HomeMy WebLinkAboutWPO202000044 VSMP - SWPPP 2021-02-12STORMWATER POLLUTION PREVENTION PLAN
TENPAS RESIDENCE / WP02020-00044
SINGLE FAMILY RESIDENCE
COMMON PLAN of DEVELOPMENT or SALE
STORMWATER POLLUTION PREVENTION PLAN (SWPPP)
For Construction Activities At:
W P02020-00044
TENPAS RESIDENCE
1 NW Wesley Chapel Rd
Free Union, VA
Albemarle County
Latitude:38.168534 N (decimal degrees)
Longitude:-78.592287 W (decimal degrees)
Construction Activity Operator:
Smith & Robertson, Inc.
Ron Smith
434-971-7026
ron@smithandrobertson.com
1128 East High St
Charlottesville, VA 22902
SWPPP Preparation Date:
February 12, 2021
CERTIFICATION
"1 certify under penalty of law that I have read and understand this document 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."
Operator Name: Si" I I (-��Q03Ska S is) utJ Sv) 1--Ti4
Title: J,(4_- ?QiSr l)
Signature: S.Cp J
Date:
APPROVED
by the Albemarle County
Community Development Department
Date 03/17/2021
07/2014, Rev. 1 File WP0202000044 Single Family Residence, CPoD, SWPPP
STORMWATER POLLUTION PREVENTION PLAN
TENPAS RESIDENCE / WP02020-00044
1.0 SWPPP Documents Located Onsite & Available for Review
SWPPP Document Type Located Onsite & Available for Review?
Registration Statement
❑ Yes
®
NA
Notice of Coverage Letter
❑ Yes
❑
NA
Construction General Permit
❑ Yes
❑
NA
Site Plan
❑ Yes
❑
NA
Erosion & Sediment Control Plan (or agreement in lieu of)
❑ Yes
❑
NA
Stormwater Management Plan (or agreement in lieu of)
❑ Yes
❑
NA
2.0 Authorized Non-Stormwater Discharges
Tvoe of Authorized Non-Stormwater Discharge Likely Present at Your Project Site?
External buildings wash down
❑ Yes
❑
No
Uncontaminated foundation or footing drains
❑ Yes
❑
No
Uncontaminated excavation dewatering
❑ Yes
❑
No
Landscape irrigation
❑ Yes
❑
No
Others [describe]
❑ Yes
❑
No
3.0 Pollution Prevention Awareness
Employees will be given a'Walk through" of the site identifying areas of possible pollution and will be shown Erosion
and Sediment Controls and Pollution Prevention Practices (identified in Sections 4.0 and 5.0 of this SWPPP) that are
applicable to their assigned job duties. A refresher meeting and 'Walk through" will be conducted on an as needed
basis.
4.0 Erosion & Sediment Controls
Select all
Estimated
Estimated
Responsible
that apply
Erosion & Sediment Control
Installation
Removal
Party
Date
Date
El
Construction Entrance
5/5/2021
10/5/2021
(Std. &Sec. 3.02
❑
Silt Fence
5/5/2021
10/5/2021
Std. & Spec. 3.05
❑
Culvert Inlet Protection
5/5/2021
10/5/2021
(Sid. & Spec. 3.08)
❑
Outlet Protection
5/5/2021
NA
Std. & Spec. 3.18
Construction Activity
El
Seeding
As required
NA
(Std.
(Std. & Spec. 3.31)
by 3.31
Operator (See Cover
Page of this SWPPP)
ElPermanent
Seeding
9/5/2021
NA
(Std. &Spec. 3.32)
El
9/5/2021
NA
(Sid. & Spec. 3.33)
(Sid.
❑
Mulching
g/5/2021
NA
(Std. & Spec. 3.35)
❑
Others [describe]
Insert Date
Insert Date
07/2014, Rev. 1 Single Family Residence, CPoD, SWPPP
STORMWATER POLLUTION PREVENTION PLAN
TENPAS RESIDENCE / WPO 2020-00044
5.0 Potential Sources of Pollution & Pollution Prevention Practices
Pollutants
a
m
N
m
m
Cd
m
w
V1
_m
'c
x
o
U
C
N
N
N
ftl
of
NX
Likely Present
E
d
>
—'
d
m
Pollution
at your
d
U)
z
a°
x
x
n
m
o_
O
00
~
S
Prevention
Responsible
Pollutant -Generating Activity
Pro'ect Site?
