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HomeMy WebLinkAboutWPO201600022 Plan - Stormwater Stormwater Management Plan 2016-03-25 Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL Stormwater Pollution Prevention Plan (SWPPP) For Construction Activities At: Harper-Shelton Mill Shelton Mill Road Albemarle County, Virginia SWPPP Prepared For: Shelter Associates 1009 E. High Street Charlottesville, Virginia 22902 434-973-8307 SWPPP Prepared By: Terra Concepts, PC 2046 Rock Quarry Road Louisa, Virginia 23093 434-531-3600 SWPPP Preparation Date: March 25, 2016 Estimated Project Dates: Project Start Date: 4-1-2016 Project Completion Date: 4-1-2017 r-, MA-K KE L "' License N. 239 t6/LSA4 PE p\- EPA SWPPP Template, Version 1.0 iii Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL Contents SECTION 1: CONTACT INFORMATION/RESPONSIBLE PARTIES 1 1.1 Operator(s) /Subcontractor(s) 1 1.2 Stormwater Team 1 SECTION 2: SITE EVALUATION, ASSESSMENT, AND PLANNING 2 2.1 Project/Site Information 2 2.2 Discharge Information 3 2.3 Nature of the Construction Activity 5 2.4 Sequence and Estimated Dates of Construction Activities 5 2.5 Allowable Non-Stormwater Discharges 5 2.6 Site Maps 6 SECTION 3: DOCUMENTATION OF COMPLIANCE WITH OTHER FEDERAL REQUIREMENTS 7 3.1 Endangered Species Protection 7 3.2 Historic Preservation 7 3.3 Safe Drinking Water Act Underground Injection Control Requirements 8 SECTION 4: EROSION AND SEDIMENT CONTROLS 9 4.1 Natural Buffers or Equivalent Sediment Controls 9 4.2 Perimeter Controls 9 4.3 Sediment Track-Out 9 4.4 Stockpiled Sediment or Soil 9 4.5 Minimize Dust 10 4.6 Minimize the Disturbance of Steep Slopes 10 4.7 Topsoil 10 4.8 Soil Compaction 10 4.9 Storm Drain Inlets 10 4.10 Constructed Stormwater Conveyance Channels 10 4.11 Sediment Basins 10 4.12 Chemical Treatment 10 4.13 Dewatering Practices 11 4.14 Other Stormwater Controls 11 4.15 Site Stabilization 11 SECTION 5: POLLUTION PREVENTION STANDARDS 12 5.1 Potential Sources of Pollution 12 5.2 Spill Prevention and Response 12 5.3 Fueling and Maintenance of Equipment or Vehicles 12 5.4 Washing of Equipment and Vehicles 12 5.5 Storage, Handling, and Disposal of Construction Products, Materials, and Wastes 12 5.6 Washing of Applicators and Containers used for Paint, Concrete or Other Materials 13 5.7 Fertilizers 13 5.8 Other Pollution Prevention Practices 13 SECTION 6: INSPECTION AND CORRECTIVE ACTION 14 6.1 Inspection Personnel and Procedures 14 6.2 Corrective Action 15 6.3 Delegation of Authority 15 SECTION 7:TRAINING 16 SECTION 8: CERTIFICATION AND NOTIFICATION 17 SWPPP APPENDICES 19 EPA SWPPP Template, Version 1.0 iv Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL SECTION 1: CONTACT INFORMATION/RESPONSIBLE PARTIES 1.1 Operator(s) /Subcontractor(s) Operator(s): Shelter Associates 1009 E. High Street Charlottesville, Virginia 22902 434-973-8307 Once the site plan is approved the project will be bid and awarded to a site contractor who shall assume responsibility for this project. Emergency 24-Hour Contact: Shelter Associates 434-973-8307 1.2 Stormwater Team Site Planner/ Report Preparation Terra Concepts, PC Mark Keller 434-531-3600 mkeller@terraconceptspc.com EPA SWPPP Template, Version 1.0 1 Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL SECTION 2: SITE EVALUATION, ASSESSMENT, AND PLANNING 2.1 Project/Site Information Project Name and Address Project/Site Name: HARPER-SHELTON MILL Project Street/Location: END OF SHELTON MILL ROAD SOUTH OF RTE 250 AND NORTH OF 1-64 NEAR BROWNSVILLE, VA City: NEAR CROZET, VA State: VIRGINIA ZIP Code: 22932 County or Similar Subdivision:ALBEMARLE COUNTY Project Latitude/Longitude 38°02' 37" N 78°40'42"W Method for determining latitude/longitude: GOOGLE EARTH ❑ USGS topographic map (specify scale: ❑ EPA Web ❑ GPS site ❑ Other (please specify): AERIAL TOPOGRAPHY BY SURVEYOR- 1' INTERVAL Horizontal Reference Datum: ❑ NAD 27 ❑ NAD 83 or WGS 84 ❑Surveyor Established via Plat of Record If you used a U.S.G.S