HomeMy WebLinkAboutWPO202200048 VSMP - SWPPP 2022-11-22A COUNTY OF ALBEMARLE
Department of Community Development
401 McIntire Road, North Wing
Charlottesville, Virginia 22902-4596
Tel. (434) 296-5832 * Fax (434) 972-4126
Stormwater Pollution Prevention Plan (SWPPP)
For Construction Activities At:
Project Name: Broadway Street Water Main Replacement
Address: Broadway Street, Charlottesville, VA 22902
Tax Map 77-40N
Prepared by:
Name: Whitman, Requardt & Associates LLP
Prepared for:
Name: (Contractor to Be Determined)
SWPPP Preparation Date:
(This document is to be made publicly available according to 9VAC25-880-70, Part 11, section D)
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
CONTENTS: (from Albemarle County Code Sec. 17405)
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
Registration Statement
General VPDES Permit for Discharges of Stormwaterfrorn 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.)
N,,r,,, Albemarle County Service Authority
contact Richard Nelson
Mailing Address 168 Spotnap Road
city: Charlottesville State: VA zip: 22911 Phone (434) 977-4511, Ext. 113
Email address (if available):
Indicate if DEQ may transmit general permit correspondence electronically: YesF&—/]NoF—1
2. Existing General Permit Registration Number (for renewals only):
3. Name and Location of the Construction Activity:
Name Broadway Street Water Main Replacement
Address (if available): Broadway Street
city: Charlottesville State VA zip: 22902
County (if not located within a city): Albemarle County
Latitude (decimal degrees): N 38.021162 — Longitude (decimal degrees): W 78.459505
Name and Location of all Off -site Support Activities to be covered under the general permit:
Name
Address (if available):
County (if not located within a City):
Latitude (decimal degrees): Longitude (decimal degrees):
4. Status of the Construction Activity (check only one): FederalE StateE]Public rV_1 PrivateF]
S. Nature of the Construction Activity (e.g., commercial, industrial, residential, agricultural, oil and gas, etc.):
Municipal
6. Name of the Receiving Water(s) and Hydrologic Unit Code (HUC):
Name Rivanna River/Moores Creek Name
HUC 020802040402 HUC
7. If the discharge is through a Municipal Separate Storm Sewer System (MS4), the name of the MS4 operator:
Albemarle County
8. Estimated Project Start and Completion Date:
Start Date (mm/dd/yyyy): January 1, 2023 Completion Date (mm/dd/yyyy): December 31, 2023
9. Total Land Area of Development (to the nearest one -hundredth acre): 1 -31 acres
Estimated Area to be Disturbed (to the nearest one -hundredth acre): 0.12 acres
10. Is the area to be disturbed part of a larger common plan of development or sale? YeSF—INoF&—/]
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
Title
Signature Date
(Please sign in INK. This Certification must be signed by the appropriate person associated with the operator identified in
Item #11.)
07/2014 Page 1 of 1
Instructions for Completing the Registration Statement
General VPDES Permit for Discharges of Stormwater from Construction Activities (VAR10)
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 (VAR1 0).
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. Now 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 1 O� Floor
P.O. Box 1105
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: (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).
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 general permit
correspondence electronically.
Item 2: Existing General Permit Registration Number
For reapplications 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 sto"water 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 (i) 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 slate, 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 aff-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). AJso, 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, Stale, 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, e1c. 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 60 order national watershed boundary
dataset.
07/2014 Page 1 of 2
Item 7: MS4 Information
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, e1c., or
physical demarcation such as boundary signs, lot stakes, or surveyor
markings indicating that construction activities may occur.
Item 11: Stomwater 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 (VAR1 0) prior to
submitting this Registration Statement. By signing this Registraton
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, stale, 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
VSMP Application Requirements
Land Disturbance, -greater than 2,500sq.ft to less than 1AC:
Single Family Development
F-I
City of Fairfax VSMP Permit Application
F-I
Plans
F-I
VSIVIP Checklist
F-I
BIVIP Agreement (if applicable)
F-I
$290 fee check
All Other Non-SFD LDAs (Commercial, Common Plan of Development, Etc.)
