discharges are authorized to discharge
under this general permit immediately upon the general permit's
effective date of July 1, 2014.
C. To Apply for Permit Coverage.
1. New Construction Activities. Any operator proposing a new
stormwater discharge from construction activities shall submit a
complete Registration Statement to the Department prior to the
commencement of land disturbance, unless exempted by Section B
above. Any operator proposing a new stormwater discharge from
construction activities in response to a public emergency where the
related work requires immediate authorization to avoid imminent
endangerment to human health or the environment is immediately
authorized to discharge under this general permit and must submit a
complete Registration Statement to the Department no later than 30
days after commencing land disturbance; documentation to
substantiate the occurrence of the public emergency must
accompany the Registration Statement.
2. Existing Construction Activities. Any operator that was
authorized to discharge under the general permit issued in 2009,
and who intends to continue coverage under this general permit,
shall submit a complete Registration Statement to the Department
on or before June 1, 2014, unless exempted by Section B above.
D. Where to Submit Registration Statements.
All Registration Statements should be submitted to:
Department of Environmental Quality
Office of Stormwater Management, 101" Floor
P.O. Box 1106
Richmond, VA 23218
LINE -BY-LINE INSTRUCTIONS
Item 1: Construction Activity Operator Information.
"Operator" means the owner or operator of any facility or activity
subject to the Stormwater Management Act and regulations. 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: (1) 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).
The entities that are considered operators will commonly consist of the
owner or developer of a project (the party with control of project plans
and specifications) or the general contractor (the party with day to day
operational control of the activities at the project site which are
necessary to ensure compliance with the general permit).
Provide the legal name (do not use a colloquial name), contact, mailing
address, telephone number, and email address (if available) of the
construction activity operator; general permit coverage will be issued to
this operator. Indicate if the Department may transmit genera' permit
correspondence electronically.
Item 2: Existing General Permit Registration Number.
For reapplication only, provide the existing general permit registration
number for the construction activity. This item does not need to be
completed for new construction activities applying for general permit
coverage.
Item 3: Name and Location of the Construction Activity
Information.
Provide the official name, street address (If available), city or county (if
not located within a City) of the construction activity. Also, provide the
latitude and longitude in decimal degrees of the approximate center of
the construction activity (e.g., N 37.5000, W 77.5000).
Name and Location of Off -site Support Activity Information.
This general permit also authorizes stormwater discharges from
support activities (e.g., concrete or asphalt batch plants, equipment
staging yards, material storage areas, excavated material disposal
areas, borrow areas) located on -site or off -site provided that (1) the
support activity is directly related to a construction activity that is
required to have general permit coverage; (ii) the support activity is not
a commercial operation, nor does it serve multiple unrelated
construction activities by different operators; (iii) the support activity
does not operate beyond the completion of the construction activity it
supports; (iv) the support activity is identified in the registration
statement at the time of general permit coverage; (v) appropriate
control measures are identified in a SWPPP and implemented to
address the discharges from the support activity areas; and (vi) all
applicable state, federal, and local approvals are obtained for the
support activity.
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
covered under this general permit. Also, provide the latitude and
longitude in decimal degrees of the approximate center of the off -site
support activities (e.g., N 37.5000, W 77.5000). Also, if an off -site
support activity is going to be covered under this general permit the
total land area of the off -site support activity and the estimated area to
be disturbed by the off -site support activity need to be included in Item
#9.
Item 4: Status of the Construction Activity.
Indicate the appropriate status (Federal, State, Public, or Private) of
the construction activity.
Item 5: Nature of the Construction Activity.
Provide a brief description of the construction activity, such as
commercial, residential, agricultural, oil and gas, etc. This list is not all
inclusive.
Item 6: Receiving Waters(s) and HUC Information.
Provide the name of the receiving water(s) and corresponding HUC for
all stormwater discharges including any stormwater discharges from
off -site support activities to be covered under this general permit.
Hydrologic Unit Code or HUC is a watershed unit established in the
most recent version of Virginia's 6" order national watershed boundary
dataset.
07/2014 Page 1 of 2
item 7: MSI: Infonation.
If stormwater is discharged through a municipal separate storm sewer
system (MS4), provide the name of the MS4 operator. The name of the
MS4 operator is generally the Town, City, County, Institute or Federal
facility where the construction activity is located.
Item 8: Construction Activity Start and Completion Date
Information.
Provide the estimated start date (month/day/year) of the construction
activity. Provide the estimated completion date (month/day/year) of
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
gather complete and accurate information for 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.
c. For a municipality, state, federal, or other public agency: by either
a principal executive officer or ranking elected official. For purposes
of this part, 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.
07/2014 Page 2 of 2
(This notice is to be posted near the main entrance according to 9VAC25-880-70, Part IT, section
C.) (Provide a copy of the DEQ coverage letter when obtained)
Issued—10/2014 Stonnwater Pollution Prevention Plan (SWPPP) Albemarle County
(Provide a detailed narrative of the construction activities. Include or reference a construction schedule and
sequence. Include any phasing.)
6
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4 �Noc hold On Kgas+b9zk1on
Issued — 10/2014 Stormwater Pollution Prevention Plan. (SWPPP) Albemarle County
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
�93;x}r:_Awsiei- A&a*r &tgadrpQk VIack
(Provide a reduced 11 x 17 copy of the latest stormwater management plan. Bo not reference only.)