topographic map,what was the scale? Additional Project Information Is the project/site located on Indian country lands, or located on a property of religious or cultural significance to an Indian tribe? NO If yes, provide the name of the Indian tribe associated with the area of Indian country (including the name of Indian reservation if applicable), or if not in Indian country, provide the name of the Indian tribe associated with the property: If you are conducting earth-disturbing activities in response to a public emergency, document the cause of the public emergency(e.g., natural disaster, extreme flooding conditions), information substantiating its occurrence (e.g., state disaster declaration), and a description of the construction necessary to reestablish effective public services: N/A Are you applying for permit coverage as a "federal operator" as defined in EPA SWPPP Template, Version 1.0 2 Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL Appendix A of the 2012 CGP? NO 2.2 Discharge Information Does your project/site discharge stormwater into a Municipal Separate Storm Sewer System (MS4)? NO Are there any surface waters that are located within 50 feet of your construction disturbances? NO EPA SWPPP Template, Version 1.0 3 Li ! Lo EC® ! £ 0 E $ ( o u., Wiz ( 3a Zt _ _i . °\ k / / } 0 - 0 2 2 { \ 2 / cI . . � � 0 E < ( . i : ) o ' 3 ) 2 3 ( @ a_ [ E . 5 ƒ a b E ( o r z / . E ) 0 \ \ 0 \ / i. / 0 E i a e / 2 22 e @ o k \ . 1- -6 _ 2 ® gr a) 7 a $ 9 / o / / / 1- o g { _ 02 � � a)\ a / \ . 2 0 \ \ / - - - 0 .- _e R R M M 5 >� � � a) FFFF [ _ t N. 0 0 0 0 0 % y 4 } \ g 2 § \ 2 ,O Z Z Z Z Z 0 0 \ m 6 6 6 § 6 >. a . / R7E � Nn❑❑❑❑ \ \ \/ \ \ \ GG » I 0 c 2 � / \ 0 3 2 G 2 _ § 2 a a & d d ) 0 0 0 z » x x ¥ ¥ o 0 0 0 - 6 ƒ 6 6 6 ) . o / = 0 L❑❑❑❑0) b 0 > E i= i= ` k £ £ / @ �. . . . . { / ± 0) f G 2 o \ \ \ \ \ \ ! [ o » g 3 » r w b k b b b \ [ / \ o # o w R » R R R 02 e e w w e { ® / / o > c \ 0 « 2 2 x 2 2 LU u E E u ( \ / + § j / - ƒ Z $ Z (/) Z \ E ) § / \ . f \ k / \ -0 ) o » E a _ c e k � ƒ \ \ U \ \ \ { G ¥ . * °- § � 7 p . 2 2 _c 3 0 0 15 P L( Z Z Z Z / o C .49 / \ � \ /\ � o❑00❑❑ / ce d ■ m 0 e 0 0 0 0 0 o ° f 2 - Z G 2 G. G G £ ) o t § 2 a o = . Z Z Z Z Z £ tL)t g / m he ¥ x » » x _0 $ + 2 « � 222 _❑❑❑❑❑ 7 _ w2 / ® ❑D❑❑❑ J m@uU ' ) fo )_ Eci N \ � a / 4/ Z et - 6 a G B G G@ e � ° / 2osa9 .E 2 - E » xx ¥ x £ � & _/ o { i ? E 7 § i ® 2 - | IJ |❑❑❑ ¢ ' \ \ ƒ 0 " 20 csi 62 ® . 4 ) © E % k R ® b ■ E } B. / § w co) $ . » w ¥ 0 3 .2 ® w es 4 4 ./ \ . Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL 2.3 Nature of the Construction Activity General Description of Project Provide a general description of the construction project: This rural residential project involves demolition of tar and chip driveway sections, several farm out-buildings, a portion of an old farm house, areas of patio and pool and removal of a small number of trees and shrubs. Construction will include new driveway sections, retaining walls, a main house addition and walkways and patios. Size of Construction Project What is the size of the property (in acres), the total area expected to be disturbed by the construction activities (in acres), and the maximum area expected to be disturbed at any one time? The farm is 269 acres. 1.50 acres of the parcel reside within the limits of work. Not all of the 1.50 acres will be disturbed.The remainder shall be left in its natural state,which is hay field and woodland.The maximum area to be disturbed at one time is roughly 1 acre. Construction Support Activities N/A 2.4 Sequence and Estimated Dates of Construction Activities Phase I Install E&S measures, perform demolition, commence grading activities, construct exterior improvements. Start date estimated as April 1, 2016 End date estimated as August 1, 2016 2.5 Allowable Non-Stormwater Discharges List of Allowable Non-Stormwater Discharges Present at the Site Type of Allowable Non-Stormwater Discharge Likely to be Present at Your Site? Discharges from emergency