Practice
Party
Clearing, grading, excavating, and
[-]Yes ❑ No
X
X
(1)
un-stabilized areas
Paving operations
❑ Yes ❑ No
X
X
X
(2)
Concrete washout and
❑ Yes ❑ No
X
X
X
(3)
cement waste
Structure construction, stucco,
Yes ❑ No
X
X
X
X
(4)
painting, and cleaning
Dewatering operations
❑ Yes ❑ No
X
X
X
(5)
Construction Activity
Material delivery and storage
❑ Yes ❑ No
X
X
X
X
X
X
X
(6)
Operator (See Cover
Page of this SWPPP)
Material use during building
❑ Yes ❑ No
X
X
X
X
X
X
(7)
process
Solid waste disposal
❑ Yes ❑ No
X
X
(8)
Sanitary waste
❑ Yes ❑ No
X
X
X
(9)
Landscaping operations
❑ Yes ❑ No
X
X
X
X
X
(10)
Others [describe]
❑ Yes ❑ No
[X]
[X]
[X]
[X]
[X]
[X]
[X]
[X]
[X]
(11)
07/2014, Rev. 1 Single Family Residence, CPoD, SWPPP
STORMWATER POLLUTION PREVENTION PLAN
TENPAS RESIDENCE / WPO 2020-00044
Pollution Prevention Practices:
(1) Clearing, grading, excavating and un-stabilized areas — Utilize erosion and sediment controls to prevent
sediment laden or turbid runoff from leaving the construction site. Dispose of clearing debris at acceptable
disposal sites. Apply permanent or temporary stabilization, sodding and/or mulching to denuded areas in
accordance with the erosion and sediment control specifications and the general VPDES permit for
discharges of stormwater from construction activities.
(2) Paving operations — Cover storm drain inlets during paving operations and utilize pollution prevention
materials such as drip pans and absorbent/oil dry for all paving machines to limit leaks and spills of paving
materials and fluids.
(3) Concrete washout and cement waste — Direct concrete wash water into a leak -proof container or leak -proof
settling basin that is designed so that no overflows can occur due to inadequate sizing or precipitation.
Hardened concrete wastes shall be removed and disposed of in a manner consistent with the handling of
other construction wastes.
(4) Structure construction, stucco, painting and cleaning — Enclose, cover or berm building material storage
areas if susceptible to contaminated stormwater runoff. Conduct painting operations consistent with local air
quality and OSHA regulations. Mix paint indoors, in a containment area or in a flat unpaved area. Prevent the
discharge of soaps, solvents, detergents and wash water from construction materials, including the clean-up
of stucco paint, form release oils and curing compounds.
(5) Dewatering operations — Construction site dewatering from building footings or other sources may not be
discharged without treatment. Sediment laden or turbid water shall be filtered, settled or similarly treated prior
to discharge.
(6) Material delivery and storage — Designate areas of the construction site for material delivery and storage.
Place near construction entrances, away from waterways, and avoid transport near drainage paths or
waterways.
(7) Material use during building process — Use materials only where and when needed to complete the
construction activity. Follow manufacturer's instructions regarding uses, protective equipment, ventilation,
flammability and mixing of chemicals.
(8) Solid waste disposal — Designate a waste collection area on the construction site that does not receive a
substantial amount of runoff from upland areas and does not drain directly to a waterway. Ensure that
containers have lids so they can be covered before periods of rain, and keep containers in a covered area
whenever possible. Schedule waste collection to prevent the containers from overfilling.
(9) Sanitary waste — Prevent the discharge of sanitary waste by providing convenient and well -maintained
portable sanitary facilities. Locate sanitary facilities in a convenient location away from waterways.
