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WPO201600006 Plan - Stormwater WPO VSMP 2016-01-25
STORMWATER POLLUTION PREVENTION PLAN (SWPPP) For Construction Activities at: SENTARA MARTHA JEFFERSON HOSPITAL HELIPAD Located in ALBEMARLE COUNTY, VIRGINIA Latitude: 38.021446 ° N (decimal degrees) Longitude: 78.443953 ° W (decimal degrees) Construction Activity Operator: Sentara Martha Jefferson Hospital Michael Spatz, HRIM, CHFM 500 Martha Jefferson Drive Charlottesville, Virginia 22911 Contact # (434) 654-7038 Company/Organization Name Sentara Martha Jefferson Hospital Michael Spatz, HRIM, CHFM 500 Martha Jefferson Drive Charlottesville, Virginia 22911 Contact # (434) 654-7038 (24-hour Emergency Contact) Developed in compliance with: General VPDES Permit for Discharges of Stormwater from Construction Activities (9VAC25-880) Prepared By: Valley Engineering 01/21/2016 VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad 1 . CERTIFICATIONS VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad 141110 Sod VALLEI I ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital lkwe CERTIFICATION By signature below I, the user of this Stormwater Pollution Prevention Plan (SWPPP), understand that the information provided by Valley Engineering in this SWPPP is provided as a convenience to the Applicant. The Applicant shall be fully responsible for full compliance with the provisions of the Clean Water Act and the provisions and guidelines of the VSMP General Permit Registration Statement— Construction Activity Stormwater Discharges (General Permit No.: VAR10). Valley Engineering shall have no legal liability for claims arising out of the use of the information provided in this SWPPP. "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Operator Name: Title: Signature: Date: VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad QUICK SWPPP CHECK LIST , 40 1.0 SWPPP Documents Located Onsite &Available for Review SWPPP Document Type Located Onsite &Available for Review? Registration Statement ❑ Yes ❑ NA Notice of Coverage Letter ❑ Yes ❑ NA Construction General Permit ❑ Yes ❑ NA Site Plan ❑ Yes ❑ NA Erosion & Sediment Control Plan (or agreement in lieu of) ❑ Yes ❑ NA Stormwater Management Plan (or agreement in lieu of) ❑ Yes ❑ NA 2.0 Authorized Non-Stormwater Discharges Type of Authorized Non-Stormwater Discharge Likely Present at Your Project Site External buildings wash down ❑ Yes ❑ No Uncontaminated foundation or footing drains ❑ Yes ❑ No Uncontaminated excavation dewatering ❑ Yes ❑ No Landscape irrigation ❑ Yes ❑ No Others [describe] ❑ Yes ❑ No 3.0 Pollution Prevention Awareness Employees will be given a "walk through" of the site identifying areas of possible pollution and will be shown Erosion and Sediment Controls and Pollution Prevention Practices (identified in Sections 4.0 and 5.0 of this SWPPP) that are applicable to their assigned job duties. A refresher meeting and "walk through" will be conducted on an as needed basis. VALLEY ENGINEERING J IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad TABLE OF CONTENTS 1 CERTIFICATIONS 2 INTRODUCTION 3 REQUIRED SWPPP COMPONENTS 4 NARRATIVE 5 DELEGATION OF AUTHORITY 6 IDENTIFICATION OF QUALIFIED PERSONNEL 7 CONSTRUCTION PLANS AND/OR OTHER 8 POLLUTION PREVENTION PLAN 10 SWPPP AMENDMENTS MODIFICATIONS, AND UPDATES 11 PUBLIC NOTICE, AVAILABILITY, AND IMPLEMENTATION OF THE SWPPP 12 SWPPP INSPECTIONS 13 CORRECTIVE ACTION 14 REGISTRATION STATEMENT FOR THE PROJECT 15 NOTICE OF COVERAGE FOR THE PROJECT 16 GENERAL VSMP PERMIT FOR DISCHAGES OF STORMWATER FROM CONSTRUCTION ACTIVITES 17 NOTICE OF TERMINATION FOR GENERAL VSMP 18 PERMIT TRANSFER AGREEMENT FORM 19 DRAINAGE REPORT 20 SUBCONTRACTOR CERTIFICATION VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad 2 . INTRODUCTION VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad i *1111111) VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad This Stormwater Pollution Prevention Plan (SWPPP) has been developed as a requirement of the General VPDES Permit for Discharges of Stormwater from Construction Activities (GCP), as defined in 9VAC25-880. The purpose of this SWPPP is to: 1) Identify potential sources of pollution that may reasonably be expected to affect the quality of storm water discharges from the construction site, and 2) To describe and ensure the implementation of practices that will be used to reduce pollutants in stormwater discharges from the construction site and to assure compliance with the conditions of the Permit. Implementation of the components of this SWPPP is required as a condition of the GCP (Tab 17). The GCP has a fixed term of 5 years from the effective date of July 1, 2014 and permit coverage is required for all VSMP land-disturbing activities. The GCP authorizes the discharge of stormwater from construction activities until the expiration date. The GCP also authorizes the discharge of stormwater from offsite support activities, provided that certain conditions are met as outlined in Part I A. 2 of the GCP. ` ✓ Certain non-stormwater discharges are also authorized and are described in Part I E of the GCP. The GCP must be maintained, modified, transferred, and terminated in accordance with the requirements outlined in the VSMP. VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad } { VALLEY ( ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad 3 . 