fire-fighting activities NO Fire hydrant flushings NO Landscape irrigation NO Waters used to wash vehicles and equipment NO Water used to control dust NO Potable water including uncontaminated water line flushings NO Routine external building wash down NO Pavement wash waters NO Uncontaminated air conditioning or compressor condensate NO EPA SWPPP Template, Version 1.0 5 Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL Uncontaminated, non-turbid discharges of ground water or spring water NO Foundation or footing drains NO Construction dewatering water NO (Note: You are reminded of the requirement to identify the likely locations of these allowable non- stormwater discharges on your site map. See Section 2.6, below, of the SWPPP Template.) 2.6 Site Maps See Appendix AHarper-Shelton Mill-8307 EPA SWPPP Template, Version 1.0 6 Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL SECTION 3: DOCUMENTATION OF COMPLIANCE WITH OTHER FEDERAL REQUIREMENTS 3.1 Endangered Species Protection Eligibility Criterion Under which criterion listed in Appendix D are you eligible for coverage under this permit? A 3.2 Historic Preservation The main house is old and portions of it may have historical value, but those parts are being preserved. Appendix E, Step 1 Do you plan on installing any of the following stormwater controls at your site? NO Check all that apply below, and proceed to Appendix E,Step 2. ❑ Dike ❑ Berm ❑ Catch Basin Appendix E, Step 2 If you answered yes in Step 1, have prior surveys or evaluations conducted on the site already determined that historic properties do not exist, or that prior disturbances at the site have precluded the existence of historic properties? • If yes, no further documentation is required for Section 3.2 of the Template. • If no, proceed to Appendix E,Step 3. Appendix E,Step 3 If you answered no in Step 2, have you determined that your installation of subsurface earth- disturbing stormwater controls will have no effect on historic properties? If yes, provide documentation of the basis for your determination. If no, proceed to Appendix E, Step 4. Appendix E, Step 4 If you answered no in Step 3, did the State Historic Preservation Officer (SHPO), Tribal Historic Preservation Office (THPO), or other tribal representative (whichever applies) respond to you EPA SWPPP Template, Version 1.0 7 Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL within 15 calendar days to indicate whether the subsurface earth disturbances caused by the installation of stormwater controls affect historic properties? 0 YES 0 NO If no, no further documentation is required for Section 3.2 of the Template. If yes, describe the nature of their response: ❑ Written indication that adverse effects to historic properties from the installation of stormwater controls can be mitigated by agreed upon actions. INSERT COPIES OF LETTERS, EMAILS, OR OTHER COMMUNICATION BETWEEN YOU AND THE APPLICABLE SHPO, THPO, OR OTHER TRIBAL REPRESENTATIVE ❑ No agreement has been reached regarding measures to mitigate effects to historic properties from the installation of stormwater controls. INSERT COPIES OF LETTERS, EMAILS, OR OTHER COMMUNICATION BETWEEN YOU AND THE APPLICABLE SHPO, THPO, OR OTHER TRIBAL REPRESENTATIVE ❑ Other: INSERT COPIES OF LETTERS, EMAILS, OR OTHER COMMUNICATION BETWEEN YOU AND THE APPLICABLE SHPO,THPO, OR OTHER TRIBAL REPRESENTATIVE 3.3 Safe Drinking Water Act Underground Injection Control Requirements Do you plan to install any of the following controls? NO Check all that apply below. ❑ Infiltration trenches (if stormwater is directed to any bored, drilled, driven shaft or dug hole that is deeper than its widest surface dimension, or has a subsurface fluid distribution system) ❑ Commercially manufactured pre-cast or pre-built proprietary subsurface detention vaults, chambers, or other devices designed to capture and infiltrate stormwater flow ❑ Drywells, seepage pits, or improved sinkholes (if stormwater is directed to any