HomeMy WebLinkAboutWPO201500039 Plan - Stormwater Stormwater Management Plan 2015-08-17 0-V�I� COUNTY OF ALBEMARLE
0TH Department of Community Development
c r ,•' ti 401 McIntire Road,North Wing
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® Charlottesville,Virginia 22902-4596
Tel. (434)296-5832 • Fax(434)972-4126
1IRGI V'
Stormwater Pollution Prevention Plan (SWPPP)
For Construction Activities At:
Project Name: Michie Tavern Water Main Re slacement Pro'ect
Address: Piedmont Virginia Community College
Parcel # 07700-00-00-02500
University of Virginia Foundation
Parcel # 07700-00-00-015B0
Prepared by:
Name: Whitman Re'uardt & Associates LLP
Prepared for:
Name: Contractor to be determined
SWPPP Preparation Date: Pta c3A# 17, ..)O( S
(This document is to be made publicly available according to 9VAC25-880-70, Part II, section D)
Issued— 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
CONTENTS: (from Albemarle County Code Sec. 17-405)
1. Registration statement
2. Notice of general permit coverage
3. Nature of activity
4. Erosion and Sediment Control Plan.
5. Stormwater Management Plan
6. Pollution Prevention Plan.
7. Discharges to impaired waters, surface waters within an applicable TMDL wasteload
allocation, and exceptional waters.
8. Qualified personnel
9. Signed Certification
10. Delegation of authority.
11. General permit copy
12. Inspection logs
Issued— 10/2014 Stormwater Pollution Prevention Plan(SWPPP) Albemarle County
Section 1. Registration statement
(Provide a signed completed copy of the DEQ registration statement)
Issued— 10/2014 Stormwater Pollution Prevention Plan (SWPPP) Albemarle County
Registration Statement
General VPDES Permit for Discharges of Stormwater from 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.)
Name: Albemarle County Service Authority
Contact: Jeremy Lynn, P.E.
Mailing Address: 168 Spotnap Road
City: Charlottesville State: VA Zip: 22911 Phone: (434)977-4511
Email address(if available): jlynn@serviceauthority.org
Indicate if DEQ may transmit general permit correspondence electronically: Yes❑x No n
2. Existing General Permit Registration Number(for renewals only):
3. Name and Location of the Construction Activity:
Name: Michie Tavern Water Main Replacement Project
Address (if available): 600 College Drive/ 1085 Lyman Manson Road
City: Charlottesville State: VA Zip: 22911
County(if not located within a City): Albemarle
Latitude (decimal degrees): N 38.0075 Longitude(decimal degrees): W 78.4789
Name and Location of all Off-site Support Activities to be covered under the general permit:
Name:
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 n Private 17
5. 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/Mechunk Creek/Moores Creek Name:
HUC: 02080204/0208020404/020802040402 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): November 2015 Completion Date(mm/dd/yyyy): August 2016
9. Total Land Area of Development(to the nearest one-hundredth acre): 1.80 acres
Estimated Area to be Disturbed (to the nearest one-hundredth acre): 1.80 acres
10. Is the area to be disturbed part of a larger common plan of development or sale? Yes❑ No n
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: -le ! n
Title: C : Er.� ���-ear
Signature: 'may Date: $(111.4.9/5–
(Please
f11Ids/S(Please sign in INK. T is 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 Stormwater from Construction Activities (VAR1O)
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 new 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,10`"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 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
07/2014 Page 2 of 2
Section 2. Notice of general permit coverage
(This notice is to be posted near the main entrance according to 9VAC25-880-70, Part II, section C.)
(Provide a copy of the DEQ coverage letter when obtained)
Issued— 10/2014 Stormwater Pollution Prevention Plan(SWPPP) Albemarle County
Section 3. Nature of activity
(Provide a detailed narrative of the construction activities. Include or reference a construction schedule and
sequence. Include any phasing.)
Construction Activities
1. Clearing and grubbing along roadway or easement.
2. Furnish and install 16" HDPE casing and 6" HDPE water carrier pipe.
3. Furnish and install 6", 4" PVC water pipe.
4. Furnish and install 6" and 4" valves.
5. Furnish and install fire hydrants, air release valves, water services, and automatic flushing
system.