F-I City of Fairfax VSIVIP Permit Application
F-I Plans
F-I Site Plan Checklist
F� BIVIP Agreement (if applicable)
F-I SWPPP
F-I $290 fee check
Chesapeake Bay Preservation Act Land -Disturbing Activity. $290
Land Disturbance = 2500sq.ft to less than 1 acre
Areas within common plans of development or sale
(except for single family detached homes) $290
Land Disturbance = 2500sq.ft to less than 1 acre
Land Disturbance, 1AC or more:
All LDAs, 1AC or More
F-I D EQ VAR 10 Registration Statement
F-I DEQ VAR 10 Notice of Termination
F� Plans
F-I Site Plan Checklist
F-I BIVIP Agreement (if applicable)
F-I SWPPP
F-I Fee per schedule below
Small Single Family Detached Home Construction
Land Disturbance = 1 acre to less than 5 acres
$209
Land Disturbance = 1 acre to less than 5 acres
$2,700
Land Disturbance = 5 acres to less than 10 acres
$3,400
Land Disturbance = 10 acres to less than 50 acres
$4,500
Land Disturbance = 50 acres to less than 100 acres
$6,100
Land Disturbance= greater than 100 acres
$9,600
NOTE: All VSMP application fees are to be submitted on a separate check.
Revenue Account: 340-313350
Virginia Stormwater Management Program WSMP) Checklist
STORMWATER MANAGEMENT PLAN PAGE(S):
YES
� NO
� NTA[DESCRIPTION
PAGE #
Narrative:
0
F-1
F-1
Contact information including the name, address and telephone
number of the owner and the tax reference number and parcel
number of the property or properties affected
-[T-EF-ET
Description of current site conditions and final site conditions
-ET=-[71-
Information on type and location of stormwater discharges
F-1
Information on the features to which stormwater is being
discharged, including water bodies classified as impaired on the
Virginia DEQ 303(d) list
-0-=TT
Information on any additional control measures to be
implemented to address a local TMDL
-EF==
A general description of the proposed stormwater management
facilities and the mechanism through which the facilities will be
operated and maintained after construction is complete
Site Information:
L-1
L-1
H
Existing drainage facilities and creeks and channels, including all
streams, ponds, culverts, ditches, wetlands, other water bodies
and floodplains
H
H
Soil types, geologic formations if karst features are present in the
area, forest cover and other vegetative areas
=-E]
H
Current land use including existing structures, roads and
locations of known utilities and easements
-ET==
Sufficient information on adjoining parcels to assess the impacts
of stormwater from the site on these parcels
-ET=TT
The limits of clearing and grading and the proposed drainage
patterns on the site
F-1
Proposed buildings, roads, parking areas, utilities and
stormwater management facilities
F-1
0=
Proposed land use with tabulation of the percentage of surface
area to be adapted to various uses, including but not limited to,
planned locations of utilities, roads and easements
Virginia Stormwater Management Program (VSMP) CheckliSt
Hydrologic Analysis:
LIH
H
* Pre -development and post -development contributing drainage
areas
L-1
H
H
Pre -development and post -development runoff rates, volumes
and velocities, and methodologies used
TT—ITTI
Pollution load and reduction requirements and calculations
Hydraulic Analysis:
H�H
Sizing calculations for stormwater control measures
H
H
Existing and proposed structural elevations (pipe inverts,
manholes, etc.)
TTTIH
Stage -storage or outlet rating curves and inflow and outflow
hydrographs for storage facilities
-0-7
F-I
Design water surface elevations
_ET_ETTT
Analysis of potential downstream impacts/effects of the project
-IT-ET-IT
Location and elevation of the lowest floor in all proposed and
existing buildings adjacent to the floodplain
_ET_ETTT
Dam safety and breach analysis
Best Management Practices (BMPs):
H
H
Type of facilities proposed (use BIVIP Clearinghouse names)
ITF—I
Location, including geographic coordinates (Lat/Long)
-IT-ETIT
Total acres treated
-7-F-D-17F
Acres impervious treated
_7F_EF_D_
Acres pervious treated
_EF
F-I
Documentation and calculations verifying compliance with water
quality and quantity requirements
EFTTApplicable
supporting documents and studies (e.g. infiltration
tests, geotechnical investigations)
—a—IT
IT
Landscaping plan for any BIVIPs or site reforestation
*Denotes items that are required in digital format "dxf'for purpose of updating the City's GIS
data.