bored, drilled, driven shaft or dug hole that is deeper than its widest surface dimension, or has a subsurface fluid distribution system) If yes, INSERT COPIES OF LETTERS, EMAILS, OR OTHER COMMUNICATION BETWEEN YOU AND THE STATE AGENCY OR EPA REGIONAL OFFICE EPA SWPPP Template, Version 1.0 8 Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL SECTION 4: EROSION AND SEDIMENT CONTROLS 4.1 Natural Buffers or Equivalent Sediment Controls Buffer Compliance Alternatives Are there any surface waters within 50 feet of your project's earth disturbances? NO 4.2 Perimeter Controls General ■ Once access to the site is established,the first activity on-site will be to install all perimeter E&S controls Specific Perimeter Controls Perimeter Control # I Silt Fence without Wire Support- E&S Std. &Spec. 3.05 Silt Fence is proposed to capture the sediments in the sheet flow. Silt Fence shall be installed in a sequenced manner as shown on the plan. To be installed around any topsoil stockpile and where small disturbed areas sheet flow toward native, stable groundcover. Install immediately. Periodic visual inspection required. Rock Check Dams- E&S Std. & Spec. 3.20 Small,temporary stone dams constructed across a drainage ditch to reduce the velocity of concentrated flows, reducing erosion of a swale or ditch. Limited to use in small open channels which drain 10 acres or less;should not be used in live streams. Owner may choose to leave this improvement in place after stabilization if approved by E&S agent. 4.3 Sediment Track-Out Specific Track-Out Controls Track-Out Control # 1 Temporary Construction Entrance - E&S Std.& Spec. 3.02 Temporary Construction Entrance is proposed to define the entry and exit point to the construction site and to provide the platform to clean construction vehicles before leaving the site. A Temporary Construction Entrance shall be installed where indicated. Install immediately. Regular maintenance required. 4.4 Stockpiled Sediment or Soil Specific Stockpile Controls Stockpile Control # 1 No stockpile is anticipated to be established.There is little grading involved and soil will be pushed around the balanced site within the course of two or three days. EPA SWPPP Template, Version 1.0 9 Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL 4.5 Minimize Dust Dust Control- E&S Std. & Spec. 3.39 Dust Control will be of little concern. This is a residential-scale renovation project on a large farm in a rural area. Little to no heavy machinery will be used. New gravel driveways will be quickly established and lawn disturbance will be stabilized in a timely manner. 4.6 Minimize the Disturbance of Steep Slopes Steep Slope Control # 1 Soil Stabilization Blankets &Matting - E&S Std. & Spec. 3.36 The installation of a protective blanket(Treatment 1) or a soil stabilization mat(Treatment 2) on a prepared planting of a steep slope, channel or shoreline. To be installed on slopes of 3:1 or greater and where necessary along diversion dikes to prevent erosion. Install once grades have been established. Visual inspection required periodically. 4.7 Topsoil Topsoil will be stripped and reapplied immediately. No stockpile is anticipated to be established. There is little grading involved and soil will be pushed around the balanced site within the course of two or three days. 4.8 Soil Compaction N/A 4.9 Storm Drain Inlets N/A 4.10 Constructed Stormwater Conveyance Channels N/A 4.11 Sediment Basins N/A 4.12 Chemical Treatment N/A EPA SWPPP Template, Version 1.0 10 Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL 4.13 Dewatering Practices N/A 4.14 Other Stormwater Controls N/A Specific Stormwater Control Practices N/A 4.15 Site Stabilization Site Stabilization Practice X Vegetative ❑Non-Vegetative ❑Temporary X Permanent Topsoiling- E&S Std. & Spec. 3.30 Topsoiling shall be installed wherever landscaping, sod or permanent seeding is proposed as indicated on the plans.To be applied to all disturbed slopes not scheduled for building or