HomeMy WebLinkAboutWPO201800066 Application WPO VSMP 2018-08-15 .�oY nLa�sa
Virginia Stormwater Management ]Program (VSMP) oeiii?�
Application for Albemarle-County
VLt ) Mock � 1-3
Project Name: DJd Thal i , LQ S A --
(The name should be the sanzeaxs it appears on plans)
Is this an amendment,to an approved plat? ''es ❑ No gf
Is this a revision or resubmission for review? Yes ❑ No CY -
County File Number: (to be provided by the County for new applications)
The following are required elements of new applications[from code section 17-401J. For revisions or
amendments,please indicate which items are_being amended. Signatures must be provided for any
submission.
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❑ A. Signature of the Property Owner for each parcel; (Required with every submission or revision, NOT
TO BE SIGNED BY AN AGENT OR CONSULTANT)
By signing this application as the.owner,I hereby certify that all requirements of these plans and permits will be
complied with,and I.have the authority to authorize the land disturbing activities and development on the subject
property. I hereby grant the.County of Albemarle the right to enter upon the property as required to ensure
compliance with the approved plans and permits.
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NOT'yEr Crab ergerpriss kiy
.R ad r) WiUiam b. Craig Apo- a 4f 8/is 118
Tax Map&Parcel Print Name of Propertl Owner Signature of Owner Date
_ Er�1cf pr+ss,5 b.f./
WiU.iam D. Croji AAAi7 �
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Tax M p&Parcel. Print Name of Propert wner Signature of Owner Date
Croi9 eprnseS ba-1
% L1 rn Crati Gvl v '2 L'i 6..1151(8
Tax ap&Parcel Print Nam;of Propert caner Signature of Owner Date
Craig EVVY
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Tax Map&Parcel Print Name of Proper Owner Signature'of Owner Date
Contact Information for the Owner(s)to receive correspondence:
Print Name. V ° i 1.11 QM . Cr ,
Address 1 D, WIC Lo)5/p
City Chr).oiCSv1 t,lX State . on Zip Aagetio
Daytime Phone( 1tr) -WOLF- E-mail U)W&Ad Crcuj &5 incu,0, (,QrYl
7/1/14,Revised: 7/10/14, 1/7/14 Page 1 of 2
❑ E. All Fees [Code section 17-208]
For new or modified plans; Total acres proposed to be disturbed Ro
Acres to be Total Fee Fee Due with this Fee with Transfer or
disturbed • .p ..ation modification of permit_
Less than 1 $290 ;.145 $20
1 and less than 5 $2,700 $1,350 $200
5 and less than 10 $3,400 $1,700 $250
10 and less than 50 $4,500 $2,250 $300
5.0 and less than 100 $6,100 $3,050 $450
100 and.more $9,600 $4,800 $700
For(minor)amendments to an approved plan; $200 per review
Variances;$150 (per request)
Mitigation Plan;$150
El C. Registration Statement:on the official DEQ form.
❑ D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402..
CI E. Stormwater Management Plan satisfying the requirements of bode section 17-403.
❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404.
❑ G. Stonnwater Pollution Prevention.Plan satisfying the requirements of code section 17-405.
❑ H. Mitigation Plan satisfying the requirements of code section 17-406.for any proposed disturbance of
stream buffers.
❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408.
❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Provide 2 copies of all plans and any supporting documents. Professional seals must have original
signatures.
Additional information if not provided on plans and documents:
Name of a Contact Person for correspondence(usually the plan-preparer, consultant or agent)
Print Name J3Q. g3Sh1flS9
Address T R.o . Poi. 61 st.o
City ChorIdrkSVi (IS State V R Zip -e1OIA
Daytime Phone(703) agog,- 4495 E-mail De. koshan.cviiG'a i corn
*When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months
from the date of county comments,the application will beideemed withdrawn. Applications without valid owner's
signatures will:not be considered valid.
FOR OFFICE USE ONLY WPO# :. .