Virginia Stormwater Management Program (VSMP) CheckflSt
Piped Systems:
YES
NO
N/A
DESCRIPTION
PAGE #
F-1
-ET
F-1
Analyzed and designed for 2/1 0-yr/25-yr/l 00-yr Storm
Primary road crossings designed for 25-yr flows and 1 O-yr
under secondary roads and other locations
-ET-ET-0-
Culverts checked for the effects of 1 00-yr Storm
No flooding of building
Structures shall result from 1 00-yr design
Energy dissipater calculations
Capacity of receiving channel downstream of channel or pipe
system
Gutter spread limited to 1 Off from the face of the curb
E
F-1
F-1
Hydraulic grade lines show 11ft below inlets
Open Channel Systems:
YES
NO
N/A
DESCRIPTION
PAGE #
TT—UTT
Proposed channel capacity analyzed and designed for pre 1 O-yr
Storm
-ET
F-1
F-1
Channel designed for a 2-yr Storm without erosion and 1 O-yr for
bank fill (liner design)
-D-17TT
Velocity Check (liners provided, if needed)
Provide channel velocities
0
F-1
F-1
Overlot grading plan
El—ITTT
Provide 1 00-yr overland relief assuming pipe system failure
Virginia Stormwater Management Program (VSMP) CheckliSt
CHESAPEAKE BAY REGULATIONS PLAN PAGE(S):
YES
NO
N/A
DESCRIPTION
PAGE #
TITT-IT
For any property depicted on the City's Chesapeake Bay
preservation area map as a resource protection area (RPA), the
applicant shall determine and show on the plan the site -specific
boundaries of the RPA components per code section 110-86(c).
The applicant shall also submit a RPA site -specific study
application available at the Zoning Division or at:
httr)://www.fairfaxva.gov/cdo/docs/RPASiteSi)ecificStudvAi)i)licati
on.1)d
TTETTUSACE
T
jurisdictional determination or verification letter for RPA
boundaries
Water quality impact assessment (WQIA) is required for any
proposed development or redevelopment unless the requirement
is waived by the Zoning Administrator
Application/waiver form is available at the Zoning Division or at:
htti)://www.fairfaxva.gov/cdi)/docsANQIAAi)i)lication.l)df
Tree management plan per code section 11 0-86(d)
TT-0-TT
I
Stormwater management plan
_ET_E1__ET
BMP maintenance plan, including inspection schedule
TT
—ET
El
BMP maintenance agreement (available at the Zoning Division)
1::F_E1_TT
Copies of any required wetland permits
Performance Standards of Chesapeake Bay Regulations:
YES
NO
N/A
DESCRIPTION
PAGE #
TT-EI-1:1-
Maximize rainwater infiltration
TT—E]--EF
Reduce the land application of nutrients and toxics
TT—EI-1:1—
Minimize erosion and sedimentation potential
-EFTT
Limit land disturbance and preserve indigenous vegetation to the
maximum extent practicable, consistent with the use or
development proposed
Virginia Stormwater Management Program WSMP) Checklist
Stormwater Pollution Prevention Plan (SWPPP) Contents:
YES
NO
N/A
DESCRIPTION
PAGE #
-E--EFTI
SWPPP package complete
11
El
0
An erosion and sediment control plan consistent with the
requirements of the Virginia Erosion and Sediment Control Law
and regulations must be designed and implemented during
construction activities.
Prior to land disturbance, this plan must be approved by either
the VESCP authority or the department in accordance with the
Virginia Erosion and Sediment Control Law and attendant
regulations.
A stormwater management plan consistent with the requirements
of the Virginia Stormwater Management Act and regulations
must be designed and implemented during construction
activities.
Prior to land disturbance, this plan must be approved by the City
of Fairfax.
]::F-E]-]::F
A pollution prevention plan that identifies potential sources of
pollutants that may reasonably be expected to affect the quality
of stormwater discharges from the construction site and describe
control measures that will be used to minimize pollutants in
stormwater discharges from the construction site must be
developed before land disturbance commences.
]::F
El
F
If a specific wasteload allocation (WLA) for a pollutant has been
established in an approved TMDL and is assigned to stormwater
discharges from a construction activity, additional control
measures must be identified and implemented by the operator so
that discharges are consistent with the assumptions and
requirements of the WLA.
NOTE: The SWPPP shall be amended whenever there is a change in design, construction,
operation or maintenance that has a significant effect on the discharge of pollutants to state
waters and that has not been previously addressed in the SWPPP. The SWPPP must be
maintained at a central location onsite. If an onsite location is unavailable, notice of the
SWPPP's location must be posted near the main entrance at the construction site.