(10) Landscaping operations — Maintain as much existing vegetation as practicable. Apply permanent or
temporary stabilization, sodding and/or mulching to denuded areas in accordance with the erosion and
sediment control specifications and the general VPDES permit for discharges of stormwater from construction
activities. Apply nutrients in accordance with manufacturer's recommendations and not during rainfall events.
(11) Others — If applicable, describe your Pollution Prevention Practice.
6.0 Stormwater Management Controls
Select all
Stormwater Management Control
Estimated
Installation
Responsible
that a I
PP y
Date
part y
Post -development Stormwater Management Controls
Common Plan
❑
provided by a
NA
Construction
Larger Common Plan of Development or Sale
Activity Operator
❑
Rooftop Disconnection
NA
❑
Sheefflow, to Vegetated Filter (1 or 2)
NA
Construction
❑
Grass Channel
NA
Activity Operator
(See Cover Page of
❑
Rainwater Harvesting
NA
this SW PPP)
❑
Permeable Pavement (1 or 2)
NA
07/2014, Rev. 1 Single Family Residence, CPoD, SWPPP
STORMWATER POLLUTION PREVENTION PLAN
TENPAS RESIDENCE / WPO 2020-00044
Select all
that apply
PP y
Stormwater Management Control
Estimated
Installation
Responsible
part y
Date
❑
Infiltration (1 or 2)
NA
Construction
❑
Bioretention (1 or 2)
NA
Activity Operator
(See Cover Page of
this SWPPP)
❑
Level Spreader
NA
7.0 Spill Prevention & Response
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.
151 Priority: Protect all people
2nd Priority: Protect equipment and property
31d Priority: Protect the environment
1. Check for hazards (flammable material, noxious fumes, cause of spill) — if flammable liquid, turn off
and nearby electrical equipment. If serious hazards are present leave the area and call 911.
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
DEO Blue Ridge Regional Office (Roanoke)
DEC Blue Ridge Regional Office (Lynchburg)
DEC Northern Regional Office
DEC Piedmont Regional Office
DEO Southwest Regional Office
DEC Tidewater Regional Office
DEC Valley Regional Office
Nights, Holidays & Weekends
VA Dept. of Emergency Management
24 Hour Reporting Service
Local Contacts
Local Fire Department
Local Police Department
540-562-6700
434-582-5120
703-583-3800
804-527-5020
276-676-4800
757-518-2000
540-574-7800
804-674-2400
434-973-8862
434-977-9041
07/2014, Rev. 1 Single Family Residence, CPoD, SWPPP
STORMWATER POLLUTION PREVENTION PLAN
TENPAS RESIDENCE / WPO 2020-00044
8.0 Inspections & Corrective Action Log (make additional copies as necessary)
Qualified Inspector
Company/Organization:
Name:
Telephone Number:
Qualifications:
Inspection Schedule
Shimp Engineering, P.C.
Justin Shimp
434-227-5140
Professional Engineer
Discharges to surface waters:
❑ Once every 5 business days; or
❑ Once every 10 business days and no later than 48 hours following a measurable storm event.
Discharges to impaired waters, surface waters within a TMDL watershed, or exceptional waters:
❑ Once every 4 business days; or
❑ Once every 5 business days and no later than 48 hours following a measurable storm event.
Inspection Date
Measurable Storm Event
Best Management
In Compliance
Corrective Action Needed;
Date Corrective
Practices (BMPs)
with SWPPP?
Responsible Parry
Action Taken
Erosion & Sediment
Controls
❑ Yes ❑ No
(Section 4.0)
Pollution Prevention
Practices
❑ Yes ❑ No
(Section 5.0)
Stormwater
❑ Yes ❑ No
Management Controls
(Section 6.0)
❑ NA
Certification
"I certify under penalty of law that I have read and understand this document 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."