Fee Amount$ Date Paid By who? Receipt# CIc# By:
7/1/14,Revised: 7/10/14, 1/7/14 Page 2 of 2
COUNTY OF ALBEMARLE
Department of Community Development
401 McIntire Road,North Wing
Charlottesville,Virginia 22902-4596
' Tel. (434)296-5832 s.Fax(434) 972-4126
Stormwater Pollution Prevention Plan (SWPPP)
For Construction Activities At:
ad J`` t :(�1 [31��1c: aa, Lod �- 43
ProjectNar��e: A`� i
Address:
TBD
Chozd--, :UA aag3a
Prepared by:
Name:
UJulXta5n b. 6-tr-t;ti
Prepared for: _
Name: 0111 BUJdL(L
SWPPP Preparation Date: 8115 118
(This document is to be made publicly available according to 9VAC25-880-70, Part II, section D)
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Issued— 10/2014 Stormwater Pollution Prevention Plan(SWPPP) Albemarle County
CONTENT'S o (from Albemarle County Code Sec. 17-405)
10 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 Stormwater from Construction Activities (VARIO)
(Please Type or Print All Information)
1. Construction Activity Operator: (General permit coverage will be issued to this operator. The Certification in Item #12 must be
signed by the appropriate person associated with this operator.)
Name: 1/Cr .t,1Ckr5
Contact: V v I l Qi��L>>Qa�r� D
Mailing Address: 1), O 80X to
City: CharIQ4-IfsvI LLQ State: U-ir) Zip: aa9'L?{o Phone: (434) oayR—Q3(4
Email address (if available): CITY)dcraij P 9 mat,I. Corr
Indicate if DEQ may transmit general permit correspondence electronically: Yes No ❑
2. Existing General Permit Registration Number(for renewals only): Clio-
3. Name and Location of the Construction Activity: ' �1
Name: DM TriadVi , abc1iC. as LSJic i- 43
Address (if available) -1113D
City: CXU r State: U Zip: a*3�,
£1.L
County(if not located within a City): . r1cvt� .
Latitude (decimal degrees): . . Longitude (decimal degrees):
Name and Locati n of all Off-site Support Activities to be covered under the general permit:
Name: 11��
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 Lam'
5. Nature of then Construction Activity(e.g., commercial, industrial, residential,agricultural, oil and gas,etc.):
cith n4
6. Name of the Receiving'Water(s) and,Hydrolloogiic��U��nit Code(HUC):
Name:CAI.L LM-A DI-l9'i . AA1 C2 (11..lt1-r 11 Name:
HUC: O3DS 03.04 0 HUC:
7. If the dischar a is through a Municipal Separate Storm Sewer System (MS4),the name of the MS4 operator:
8. Estimated Project Start and Cpmpletion Date:
Start Date(rnm/dd/yyyy): 10 18I I$ Completion Date (mm/dd/yyyy): (47113I ti!
9. Total Land Area of Development(to the nearest one-hundredth acre): 4,&
Estimated Area to be Disturbed (to the nearest one-hundredth acre): oat
10. Is the area to be disturbed part of a larger common plan of development or/sale? Yes V 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 rriy 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 forlI ''knowing violations." VP
� �JU���G�
Printed Name: A V I Ul Ghn'' V. Gr Title: V IJ
Signature: /' Date: . e1I5`18
(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
• Instructions for Completing the Registration Statement
General VPDES Permit for Discharges of StorrWater from Construction Activities (VAR10)
GENERAL The entities that are considered operators will commonly consist of the
owner or developer of a project (the party with control of project plans
A.Coverage Under.this General Permit. and specifications) or the general contractor(the party with day to day
operational control of the activities at the project site which are
Any operator applying for coverage under this general permit who is necessary to ensure compliance with the general permit).
required to submit a Registration Statement (see Section B below)
must submit a complete Registration Statement to the Department. Provide the legal name(do not use a colloquial name),contact,mailing
The Registration Statement serves as a Notice of Intent for coverage address; telephone number, and email address (if available) of the
under the General VPDES Permit for Discharges of Stormwater from construction activity operator;general permit coverage will be issued to
Construction Activities(VAR10). this operator. Indicate if the Department may transmit general permit
correspondence electronically.