6. Locate and connect to existing water main.
7. Abandon existing water main.
8. Restoration of all easements, yards, parking lot.
9. Place asphalt pavement according to VDOT specifications.
10. Testing of all water pipe and all appurtenances.
11. Disinfection of water main.
12. Any incidental work to complete project.
Anticipated Schedule
Start Construction: November 2015
End Construction: August 2016
Sequence of Construction
1. Notify the Albemarle County Service Authority (ACSA) inspector in writing seven days prior to
commencing construction of this project. The inspector will notify the City of Scottsville's (City)
Erosion and Sediment Control Regulatory Agency to arrange an on-site preconstruction meeting at
least 48 hours prior to the issuance of a Land Disturbance Permit.
2. Remove existing debris from drainage ditches and haul to an appropriate disposal site.
3. Install all erosion and sediment control measures.
4. Notify the ACSA and City inspectors when initial erosion control measures are in place.
5. 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.
6. Test water mains, connect new water service connections, and overlay existing roads and gravel
drives.
7. No stockpile is anticipated for this project.
8. Upon completion of work, apply permanent seeding to all disturbed areas.
9. When disturbed area are stabilized to the satisfaction of the inspectors and the engineer, remove all
temporary erosion and sediment control devices.
10. Notify the ACSA and City 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, 11 x17 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 11x17 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 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.)
(To be inserted into SWPPP following final review and approval.)
Issued— 10/2014 Stormwater Pollution Prevention Plan(SWPPP) Albemarle County
B. Sources of Pollutants, locations, and prevention practices
Pollutant,or Pollutant Location on site Prevention Practices,
Generating Activity Control Measures
No additional activities—N/A
C. Sources of Pollutants continued. Common activities and minimum control and prevention
practices
Pollutant,or Pollutant Prevention Practices,
Generating Activity Location on site Control Measures
Follow Erosion and Sediment Control
Clearing,grading,excavating,and un- Land disturbance area Plan. Dispose of clearing debris at
stabilized areas acceptable disposal sites.Seed and mulch.
or sod within 7 days of land clearing
Cover storm drain inlets and use drip pans
Paving operations Roads and driveways and absorbent/oil 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 containment area or
Structure construction,stucco, Structures in a flat unpaved area. Prevent the
painting, and cleaning discharge of soaps,solvents,detergents
and wash water,paint,form release oils
and curing compounds.
Water shall be filtered,settled or similarly
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 Prevention Practices,
Generating Activity Location on site 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. Scheduled collection to prevent
overfilling. MATERIALS NOT TO BE
BURIED ON-SITE
Convenient and well-maintained portable
sanitary facilities will be provided,and
Sanitary 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
control as specified on plan.Minimize
Wash Waters Wash areas shown on plan 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
MinimLation of exposure to precipitation and stormwater. Minimize the exposure of building materials, building products,
construction wastes,trash, landscape materials, fertilizers,pesticides,herbicides,detergents,sanitary waste,and other materials
present on the site to precipitation and to stormwater.
(Identify all non-stormwater discharges to occur on your site. Keep this plan up-to-date with ongoing site
changes and inspections. See CGP, 9VAC25-880-70 section E for examples of non-stormwater discharges.)
D. Non-stormwater discharges
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 discharges from spills and leaks. Minimize the discharge of pollutants from spills and leaks and implement chemical spill
and leak prevention and response procedures as follows.
Respond to all spills, leaks and discharges as follows;
Report all spills, leaks and discharges as follows;
(Provide detailed response and reporting practices according to 9VAC25-880-70, Part II, section A.4.e.)
(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 TMDL
wasteload allocation, and exceptional waters.
(Provide detailed measures for any applicable TMDL)
(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
"I certify under penalty of law that this document and all attachments were prepared under my direction or
supervision in accordance with a system designed to assure that qualified personnel properly gather and
evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my
knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
submitting false information, including the possibility of fine and imprisonment for knowing violations."
Owner/Operator Name:
Company: ptlbz;.ro.1z C-0„1-,\ S��v,� �i oc'1
Title: Se, .:,t' t_ v.k tcrNI LC—
Signature:
Date: SI O Id'JIS
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 II, 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
Instructions for Completing the Registration Statement
General VPDES Permit for Discharges of Stormwater 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 new 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,10`h 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 6th 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 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
07/2014 Page 2 of 2
Section 2. Notice of general permit coverage
(This notice is to be posted near the main entrance according to 9VAC25-880-70, Part II, section C.)
(Provide a copy of the DEQ coverage letter when obtained)
Issued— 10/2014 Stormwater Pollution Prevention Plan(SWPPP) Albemarle County
Section 3. Nature of activity
(Provide a detailed narrative of the construction activities. Include or reference a construction schedule and
sequence. Include any phasing.)