Issued—10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
(reference County Code 17-404 and State Regulation 9VAC25-880-70 part 11 section A.4)
A. Plan showing pollution activities and prevention practices
(Provide a reduced 11x17 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
s-r� It-sor.:s
FL el, gcs, oil, coo:a: it
Sot to be sto•-ed w site
A`ot to be stored o". site, clae.n arev Sc�
Concrete
Concrete wesh out
wash out, dispose when dey
Paint
Garages
Wash in washout
cleaning materials
garages
Wash in washout
Asphalt
Only used to pave
use leftovers for curbs
Termite spray
Sprayed around foundation
per code
Drywall compound
Garages
Let dry and dispose of
block mortar
within silt fencing
Cure before disposing of
Tile grout
inside
clean in washout
C. Sources of Pollutants, continued. Common activities and minimum control and prevention
--- 4
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
acceptable disposal sites. Seed and mulch,
stabilized areas
or sod within 7 days of land cleating
Cover storm drain inlets and use drip
Paving operations
Roads and driveways
pans and absorbentloil 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,
Structuresin
aflat unpaved area Prevent the
discharge of soaps, solvents, detergents
p i tiny and cleaning
and wash water, paint, form release oils
and curing compounds.
Water shall be filtered, settled or similarly
Dewatering operations
Dewatering sites shown on plan
treated prior to discharge as shown on
Designated areas for material delivery
and storage. Placed near construction
Material delivery and storage
Designated area shown on plan
entrances, away from waterways and
drgnM paths
Follow manufacturer's instructions
Material use during building process
Building areas
. MSDS's attached
waste collection area will not receive a
substantial amount ofrunoff from upland
Current designated container areas
areas and d�not of drain y to a
lids
Solid waste disposal
on plan
w�'way-s have 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
Poilutant, or aollttant
-
Location on site
?revention 3rsctic:s,
Generating Activity
Control Measures
overfilling. MATERIALS NOT TO BE
BURIED ON -SITE
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
better control as specified on plan.
Wash Waters
Wash areas shown on plan
Minimize the discharge of pollutants
from equipment and vehicle washing
Designated areas and details shown on
Provide containment and filtering for all
Vehicle and equipment washing
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.)
D.
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.)
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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 A.4.e.)
G. Pollution Prevention Awareness
(Describe training and procedures to provide awareness and compliance for all measures in this
rIncnment: waste management, wash waters, prevention measures, etc.)
Issued—10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
Aes,sonse and re 3orclrg prac- i.as
Most spills can be cleaned up following manufacturer specifications. Absorbent/oil dry, sealable
containers, plastic bags, and shovels/brooms are suggested minimum spill response items that should be
available at this location.
1n Priority: Protect all people
2"d Priority: Protect equipment and property
3rd Priority: Protect the environment
1. Check for hazards (flammable material, noxious fumes, cause of spill) — if flammable liquid,
turn off engines and nearby electrical equipment. If serious hazards are present, leave the area and call
911. LARGE SPILLS ARE LIKELY TO PRESENT HAZARD.
2. Make sure the spill area is safe to enter and that it does not pose an immediate threat to health
or safety of any person.
3. Stop the spill source..
4. Call co-workers and supervisor for assistance and to make them aware of the spill and potential
dangers.
5. If possible, stop spill from entering drains (use absorbent or other material as necessary).
6. Stop spill from spreading (use absorbent or other material).
7. If spilled material has entered a storm sewer; contact locality's storm water department.
8. Clean up spilled material according, to manufacturer specifications; for liquid spills, use
absorbent materials and do not flush area with water.
9. Properly dispose of cleaning materials and used absorbent material according to manufacturer
specifications.
Emergency Contacts:
Normal Working Hours DEQ Valley Regional Office 540-574-7800
Nights, Holidays & Weekends VA Dept. of Emergency Management 804-674-2400
C. Poiut:onPreventicrcAvva:e-.ess
All Project Managers for our company are trained to comply with standard SWPPP procedures.
This includes the following:
• Tarping and un-tarping dumpsters
• Removal and disposal of concrete washouts
• Location of toilets and dumpsters
• Silt fence requirements
• Removal and disposal of any spilled pollutants
• Daily and weekly reporting practices
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'%,✓2+SS'2� s?i3 g�� s�,;s`tfl:f 1y and 3x -)P"�lifrn sJ -wk-Irs,
(Provi?.ie detailed measures for an} applicable T%MDLI
Issued — I Oiy014 Stormwater Pollution Prevention Plan (SWPPP) :Ubemarle County
The following personnel are responsible for inspections;
(Provide the n:emc. telephone number, and qualifications of the qualified personnel conducting inspections.)
ScA
�osh4ns
vvi Mark
(-103) a8a - 49a5
PliOlee�- Mgtu�r
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
S gy y, I'3 a% �' 7't its
(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: Vvi ai Q1rgDI _, Cml'
Company: C171LYLs
Title: `mJ(r}— rr GU(7lOfl
Signature:
Date: 8 I S 18
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
(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, 1111 I/l IQ D , CV (name), hereby designate the person or specifically described position below to be a duly authorized
repres tive for the par ose of overseein compliance with environmental requirements, including the Construction General Permit,
at the V46 8 HAN construction site. The designee is authorized to sign any reports, stormwater
pollution prevention tans land all other documents required by the permit.
—jCL�$I l�s�� ' (name of person or position)
(company)
(address)
(city, state, zip)
G� V" (phone)
(703) a8a.-qy-as
By signing this authorization, I confinn 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: WiUkafy-1 D.
Company:
Title: VP Df 6s "t6or.�.
Signature: k4f� / , U
Date: 8) 15I 1 E)
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
(Provide a copy of the construction general permit, 9VAC25-880)
Issued — 10/2014 Stonnwater Pollution Prevention Plan (SWPPP) Albemarle County
(Provide templates for your inspections. Requirements are listed in 9VAC25-880-70, Part II, section B and I'.)
Issued — 10/2014 Stonnwater Pollution Prevention Plan (S WPPP) Albemarle County
Community