pavement. Install immediately after achieving final grade. Permanent Seeding - E&S Std. & Spec. 3.32 All areas temporary disturbed by construction and not scheduled to be placed in building, parking lot, paving, landscape mulch or sod shall be stabilized with permanent seeding immediately following establishment of final grades. Unless otherwise specified, permanent seeding will be done with a seed mix approved by the Owner prior to application in accordance to E&S Std. and Spec. 3.31 of the 1992 Virginia Erosion and Sediment Control Handbook. To be applied to all disturbed slopes not scheduled for building or pavement. Install immediately after achieving final grade. Water regularly to initiate germination and establishment. Mulching-E&S Std. &Spec. 3.35 Mulching shall be installed in limited areas where landscaping occurs or where maintenance of proposed grass stands would be preclusive. See plans. To be applied to all disturbed slopes not scheduled for building or pavement. Install immediately after permanent seeding takes place. Regular inspection and periodic maintenance required. EPA SWPPP Template, Version 1.0 11 Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL SECTION 5: POLLUTION PREVENTION STANDARDS 5.1 Potential Sources of Pollution This is very simple project involving both demolition and new construction around an old farm house located in the middle of a large farm. Construction activities shall occur on a gentle knoll and are no where near dry swales or other drainage-ways. Stockton Creek is several hundred feet away.The "potential sources of pollution" would be leaks, spills or exhaust resulting from heavy equipment operation during earth-moving and wind-borne waste escaping the property. A dumpster will be on site for deposal of any waste. There does not seem to be any reason to maintain emergency response (HAZMAT) materials on-site. It is anticipated that a porta-jon will also be on-site for use during construction. 5.2 Spill Prevention and Response The contractor shall maintain on-site instructions regarding how to respond to a HAZMAT situation. 5.3 Fueling and Maintenance of Equipment or Vehicles While this is only to expected to occur during a one-week time frame,fueling of vehicles and equipment shall take place on flat gravel areas within the limits of work. No bulk storage of fuels or similar liquids shall be maintained on site. Fuel shall be imported as needed by separate vehicle. 5.4 Washing of Equipment and Vehicles Construction vehicles will remain on-site until no longer needed.They will be washed at the temporary construction entrance. 5.5 Storage, Handling, and Disposal of Construction Products, Materials, and Wastes No bulk storage of containerized materials that are are considered potential pollution hazards is anticipated. Other materials materials that are are considered potential pollution hazards such as pressure-treated wood may be kept on a gravel surface and covered with plastic sheeting or a tarp. All construction waste shall be deposited into a dumpster and taken to a local waste-management facility wher it can be properly handled and disposed of. 5.5.1 Building Products Building products shall arrive on site just prior to their installation. Waste from building products and/or procedures shall be cleaned up every day and deposited into a dumpster for later transport to a waste- management facility. Potentially hazardous materials shall be stored in the freight container. 5.5.2 Pesticides, Herbicides, Insecticides, Fertilizers, and Landscape Materials The only applications of this nature may be termite applications around the new building addition,which shall be applied by a licensed professional. EPA SWPPP Template, Version 1.0 12 Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL 5.5.3 Diesel Fuel, Oil, Hydraulic Fluids, Other Petroleum Products, and Other Chemicals During construction, no fuel, oil, hydraulic fluids or other petroleum products shall be stored on-site. They shall be brought to the site on an as-needed basis via pickup truck and applied as required. Spills shall be handled according to HAZMAT protocol by the contractor. HAZMAT supplies shall be kept in the freight container. 