B.Single-family Detached Residential Structures.
Item 2:Existing General Permit Registration Number.
Operators with an existing stormwater discharge or proposing a new
stormwater discharge associated with the construction of a single- For reapplications only, provide the existing general permit registration
family detached residential structure are not required to submit a number for the construction activity. This item does not.need to be
Registration Statement or the Department of Environmental Quality completed for new construction activities applying for general permit
', (DEQ)portion of the general permit fee. coverage.
Operators of these types of discharges are authorized to discharge Item 3: Name and Location of the Construction Activity
under this general permit immediately upon the general permit's Information.
effective date of July 1,2014'.
Provide the official name, street address(if available),city or county(if
C.To Apply for Permit Coverage. not located within a City)of the construction activity. Also, provide the
latitude and longitude in decimal degrees of the approximate center of
1. New Construction Activities. Any operator proposing a the construction activity(e.g., N 37.5000,W 77.5000).
stormwater discharge from construction activities_shall submit .a
complete Registration Statement to the Department prior to the Name and Location of Off-site Support Activity Information.
commencement of land disturbance, unless exempted by Section B
above. Any operator proposing a new stormwater discharge from This general permit also authorizes stormwater discharges from
construction activities in response to a public emergency where the support activities (e.g., concrete or asphalt batch plants, equipment
related work requires immediate authorization -to avoid imminent staging yards, material storage areas, excavated material disposal
endangerment to human health or the environment is immediately areas, borrow areas) located on-site or off-site provided that (i) the
authorized to discharge under this general permit and must submit a. support activity is directly related to a construction activity that is
complete Registration Statement to the Department no later than 30 required to have general permit coverage; (ii)the support activity is not
days after commencing land disturbance; documentation to a commercial operation, nor does it serve multiple unrelated
substantiate the occurrence of the public emergency must construction activities by different operators; (iii) the support activity
accompany the Registration Statement. does not operate beyond the completion of the construction activity it
supports; (iv) the support activity is identified in the registration
2. Existing Construction Activities. Any operator that was statement at the time of general permit coverage; (v) appropriate
authorized to discharge under the general permit issued in 2009, control measures are identified in. a SWPPP and implemented to
and who intends to continue coverage under this general permit, address the discharges from the support activity areas; and (vi) all
shall submit a complete Registration Statement to the Department applicable state, federal, and local approvals are obtained for the
on or before June 1,2014, unless exempted by Section B above. support activity.
D.Where to Submit Registration Statements. Provide the official name,street address(if available), City and County
(if not located within a City) of all off-site'support activities to be
All Registration Statements should be-submitted to: covered under this general permit. Also, provide the latitude and
longitude in decimal degrees of the approximate center of the off-site
Department of Environmental Quality support activities (e.g., N 37.5000, W 77.5000). Also, if an off-site
Office of Stormwater Management,10th Floor support activity is going to be covered under this general permit the
P.O.Box 1105 total land area of the off-site support activity and the estimated area to
Richmond,VA 23218 • be disturbed by the off-site support activity need to be included in Item
#9.
LINE-BY-LINE INSTRUCTIONS
Item 4:Status of the Construction Activity.
Item 1:Construction Activity Operator Information.