Operator Name:
Signature:
Date:
Inspector Name:
Signature:
Date:
07/2014, Rev. 1 Single Family Residence, CPoD, SWPPP
STORMWATER POLLUTION PREVENTION PLAN
TENPAS RESIDENCE / WPO 2020-00044
9.0 Grading & Stabilization Activities Log
Date
Grading
Activity
Initiated
Description of the
Grading Activity
(including location)
Date
Grading
Activity
Ceased
Date
Stabilization
Measures
Initiated
Description of the
Stabilization Measure
(including location)
10.0 SWPPP Modification & Update Log
Modification Description of the Modification / Update Modification Prepared By
Date (name & title)
07/2014, Rev. 1 Single Family Residence, CPoD, SWPPP
INSTRUCTIONS for COMPLETING the
SINGE FAMILY RESIDENCE, COMMON PLAN of DEVELOPMENT or SALE
STORMWATER POLLUTION PREVENTION PLAN (SWPPP)
General
A Stormwater Pollution Prevention Plan (SWPPP) must be developed prior to obtaining locality (e.g., City, County, Town)
authorization to commence land disturbance.
Cover Pace
For a construction activity, enter the projectIsite name and physical address (if available), including city (or town), state and zip
code. Enter the latitude and longitude in decimal degrees of the construction activity.
Enter the Construction Activity Operator's company/organization name, the Operator's name and mailing address, including city (or
town), state, and zip code, telephone number, email address (if available), and a 24-hour emergency contact.
Enter the SWPPP preparation date.
The Construction Activity Operator identified on the cover page of the SWPPP is responsible for certifying the information contained
therein. Please sicn the certification in INK. Please note that state statues require the SWPPP to be signed as follows:
(1) For a corporation: by a responsible corporate officer;
(2) For a partnership or sole proprietorship: by a general partner or the proprietor, respectively;
(3) For a municipality, state, federal, or other public agency: by either a principal executive officer or ranking elected official.
Section 1.0 SWPPP Documents Located Onsite & Available for Review
Utilize the provided checklist to ensure that the required SWPPP documents are located onsite and are available for review, if
applicable.
Section 2.0 Authorized Non-Stormwater Discharges
Identify the authorized non-stormwater discharges likely to be present at the project site. If an unlisted authorized non-stormwater
discharge is likely to be present at the project site, provide it here.
Section 3.0 Pollution Prevention Awareness
Provide employees with a `Walk through" of the project site and identity areas of possible pollution, erosion and sediment controls,
and pollution prevention practices which are applicable to their assigned job duties. Conduct refresher meetings and perform
additional "walk throughs" on an as needed basis.
Section 4.0 Erosion & Sediment Controls
Identity the erosion and sediment controls to be implemented at the project site. For each erosion and sediment control, enter the
estimated installation date and estimated removal date. If an unlisted erosion and sediment control will be implemented at the
project site, provide the applicable information here.
Section 5.0 Potential Sources of Pollution & Pollution Prevention Practices
Identify the pollutant -generating activities likely to be present at the project site; implement and maintain the corresponding pollution
prevention practices. If an unlisted pollutant -generating activity is likely to be present at the project site, describe it, identify the
associated pollutant(s), and provide the corresponding pollution prevention practice(s) to be implemented and maintained.
Section 6.0 Stormwater Management Controls
Identify the stormwater management controls to be implemented at the project site, if applicable. For each stormwater management
control, enter the estimated installation date. If an unlisted stormwater management control will be implemented at the project site,
provide the applicable information here.
Section 7.0 Spill Prevention & Response
Most spills can be cleaned up following manufacturer specifications. The priority should be to protect all people, equipment,
property, and the environment. Enter the telephone number of your local fire and police departments.
Section 8.0 Inspections & Corrective Action Log
Enter the qualified inspector's company/organization name, the inspector's name, telephone number, and qualifications. Select the
applicable inspection schedule, enter the construction activity inspection date, and enter the date and rainfall amount of the last
measurable storm event (if applicable). Identity if the implemented best management practices are in compliance with the SWPPP.
Enter corrective actions needed; the party responsible for implementing the corrective actions, and the date corrective actions were
taken, if applicable. Make additional copies of the inspection and corrective action log as necessary.
Section 9.0 Grading & Stabilization Activities Log
Enter the date grading activities were initiated, a description of the grading activities including location, the date grading activities
ceased, the date stabilization measures were initiated, and a description of the stabilization measures including location.
Section 10.0 SWPPP Modification & Update Log
Enter the SWPPP modification date, description of the SWPPP modification/update, and the name and title of the SWPPP
modification preparer, if applicable.