5.5.4 Hazardous or Toxic Waste All unused solvents and other potentially hazardous or toxic waste shall be containerized and taken to a proper facility that accepts such material. Spills shall be handled according to HAZMAT protocol by the contractor. HAZMAT supplies shall be kept in the freight container. 5.5.5 Construction and Domestic Waste A dumpster will be on site for deposal of any construction waste and the container shall be periodically taken to a waste-management facility. 5.5.6 Sanitary Waste It is anticipated that a porta-jon will also be on-site for use during construction. It shall be secured to the ground to prevent displacement. 5.6 Washing of Applicators and Containers used for Paint, Concrete or Other Materials All materials that qualify under this description shall be removed from the subject site without washing or cleaning. Cleaning shall take place at the applicator's facility. 5.7 Fertilizers See 5.5.2 5.8 Other Pollution Prevention Practices N/A EPA SWPPP Template, Version 1.0 13 Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL SECTION 6: INSPECTION AND CORRECTIVE ACTION 6.1 Inspection Personnel and Procedures All inspections shall be done or directed by the Contractor. Personnel Responsible for Inspections INSERT NAMES OF PERSONNEL OR TYPES OF PERSONNEL WHO WILL BE CONDUCTING SITE INSPECTIONS HERE Note: All personnel conducting inspections must be considered a "qualified person." CGP Part 4.1.1 clarifies that a "qualified person" is a person knowledgeable in the principles and practices of erosion and sediment controls and pollution prevention,who possesses the skills to assess conditions at the construction site that could impact stormwater quality, and the skills to assess the effectiveness of any stormwater controls selected and installed to meet the requirements of this permit. Inspection Schedule Specific Inspection Frequency INSERT INSPECTION SCHEDULE BASED ON CGP PARTS 4.1.2, 4.1.3, OR 4.1.4, WHICHEVER APPLIES Rain Gauge Location (if applicable) SPECIFY LOCATION(S) OF RAIN GAUGE TO BE USED FOR DETERMINING WHETHER A RAIN EVENT OF 0.25 INCHES OR GREATER HAS OCCURRED (only applies to inspections conducted for Part 4.1.2.2, 4.1.3, or 4.1.4.2) Reductions in Inspection Frequency (if applicable) • For the reduction in inspections resulting from stabilization: SPECIFY (1) LOCATIONS WHERE STABILIZATION STEPS HAVE BEEN COMPLETED AND (2) DATE THAT THEY WERE COMPLETED (Note: It is likely that you will not be able to include this in your initial SWPPP. If you qualify for this reduction (see CGP Part 4.1.4.1), you will need to modify your SWPPP to include this information.) • For the reduction in inspections in arid, semi-arid, or drought-stricken areas: INSERT BEGINNING AND ENDING DATES OF THE SEASONALLY-DEFINED ARID PERIOD FOR YOUR AREA OR THE VALID PERIOD OF DROUGHT • For reduction in inspections due to frozen conditions: INSERT BEGINNING AND ENDING DATES OF FROZEN CONDITIONS ON YOUR SITE Inspection Report Forms INSERT COPY OF ANY INSPECTION REPORT FORMS YOU WILL USE HERE OR IN APPENDIX D EPA SWPPP Template, Version 1.0 14 Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL 6.2 Corrective Action Instructions(CGP Parts 5 and 7.2.12): — Describe the procedures for taking corrective action in compliance with CGP Part 5. Personnel Responsible for Corrective Actions INSERT NAMES OF PERSONNEL OR TYPES OF PERSONNEL RESPONSIBLE FOR CORRECTIVE ACTIONS Corrective Action Forms INSERT A COPY OF ANY CORRECTIVE ACTION FORMS YOU WILL USE HERE OR IN APPENDIX E 6.3 Delegation of Authority Duly Authorized Representative(s) or Position(s): Insert Company or Organization Name: Insert Name: Insert Position: Insert Address: Insert City,State, Zip Code: Insert Telephone Number: Insert Fax/Email: EPA SWPPP Template, Version 1.0 15 Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL SECTION 7:TRAINING Table 7-1: Documentation for Completion of Training Name Date Training Completed INSERT NAME OF PERSONNEL HERE INSERT COMPLETION DATE HERE INSERT NAME OF PERSONNEL HERE INSERT COMPLETION DATE HERE INSERT NAME OF PERSONNEL HERE INSERT COMPLETION DATE HERE INSERT NAME OF PERSONNEL HERE INSERT COMPLETION DATE HERE INSERT NAME OF PERSONNEL HERE INSERT COMPLETION DATE HERE INSERT NAME OF PERSONNEL HERE INSERT COMPLETION DATE HERE INSERT NAME OF PERSONNEL HERE INSERT COMPLETION DATE HERE INSERT NAME OF PERSONNEL HERE INSERT COMPLETION DATE HERE INSERT NAME OF PERSONNEL HERE INSERT COMPLETION DATE HERE INSERT NAME OF PERSONNEL HERE INSERT COMPLETION DATE HERE INSERT NAME OF PERSONNEL HERE INSERT COMPLETION DATE HERE INSERT NAME OF PERSONNEL HERE INSERT COMPLETION DATE HERE INSERT NAME OF PERSONNEL HERE INSERT COMPLETION DATE HERE INSERT NAME OF PERSONNEL HERE INSERT COMPLETION DATE HERE INSERT NAME OF PERSONNEL HERE INSERT COMPLETION DATE HERE EPA SWPPP Template, Version 1.0 16 Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL SECTION 8: CERTIFICATION AND NOTIFICATION 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 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. Name: Title: Signature: Date: [Repeat as needed for multiple construction operators at the site.] EPA SWPPP Template, Version 1.0 17 Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL EPA SWPPP Template, Version 1.0 18 Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL SWPPP APPENDICES Attach the following documentation to the SWPPP: Appendix A-Site Maps Appendix B-Copy of 2012 CGP Appendix C-NOI and EPA Authorization Email Appendix D-Inspection Form (Note: EPA is in the process of developing a sample inspection form for use by CGP permittees. The form will be made available at http://cfpub.epa.gov/npdes/stormwater/cgp.cfm.) Appendix E-Corrective Action Form (Note: EPA is in the process of developing a sample corrective action form for use by CGP permittees. The form will be made available at http://cfpub.epa.gov/npdes/stormwater/cgr .cfm.) Appendix F-SWPPP Amendment Log Appendix G-Subcontractor Certifications/Agreements Appendix H-Grading and Stabilization Activities Log Appendix I-Training Log Appendix J-Delegation of Authority Appendix K-Endangered Species Documentation Appendix L-Historic Preservation Documentation EPA SWPPP Template, Version 1.0 19 Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL Appendix A-Site Maps INSERT SITE MAPS CONSISTENT WITH TEMPLATE SECTION 2.6 EPA SWPPP Template, Version 1.0 I 1'14'; t41' k �3 € iiia�M � n kf' ' F� a. e>; '' .' I a .,„.,....„:41,...„z ,,, , ,, "N---,* ,,i: '` wga:. • iwt •{• oi 14 39: - 'e. "'boy".. p li, -., :: •'. k.:,,,71.;..,' , ,;: , ,O4 1T. 0. 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Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL Appendix B-Copy of 2012 CGP INSERT COPY OF 2012 CGP EPA SWPPP Template, Version 1.0 Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL Appendix C-Copy of NOI and EPA Authorization email INSERT COPY OF NOI AND EPA'S AUTHORIZATION EMAIL PROVIDING COVERAGE UNDER THE CGP EPA SWPPP Template, Version 1.0 Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL Appendix D-Copy of Inspection Form INSERT COPY OF ANY INSPECTION FORMS YOU WILL USE TO PREPARE INSPECTION REPORTS EPA SWPPP Template, Version 1.0 Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL Appendix E-Copy of Corrective Action Form INSERT COPY OF CORRECTIVE ACTION FORMS YOU WILL USE EPA SWPPP Template, Version 1.0 Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL Appendix F-Sample SWPPP Amendment Log Instructions(see CGP Part 7.4): - Create a log here of changes and updates to the SWPPP. You may use the table below to track these modifications. - SWPPP modifications are required,pursuant to CGP Part 7.4.1 in the following circumstances: 1. Whenever new operators become