Indicate the appropriate status (Federal, State, Public, or Private) of
"Operator" means the owner or operator of any facility or activity the construction activity
subject to the Stormwater Management Act and regulations. In the
context of stormwater associated with a large or small construction Item 5: Nature of the Construction Activity.
activity, operator means any person associated with a construction
project that meets either of the following two criteria:(i)the person has Provide a brief description of the construction activity, such as
direct operational control over construction plans and specifications, commercial, residential, agricultural, oil and gas, etc.This list is not all
including the ability to make modifications to those plans, and inclusive.
specifications or (ii) the person has day-to-day operational control of
those activities at a project that are necessary to ensure compliance Item 6: Receiving Waters(s)and HUC Information.
with a stormwater pollution prevention plan for the site or other state
permit or VSMP authority permit conditions (i.e.,they are authorized to Provide the name of the receiving water(s)and corresponding HUC for
direct workers at a site to carry out activities required by the all stormwater discharges including any stormwater discharges from
stormwater pollution prevention plan or comply with other permit off-site support activities to be covered under this general permit.
conditions) Hydrologic Unit Code or HUC is a watershed-unit established in the
most recent version of Virginia's 6`h order national watershed boundary
dataset.
07/2014 Page 1 of 2
assigned or delegated to the manager in accordance with
Item 7: MS4 information. corporate procedures.
If stormwater is discharged through a municipal separate storm sewer b. For a partnership or sole proprietorship by a general partner or
system(MS4), provide the name of the MS4 operator The name of the the proprietor, respectively.
MS4 operator,is generally the Town, City, County,institute or Federal
facility where the construction activity is located. c. For a municipality,state, federal, or other public agency: by either
a principal executive officer or ranking:elected official. For purposes
Item 8: Construction Activity Start and Completion Date of this part,a principal executive officer of a public agency includes:
Information.
(i)The chief executive officer of the agency,or
Provide the estimated start date (month/day/year) of the construction
activity. Provide the estimated completion date (month/day/year) of (ii)A senior executive officer having responsibility for the overall
the construction activity. operations of a principal geographic unit of the agency.
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 operatoridentified •
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
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07/2014 Page 2 of 2
Section 2 Notice of gef eral permit coverage
(This notice is to be.posted near the main entrance according to 9VAC25-880-70, Part II, section
C.) (Provide a copy of the DEQ coverage letter when obtained)
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Issued— 10/2014 Stormwater Pollution Prevention Plan(SWPPP)Albemarle County
• Section 3 Natug c of activity
(Provide a detailed,narrative of the construction activities. Include or reference a construction schedule and
sequence. Include any phasing.)
- ConS--huc)k of) of 43 ocliackDA 0 -L homes
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Issued— 10/2014 Stormwater Pollution Prevention Plan(SWPPP)Albemarle County
Section 4. Erosion and Sediment Control Plano
(Provide a reduced, 11x17 copy of the latest Erosion and Sediment Control Plan. Do not reference only.)
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Issued— 10/2014 Storm-Water Pollution Prevention Plan(SWPPP) Albemarle County
Section 5. Stormwater Management Plan
(Provide a reduced 1 lx17 copy of the latest stormwater management plan. Do not reference only.)
Issued— 10/2014 Stoiiiiwater Pollution Prevention Plan(SWPPP)Albemarle County
Section 6. Pollution Prevention Plan.
(reference County Code 17-404 and'State Regulation 9VAC25-880-70 part II section A.4)
A. Plan showing pollution activities and prevention practices
(Provide a reduced 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.)
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Issued— 10/2014 Stormwater Pollution Prevention Plan(SWPPP)Albemarle County
B. Sources of tbollutaritsy location&and prevention practices
Pollutant,or Pollutant Prevention Practices,
Generating Activity li�oealioen on site Control Measures
Fuel,gas,oil,coolant Not to be stored on site Not to be stored on site, clean any s
Concrete Concrete wash out wash out,dispose when dry
Paint Garages I Wash in washout
cleaning materials I garages I Wash in washout
Asphalt JOnly.usedto pave J use leftovers for curbs
Termite spray I Sprayed around foundation I per code
Drywall compound Garages Let dry and dispose of
block mortar within silt fencing Cure before disposing of
Tile grout I inside clean in washout
I 1 •
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I
C. Sources of Pollutants, continued. Common activities and minimum control and prevention
ractices
Pollutant,or Pollutant Prevention Practices,
Generating Activity Location on Site Control Measures
Follow Erosion and Sediment Control
CIearing,grading,excavating,and un- Plan.Dispose of clearing debris at
stabilized areas Land disturbance area acceptable disposal sites.Seed and mulch,
or sod within 7 days of land clearing
Cover storm drain inlets and use drip
Paving operations Roads and driveways pans and absorbent/oil dry for ailpaving
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, in a flat unpaved area.Prevent the
painting,and cleaning Structures 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
Material delivery and storage Designated area shown on plan and storage.Placed near construction
entrances,away from waterways and
drainage paths -
Material use duringbuilding process Building areas Follow manufacturer's instructions
.MSDS's attached.