Construction Activities
1. Clearing and grubbing along roadway or easement.
2. Furnish and install 16" HDPE casing and 6" HDPE water carrier pipe.
3. Furnish and install 6", 4" PVC water pipe.
4. Furnish and install 6" and 4" valves.
5. Furnish and install fire hydrants, air release valves, water services, and automatic flushing
system.
6. Locate and connect to existing water main.
7. Abandon existing water main.
8. Restoration of all easements, yards, parking lot.
9. Place asphalt pavement according to VDOT specifications.
10. Testing of all water pipe and all appurtenances.
11. Disinfection of water main.
12. Any incidental work to complete project.
Anticipated Schedule
Start Construction: November 2015
End Construction: August 2016
Sequence of Construction
1. Notify the Albemarle County Service Authority (ACSA) inspector in writing seven days prior to
commencing construction of this project. The inspector will notify the City of Scottsville's (City)
Erosion and Sediment Control Regulatory Agency to arrange an on-site preconstruction meeting at
least 48 hours prior to the issuance of a Land Disturbance Permit.
2. Remove existing debris from drainage ditches and haul to an appropriate disposal site.
3. Install all erosion and sediment control measures.
4. Notify the ACSA and City inspectors when initial erosion control measures are in place.
5. 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.
6. Test water mains, connect new water service connections, and overlay existing roads and gravel
drives.
7. No stockpile is anticipated for this project.
8. Upon completion of work, apply permanent seeding to all disturbed areas.
9. When disturbed area are stabilized to the satisfaction of the inspectors and the engineer, remove all
temporary erosion and sediment control devices.
10. Notify the ACSA and City 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, 11 x 17 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 l l 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 part II section A.4)
A. Plan showing pollution activities and prevention practices
(Provide a reduced 1 lx17 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 Stormwater Pollution Prevention Plan(SWPPP) Albemarle County
B. Sources of Pollutants, locations, and prevention practices
Pollutant,or Pollutant Location on site Prevention Practices,
Generating Activity Control Measures
No additional activities—N/A
C. Sources of Pollutants continued. Common activities and minimum control and prevention
practices
Pollutant,or Pollutant Prevention Practices,
Generating Activity Location on site Control Measures
Follow Erosion and Sediment Control
Clearing,grading,excavating,and un- Land disturbance area Plan. Dispose of clearing debris at
stabilized areas acceptable disposal sites.Seed and mulch,
or sod within 7 days of land clearing
Cover storm drain inlets and use drip pans
Paving operations Roads and driveways and absorbent/oil 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 containment area or
Structure construction,stucco, Structures in a flat unpaved area. Prevent the
painting, and cleaning discharge of soaps,solvents,detergents
and wash water,paint,form release oils
and curing compounds.
Water shall be filtered,settled or similarly
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 Prevention Practices,
Generating Activity Location on site 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. Scheduled collection to prevent
overfilling. MATERIALS NOT TO BE
BURIED ON-SITE
Convenient and well-maintained portable
sanitary facilities will be provided,and
Sanitary 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 of exposure to precipitation and stormwater. Minimize the exposure of building materials,building products,
construction wastes,trash, landscape materials,fertilizers,pesticides,herbicides,detergents,sanitary waste,and other materials
present on the site to precipitation and to stormwater.
(Identify all non-stormwater discharges to occur on your site. Keep this plan up-to-date with ongoing site
changes and inspections. See CGP, 9VAC25-880-70 section E for examples of non-stormwater discharges.)
D. Non-stormwater discharges
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 discharges from spills and leaks. Minimize the discharge of pollutants from spills and leaks and implement chemical spill
and leak prevention and response procedures as follows.
Respond to all spills, leaks and discharges as follows;
Report all spills, leaks and discharges as follows;
(Provide detailed response and reporting practices according to 9VAC25-880-70, Part II, section A.4.e.)
(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 TMDL
wasteload allocation, and exceptional waters.
(Provide detailed measures for any applicable TMDL)
(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
"I certify under penalty of law that this document and all attachments were prepared under my direction or
supervision in accordance with a system designed to assure that qualified personnel properly gather and
evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my
knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
submitting false information, including the possibility of fine and imprisonment for knowing violations."
Owner/Operator Name: Lr- r.
Company: A l6a‘'I Co.�Y.�7 Seru:(c A1/4_1_00
Title: Se,kt-- C. J .\
Signature: 2ese—r-127
Date: '1101 1 S
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 II, 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