Virginia Stormwater Management Program (VSMP) CheckliSt
Pollution Prevention Plan (PPP) Contents:
YES
NO
N/A
DESCRIPTION
PAGE #
-ITTT
A pollution prevention plan, as required by 9VAC25-870-56, shall
be developed, implemented and updated as necessary and must
detail the design, installation, implementation and maintenance
of effective pollution prevention measures to minimize the
discharge of pollutants.
Minimize the discharge of pollutants from equipment and vehicle
washing, wheel wash water and other wash waters
Wash waters must be treated in a sediment basin or alternative
control that provides equivalent or better treatment prior to
discharge.
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
-11-ET-EF
The pollution prevention plan shall include effective best
management practices to prohibit the following discharges:
(a) Wastewater from washout of concrete, unless managed
by an appropriate control
(b) Wastewater from washout and cleanout of stucco, paint,
form release oils, curing compounds and other
construction materials
(c) Fuels, oils or other pollutants used in vehicle and
equipment operation and maintenance
(d) Soaps or solvents used in vehicle and equipment
washing
NOTE: Discharges from dewatering activities, including discharges from dewatering of trenches
and excavations, are prohibited unless managed by appropriate controls.
General Permit for Discharges of Stormwater from Construction Activities (VAR1 0)
Notice of Termination
1. Construction Activity Operator:
Mailing
(Please Type or Print All Information)
State:_ Zip: Phone:
Email address (if available):
2. Location of Construction Activity (As listed on registration statement):
County:
If street address unavailable: Latitude Longitude
3. Stormwater General Permit Number:
4. The Reason for Terminating Coverage Under the General Permit (The construction activity operator may only submit a Notice
of Termination after one or more of the conditions below have been met):
ElA. Necessary post -construction control measures included in the SWPPP for the site are in place and functioning
effectively and final stabilization has been achieved on all portions of the site for which the operator is responsible;
ElB. Another operator has assumed control over all areas of the site that have not been finally stabilized and obtained
coverage for the ongoing discharge;
F1C. Coverage under an altemative VPDES or State permit has been obtained; or
D. For residential construction only, temporary stabilization has been completed and the residence has been transferred
to the homeowner.
The Notice of Termination must be submitted within 30 days of one of the above conditions being met Authorization to
discharge terminates at midnight on the date that the Notice of Termination is submitted for conditions B through D
above. Authorization to discharge terminates upon notification from the Department or 60 days after the submittal of the
Notice of Termination (whichever occurs first) for condition A above.
5. Permanent Control Measures Installed: Attach a list of permanent control measures (both structural and non-structural) that
were installed at the construction site. For each control measure, include the following information: (a) Type of control measure
installed and the date that it became functional as a permanent control measure; (b) Geographic location (county or city and
Hydrologic Unit Code) (latitude and longitude may additionally be included if available); (c) Waterbody the control measure
discharges into; and, (d) Number of acres that will be treated (to the nearest one -tenth of an acre).
If no permanent control measures were installed please check this box F�
6. Participation in a ReClional Stormwater Management Plan: Where applicable, attach the following information related to
participation in a regional stormwater management plan: (a) Type of regional facility to which the site discharges; (b) Geographic
location of any regional facility to which the site discharges (county or city and Hydrologic Unit Code); (c) Geographic location of
the site (county or city and Hydrologic Unit Code) (latitude and longitude may additionally be included if available); and (d) Number
of acres treated by a regional facility.
7. Nutrient Offsets: Where applicable, attach the following information related to nutrient offsets that were acquired in accordance
with §62.1-44.15:35 of the Code of Virginia: (a) Name of the broker from which offsets were acquired; (b) Geographic location
(county or city and Hydrologic Unit Code) of the brokers offset generating facility; (c) Number of nutrient offsets acquired (lbs. per
acre per year); and (d) Nutrient reductions achieved on site (lbs. per acre per year).
8. Certification:
"I certify under penalty of law that I have read and understand this notice of termination 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."
Print Name: Title:
Signature: Date:
(Please sign In INK. The person signing this form must be associated with the operator identified in Item #1 above.)
Mail to: Devartment of Environmental Quality, Office of Stormwater Management, 1 oth Floor, P.O. Box 1105, Richmond, VA 23218
(DEC 199-147) (08/13)
INSTRUCTIONS for FORM DEQ 199-147
General Permit Notice of Termination - Construction Activity Stormwater Discharges
General
A Notice of Termination must be submitted when an
operator no longer wishes to be covered under the General
Permit for Stormwater Discharges from Construction
Activities.