07/2014, Rev. 1 Single Family Residence, CPoD, SWPPP
VIRGINL4 DEPARTMENT OF ENVIRONMENTAL QUALITY
1111 E. Main Street, Suite 1400, Richmond, Virginia 23219
P.O. Box 1105, Richmond, Virginia 23218
(800)592-5482
www.deg.vir i� nia.gov
Matthew J. Strickler David K. Paylor
Secretary of Natural Resources Director
(804)698-4000
July 1, 2019
TO: Any Operator constructing a Single -Family Detached Residential Structure
RE: Coverage under the 2019 VPDES Construction General Permit (VAR10)
Construction of a Single -Family Detached Residential Structure
Various locations throughout the Commonwealth of Virginia
Dear Permittee
Any operator with a stormwater discharge associated with the construction of a single-family detached residential
structure, within or outside a common plan of development or sale, is authorized to discharge under the General
VPDES Permit for Discharges of Stormwater from Construction Activities (VAR10) and is not required to submit a
registration statement or the Department of Environmental Quality portion of the permit fee provided that they
comply with the terms and conditions of the general permit. The effective date of your coverage under this general
permit is July 1, 2019 or the date of locality authorization to commence land disturbance, whichever is later. The
general permit will expire on June 30, 2024.
A copy of the general permit can be obtained from DEQ's webpage at the following location:
http://www.deg.vir_qi n ia.a ov/Porta Is/0/D EQ/ W ater/Publ i cations/CG P2019. pdf.
The general permit contains the applicable Stormwater Pollution Prevention Plan (SWPPP) requirements and other
conditions of coverage. Please print the general permit and read it carefully as you will be responsible for
compliance with all permit conditions.
If your activity discharges to a surface water that is impaired or designated as exceptional, please see below for
additional requirements:
1. Does this proposed land -disturbing activity discharge to a surface water identified as impaired or for which a
TMDL wasteload allocation has been established and approved prior to the term of the general permit for (i)
sediment or a sediment -related parameter or (ii) nutrients? If YES, then the following general permit (Part I B
4 a) and SWPPP requirements (Part II B 5) must be implemented for the land -disturbing activity:
• Permanent or temporary soil stabilization shall be applied to denuded areas within seven (7) days after final
grade is reached on any portion of the site;
• Nutrients (e.g., fertilizers) shall be applied in accordance with manufacturer's recommendations or an
approved nutrient management plan and shall not be applied during rainfall events;
• Inspections shall be conducted at a frequency of (i) at least once every four (4) business days or (ii) at least
once every (5) business days and no later than 24 hours following a measurable storm event. In the event
that a measurable storm event occurs when there are more than 24 hours between business days, the
inspection shall be conducted on the next business day; and
• Representative inspections used by utility line installation, pipeline construction, or other similar linear
construction activities shall inspect all outfalls.
Construction General Permit (VAR10)
Single -Family Detached Residential Structure
Page 2
2. Does this proposed land -disturbing activity discharge to a surface water identified as impaired or for which a
TMDL wasteload allocation has been established and approved prior to the term of the general permit for
polychlorinated biphenyl (PCB)? If YES, then the following general permit (Part I B 4 b) and SWPPP
requirements (Part II B 6) must be implemented for the land -disturbing activity:
• Implement an approved erosion and sediment control plan;
• Dispose of PCB -contaminated materials in compliance with applicable state, federal, and local requirements
to minimize the exposure of PCB -containing building materials;
• Inspections shall be conducted at a frequency of (i) at least once every four (4) business days or (ii) at least
once every (5) business days and no later than 24 hours following a measurable storm event. In the event
that a measurable storm event occurs when there are more than 24 hours between business days, the
inspection shall be conducted on the next business day; and
• Representative inspections used by utility line installation, pipeline construction, or other similar linear
construction activities shall inspect all outfalls.