active in construction activities on your site,or you make changes to your construction plans,stormwater control measures, pollution prevention measures,or other activities at your site that are no longer accurately reflected in your SWPPP; 2. To reflect areas on your site map where operational control has been transferred {and the date of transfer)since initiating permit coverage; 3. If inspections or investigations determine that SWPPP modifications are necessary for compliance with this permit; 4. Where EPA determines it is necessary to impose additional requirements on your discharge;and 5. To reflect any revisions to applicable federal,state,tribal,or local requirements that affect the stormwater control measures implemented at the site. - If applicable,if a change in chemical treatment systems or chemically-enhanced stormwater control is made, including use of a different treatment chemical,different dosage rate, or different area of application. K• �:, m Nair EPA SWPPP Template, Version 1.0 Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL Appendix G-Sample Subcontractor Certifications/Agreements SUBCONTRACTOR CERTIFICATION STORMWATER POLLUTION PREVENTION PLAN Project Number: Project Title: Operator(s): As a subcontractor,you are required to comply with the Stormwater Pollution Prevention Plan (SWPPP) for any work that you perform on-site. Any person or group who violates any condition of the SWPPP may be subject to substantial penalties or loss of contract. You are encouraged to advise each of your employees working on this project of the requirements of the SWPPP. A copy of the SWPPP is available for your review at the office trailer. Each subcontractor engaged in activities at the construction site that could impact stormwater must be identified and sign the following certification statement: I certify under the penalty of law that I have read and understand the terms and conditions of the SWPPP for the above designated project and agree to follow the practices described in the SWPPP. This certification is hereby signed in reference to the above named project: Company: Address: Telephone Number: Type of construction service to be provided: Signature: Title: Date: EPA SWPPP Template, Version 1.0 , C J N ...9 \ W N „,i,;.,It.4!'it'-''' > . N Q c O ;y z ► E i O \ 4 O ,,� % .: E N a ,- x�C m t J• !NN ON' 0:, � 0 E,O ' ' ,. a)oF a� EQ NCO „ d\ Na aK QN s Lu aOs h�h a ,F �X s . '`C sQ. 0 CD Q. Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL Appendix I-Sample SWPPP Training Log Stormwater Pollution Prevention Training Log Project Name: Project Location: Instructor's Name(s): Instructor's Title(s): Course Location: Date: Course Length (hours): Stormwater Training Topic: (check as appropriate) ❑ Sediment and Erosion U Emergency Procedures Controls U Stabilization Controls U Inspections/Corrective Actions U Pollution Prevention Measures Specific Training Objective: Attendee Roster: (attach additional pages as necessary) No. Name of Attendee Company 1 2 3 4 5 6 7 8 EPA SWPPP Template, Version 1.0 Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL Appendix J-Sample Delegation of Authority Form Delegation of Authority (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 Appendix I of EPA's Construction General Permit (CGP), and that the designee above meets the definition of a "duly authorized representative" as set forth in Appendix I. 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 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. Name: Company: Title: Signature: Date: EPA SWPPP Template, Version 1.0 Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL Appendix K- Endangered Species Documentation INSERT DOCUMENTATION CONSISTENT WITH SWPPP TEMPLATE SECTION 3.1 EPA SWPPP Template, Version 1.0 Stormwater Pollution Prevention Plan (SWPPP) HARPER-SHELTON MILL Appendix L- Historic Properties Documentation INSERT DOCUMENTATION CONSISTENT WITH SWPPP TEMPLATE SECTION 3.2 EPA SWPPP Template, Version 1.0