Mail to: Department of Environmental Quality
Office of Stormwater Management, 1 (Yh Floor
P.O. Box 1105
Richmond, VA 23218
Section 1 Activity Operator Information
Give the legal name of the person, firm, public organization,
or any other entity that was issued the general permit for
the site described in this Notice of Termination. Do not use
a colloquial name. Enter the complete address and phone
number of the operator.
Section 2 Activity Location Information
Enter the activity's official name and complete street
address, including city (or town), county (if not located
within a City), state and ZIP code. If the site lacks a street
address, enter the city (or town), county (if not located
within a City) and the latitude and longitude in degrees,
minutes, seconds (DMS).
Section 3 Permit Information
Enter the existing Stormwater General Permit Number
assigned to the activity or site identified in Section 1 that the
operator wishes to be terminated.
Section 4 Reason for Termination
Check the appropriate statement indicating the reason for
submitting this Notice of Termination. The Notice of
Termination may only be submitted after one or more of the
following conditions have been met:
A. Necessary post -construction control measures
included in the SWPPP for the site are in place and
functioning and final stabilization has been achieved
on all portions of the site for which the operator is
responsible;
B. Another operator has assumed control over all areas
of the site that have not been finally stabilized;
C. Coverage under an alternative VPDES or State
permit has been obtained; or
D. For residential construction only, temporary
stabilization has been completed and the residence
has been transferred to the homeowner.
The Notice of Termination must be submitted within 30
days of one of the above conditions being met.
Section 5 Permanent Control Measures Installed
Attach a list of the permanent control measures (both
structural and non-structural) that were installed at the
construction site. For each control measure, include the
following information:
(a) Type of control measure installed;
(b) Geographic location (county or city and Hydrologic
Unit Code);
(c) Waterbody the control measure discharges into; and,
(d) Number of acres that will be treated (to the nearest
one -tenth of an acre).
If no permanent control measures were installed, please
check the box at the end of this section.
Section 6 Participation in a Regional Stormwater
Management Plan
Where applicable, attach the following information related to
participation in a regional stormwater management plan: (a)
Type of regional facility to which the site discharges; (b)
Geographic location of any regional facility to which the site
discharges (county or city and Hydrologic Unit Code); (c)
Geographic location of the site (county or city and
Hydrologic Unit Code) (latitude and longitude may
additionally be included if available); and, (d) Number of
acres treated by a regional facility.
Section 7 Nutrient Offsets
Where applicable, attach the following information related to
nutrient offsets that were acquired in accordance with
§62.1-44.15:35 of the Code of Virginia: (a) Name of the
broker from which offsets were acquired; (b) Geographic
location (county or city and Hydrologic Unit Code) of the
brokers offset generating facility; (c) Number of nutrient
offsets acquired (lbs. per acre per year); and (d) Nutrient
reductions achieved on site (lbs. per acre per year).
Section 8 Certification
State statutes provide for severe penalties for submitting
false information on this Notice of Termination. State
regulations require this Notice of Termination to be signed
as follows:
For a corporation: by a responsible corporate
officer. For the purpose of this section, a responsible
corporate officer means: (1) 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- or decision -making functions for the
corporation, or (2) the manager of one or more
manufacturing, production, or operating facilities provided
the manager is authorized to make management decisions
which 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
environmental 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.
For a partnership or sole proprietorship: by a
general partner or the proprietor.
For a municipality, state, federal, or other public
agency: by either a principal executive officer or a ranking
elected official.
The Department of Environmental Quality reserves the riqht to request additional information not directly addressed by th
registration statement if, in its discretion, a facility or operation poses a potential impact on water quality,
(DEQ 199-147) (08/13)
Section 2. Notice of general permit coverage
(This notice is to be posted near the main entrance according to 9VAC25-880-70, Part 11, 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.)
Construction Activities
I . Fumish and install 8", 6", and 4" Ductile Iron water main.
2. Fumish and install 8" tapping sleeve and valve with valve box
3. Fumish and install 6" and 4" gate valves.
4. Furnish and install fire hydrants, air release valves, and blow offs.
5. Locate and connect to existing water mains.
6. Restoration of all easements, yards, parking lot.
7. Place asphalt pavement according to VDOT specifications.
8. Test all pipe and all appurtenances.
9. Disinfection of water main.
10. Any incidental work to complete project.
Anticipated Schedule:
Start Construction: January 1, 2023
End Construction: December 31, 2023
Sequence of Construction
I . Notify the Albemarle County Service Authority (ACSA) inspector in writing seven days prior to
commencing construction of this project. The inspector will notify the ACSA to arrange an on -site
preconstruction meeting at least 48 hours prior to the issuance of a Land Disturbance Permit.