waste collection area will not receive a
substantial amount of runoff from upland
Solid waste disposal Current designated container areas areas and does not drain directly to a
on plan waterway.Containers have lids covered
before periods of rain,or are in a covered
area Scheduled collection to prevent
Issued— 10/2014 Stormwater Pollution Prevention Plan.(SWPPP)Albemarle County
Pollutant,or Pollutant Prevention Practices,
Generating Activity Location on site 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 CUP,.9VAC25-880-70 section E for examples of non-stormwater discharges.) --
D. Non-stormwater discharges
Discharge Pollutants or Pollutant Location on Site
Constituents
Sarin- be aila .
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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P. 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 TI, section A.4.e.)
aS dk
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.)
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3'
Issued— 10/2014 Stormwater Pollution Prevention Plan(SWPPP) Albernarle County
F. Response and reporting practices
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.
1'Priority: Protect all people
2nd 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 A 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
G. Polution Prevention Awareness
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
Section 7. Discharges to impaired waters, surface waters within an applicable TIVIDL
wasteload allocation, and exceptional waters.
(Provide detailed measures for any applicable TMDL)
Ni
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.)
Sh S J (75 Olejea nailer
i i .10, D. (434)aLW- a VP 0-C GDrs+iur=hQ
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Issued— 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
Section 9 Signed. Certification
(Provide certification according to 9VAC25-870-370)
CERTIFICATION
"I certify under penalty of law that this document and all attachments we're 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: WI!Ai i' D. Cr. a.-
Company: Groj ICI d i S
Title: Y P D- Co-fl Uu.C..-,-1Or
Signature: � /i,
Date: Ob S 116
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Issued— 10/2014 Stormwater Pollution Prevention Plan(SWPPP)Albemarle County
Section 10. Delegation of authority.
(Provide the persons or positions with authority to sign inspection reports or to modify the stormwater pollution
prevention plan. A formal,.signed.delegation of authority is needed.)
Delegation of Authority
I, V V II,Ila m I D. (name),hereby designate the person or specifically described position below to be a duly authorized
representative;fiio,rrthe p ose of overseeing compliance with environmental requirements,including the Construction General Permit,
at the(Q I f itil VI i I , lock. +
, I05 I-. 3 construction site. The designee is authorized to sign any reports,stormwater
pollution prevention 15 ans and all other documents required by the permit.
VUCS (name of person or position)
(company)
Cratl (address)
. R 1 . �Q (city,state,zip)
chariokesvl ilk,U.. (phone)
(io3') aZa-44�5
By signing this aut iorizat on,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: V V i 1/L i dry, ). Chaij
Company: C •BLu I s
Title: VP a S `01--)Q,m •
Signature:- k/i a .
Date: Si iS I l 6
Issued— 10/2014 Stormwater Pollution.Prevention Plan(SWPPP)Albemarle County
Section 11. General permit copy
(Provide a copy of the construction general permit, 9VAC25-880)
Issued— 10/2014 Stormwater Pollution Prevention Plan(SWPPP)Albemarle County
Section 12. Inspection logs
(Provide templates for your inspections. Requirements are listed in 9VAC25-880-70, Part II, section B and F.)
) 14- 0147106-d Ahan—qablaLLYitf
•
Issued— 10/2014 Stounwater Pollution Prevention Plan (SWPPP) Albemarle County
Community
Job Date Report