3. Does this proposed land -disturbing activity discharge to an exceptional water as identified in Section 30 of the
Water Quality Standards, 9VAC 25-260? If YES, then the following general permit (Part I B 5) and SWPPP
requirements (Part II B 7) must be implemented for the land -disturbing activity:
• Permanent or temporary soil stabilization shall be applied to denuded areas within seven (7) days after final
grade is reached on any portion of the site;
• Nutrients (e.g., fertilizers) shall be applied in accordance with manufacturer's recommendations or an
approved nutrient management plan and shall not be applied during rainfall events;
• Inspections shall be conducted at a frequency of (i) at least once every four (4) business days or (ii) at least
once every (5) business days and no later than 24 hours following a measurable storm event. In the event
that a measurable storm event occurs when there are more than 24 hours between business days, the
inspection shall be conducted on the next business day; and
• Representative inspections used by utility line installation, pipeline construction, or other similar linear
construction activities shall inspect all outfalls.
Any operator with an existing (i.e., previously permitted) stormwater discharge associated with the construction of
a single-family detached residential structure, within or outside a common plan of development or sale, must update
their SWPPP to incorporate the changes to the Construction General Permit effective July 1, 2019. Please update
your SWPPP as soon as possible but no later than sixty (60) days from the date of this letter.
If you have any questions about this permit, please contact the DEQ Office of Stormwater Management at
ConstructionG PCa)deg.virginia.aov.
Sincerely,
Andrew J. Hammond II, Acting Manager
Office of Stormwater Management
COMMONWEALTH of VIRGINIA
DEPARTMENT OF ENVIRONMENTAL QUALITY
AGREEMENT IN LIEU OF A STORMWATER MANAGEMENT PLAN
SINGLE-FAMILY DETACHED RESIDENTIAL STRUCTURE
Construction Activity Operator:
Name: Smith & Robertson, Inc.
Contact: Ron Smith
Mailing Address: 1128 East High St
City: Charlottesville State: VA Zip: 22902 Phone: 434-531-1414
Email address (if available): ron@smithandrobertson.com
Location of Single -Family Detached Residential Structure:
Address (if no address description of location): Wesley Chapel Rd (Across from CS Farm)
City: Free Union State: Virginia Zip: 22932
County (if not located within a City): Albemarle
In place of a Stormwater Management Plan for the construction of this single-family
detached residential structure, I agree to comply with the requirements of this "Agreement
in Lieu of a Stormwater Management Plan" (or other requirements as established by the
Department when necessary) to ensure compliance with the applicable post -construction
stormwater management provisions of the Virginia Stormwater Management Program
(VSMP) Regulations.
REQUIREMENTS
As required by the Construction General Permit (VAR10), a copy of this signed and
dated "Agreement in Lieu of a Stormwater Management Plan" shall be maintained in
my Stormwater Pollution Prevention Plan (SWPPP) for the construction activity.
5/2019 Page 1 of 2
• Post -construction runoff from the property shall be minimized to the maximum extent
practicable and shall be controlled to prevent flooding or erosion damage from
occurring on adjacent or downstream properties. In meeting this requirement, I agree
to direct:
o runoff from rooftops as non -erosive sheet flow to well -vegetated areas on the
property to the maximum extent practicable,
o runoff from on -lot impervious surfaces (e.g., driveways, parking areas, sidewalks)
as non -erosive sheet flow to well -vegetated areas on the property to the maximum
extent practicable, and
o runoff from lawns as non -erosive sheet flow to undisturbed naturally -vegetated
areas on the property to the maximum extent practicable.
I fully understand that not complying may result in the revocation of this "Agreement in
Lieu of a Stormwater Management Plan" and that the submission of a project -specific
Stormwater Management Plan in accordance with 9VAC25-870-55 of the VSMP
Regulations may be required.
This "Agreement in Lieu of a Stormwater Management Plan" does not authorize land
disturbance. Land -disturbing activities nsnnnt henin iintil tho nnnlirnhlo lnrnl
S m "I 4 � K0 6s --TS o� /0G.
Printed Name: R ot� 3 SM l-R) Title:
Jiro- 2,7—j 9�nJj
Signature: Date: o 20 2-
(Please sign in INK. This certification must be signed by the operator of the
construction activity identified above)
5/2019 Page 2 of 2