2. Install all erosion and sediment control measures.
3. Notify the ACSA inspectors when initial erosion control measures are in place.
4. Locate all existing utilities and construct all water main improvements and water service
connections. Place and compact approved backfill materials as trenching and installations proceed.
5. Test water mains, connect new water service connections, and overlay existing roads and gravel
drives.
6. No stockpile is anticipated for this project.
7. Upon completion of work, apply permanent seeding to all disturbed areas.
8. When disturbed area are stabilized to the satisfaction of the inspectors and the engineer, remove all
temporary erosion and sediment control devices.
9. Notify the ACSA inspectors when all work is complete.
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
Section 4. Erosion and Sediment Control Plan.
(Provide a reduced, I W7 copy of the latest Erosion and Sediment Control Plan. Do not reference only.)
(To be inserted into SWPPP following final review and approval.)
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
Section 5. Stormwater Management Plan
(Provide a reduced I I x 17 copy of the latest stormwater management plan. Do not reference only.)
(Not required.)
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
Section 6. Pollution Prevention Plan.
(reference County Code 17-404 and State Regulation 9VAC25-880-70 pan 11 section A.4)
A. Plan showing pollution activities and prevention practices
(Provide a reduced I W7 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.)
(To be inserted into SWPPP` following final review and approval.)
Issued — 10/2014 Storrawater Pollution Prevention Plan (SWPPP) Albemarle County
B.
z5ources oi it-onutams. iocanons. anu
Pollutant, or Pollutant Location on site Prevention Practices,
Generating A Control N
No additional activities — N/A
C. Sources of Pollutants continued. Common activities and minimum control and prevention
practices
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
stabil ized areas
acceptable disposal sites. Seed and mulch,
or sod within 7 days of land clearing
Cover storin drain inlets and use drip pans
Paving operations
Roads and driveways
and absorberit/od dry for all paving
machines to limit leaks and spills
Direct concrete wash water into a leak -
Concrete washout and
Current location and detail shown on
proof container or leak -proof settling basin
cement waste
plan
that is designed so that no overflows can
occur
Enclose or cover material storage areas.
Mix paint indoors in a contairanent 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
Dewatering operations
Dewatering sites shown on plan
treated prior to discharge as shown on
plan.
Designated areas for material delivery and
Material delivery and storage
Designated area shown on plan
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
areas and does not drain directly to a
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
Pollutant, or Pollutant
Location on site
Prevention Practices,
Generating Activity
Control Measures
Current designated container areas on
waterway. Containers have lids covered
Solid waste disposal
plan
before periods of rain, or are in a covered
area. Schedidedcollectiontoprevent
overfilling. MATERIALS NOT TO BE
BURIED ON -SITE
Convenient and well -maintained portable
sanitary facilities mill be provided, and
Sarmary waste
Current locations shown on plan
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
Wash Waters
Wash areas shown on plan
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 ofexposure topreciphation 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.
Non-stormwater discharees
Discharge Pollutants or Pollutant Location on Site
Constituents
None anticipated N/A N/A
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.)
(To be provided by contractor.)
F. Response and reporting practices
Minimize dischargesfrom 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 11, section AA.e.)
(To be provided by contractor.)
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.)
(To be provided by contractor.)
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
Section 7. Discharges to impaired waters, surface waters within an applicable TNIDL
wasteload allocation, and exceptional waters.
(Provide detailed measures for any applicable T�ML)
(Not required — N/A)
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.)
(To be provided by contractor.)
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
Section 9. Signed Certification
(Provide certification according to 9VAC25-870-370. For purposes of plan review and approvals, this
certification should be the owner of the property, the same signature as appears on the bonds and
applications. Another operator can be designated on the delegation of authority form to follow.)
CERTIFICATION
1 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 infonnation 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 infonnation, including the possibility of fine and imprisonment for knowing violations."
Owner/Operator Name:
Company:
Title:
Signature:
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
1, (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:
(To be provided by contractor.)
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)
(To be inserted upon receipt.)
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 11, section B and F.)
(To be provided by contractor.)
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
Issued — 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County