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Z' CL C a_ a_ a) O E u- 0c5 0- _ m a O 0_ O a. -0 a_ - ccd - .0 L a. a) ' a. as � as a. 0 a_ L 0 cn -p O _p (o a) Q) E a) a) -8 a) C a) +. cI- C3 o I- _c o H H E - 8 H e STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad r/ 4 . NARRATIVE VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad ,4010) VALLEY I ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad In accordance with the General VPDES Permit for Discharges of Stormwater from kkige Construction Activities, the SWPPP must include a narrative description of the nature of the construction activity, including the function of the project (e.g., low density residential, shopping mall, highway, etc.). Option 1 — Written Narrative The purpose of this project is the demolition and removal of existing parking and construction of a FAA permitted heliport which will be associated with the existing hospital as shown in the construction plans titled "Sentara Martha Jefferson Hospital Helipad" as prepared by Valley Engineering for the specified project. Option 2 — Fill-in-the-Blank Narrative Nature and function of the Project: 4111610, Number of Lots created: Location of Project: 500 Martha Jefferson Drive, Charlottesville, Va 22911 VALLEY I ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad 5 . DELEGATION OF AUTHORITY VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad ' ' f { VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Name Title Company Phone #: I certify the individual or position named above has the delegated authority to sign inspection reports and/or amend or modify this SWPPP. "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." OPERATOR Signature: Date: Name: Title: Company: VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad REVISIONS TO DELEGATION OF AUTHORITY In accordance with the General VPDES Permit for Discharges of Stormwater from Construction Activities, the individuals or positions with delegated authority to sign inspection reports and/or amend this SWPPP must be identified. If the individual or position identified on the Title Sheet of the SWPPP changes or additional individuals or positions are given this responsibility after the preconstruction meeting occurs, the changes/additions must be noted below and submitted to the county inspector. { Print Name: Title: Company: Phone #: I certify the individual or position named above has the delegated authority to sign inspection reports and/or amend or modify this SWPPP. Operator Signature: Date: Noir Print Name: Title: Company: Phone #: I certify the individual or position named above has the delegated authority to sign inspection reports and/or amend or modify this SWPPP. Operator Signature: Date: VALLEY ENGINEERING IDEAS MADE REAL ff 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Print Name: Title: Company: Phone #: I certify the individual or position named above has the delegated authority to sign inspection reports and/or amend or modify this SWPPP. Operator Signature: Date: Print Name: Title: Company: Phone #: I certify the individual or position named above has the delegated authority to sign inspection reports and/or amend or modify this SWPPP. Operator Signature: Date: Note: Operator/ Inspector may make additional copies of this page if needed. VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad { VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad 6 . IDENTIFICATION OF QUALIFIED PERSONNEL VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad *44111) �yy 4 J VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad In accordance with the General VSMP Permit for Discharges of Stormwater from Construction "Activities, the individuals responsible for conducting on-site and off-site inspections must be identified. If the identified individual changes or additional individuals are given this responsibility after the preconstruction meeting occurs, the changes / additions must be noted below. (copy this sheet for additional personnel) Print Name: Company: Address: Phone #: Qualificans: Responsible Land Disturber# Certified E&S Inspector# Certified SWM Inspector# Licensed Professional(P.E. L.S, etc. Other: Print Name: Company: Address: Phone #: Qualificans: Responsible Land Disturber# Certified E&S Inspector# Certified SWM Inspector# Licensed Professional (P.E. L.S, etc. Other: VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Print Name: Company: Address: Phone #: Qualificans: Responsible Land Disturber# Certified E&S Inspector# Certified SWM Inspector# Licensed Professional (P.E. L.S, etc. Other: Print Name: Company: Address: Phone #: Qualificans: Responsible Land Disturber# Certified E&S Inspector# Certified SWM Inspector# Licensed Professional (P.E. LS, etc. Other: VALLEY ENGINEERING 4111) IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com ) STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad 7 . CONSTRUCTION PLANS AND / OR O VALLEY j ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad ti VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Construction Plans A Construction Plan or a Site Plan (CP/SP) have been developed and approved for the project titled: Sentara Martha Jefferson Hospital Helipad (project title) Construction Plans or a Site Plan (CPs/SP) was prepared by: Valley Engineering, PLC (consultant) CP/SP was approved for content on: (date of Director's (or his designate's) signature) The preconstruction meeting was held on: (date of preconstruction meeting) Erosion and Sediment Control Plan An Erosion and Sediment Control (ESC) Plan was developed as a required component of the ECP and was approved as authorized by the Virginia Erosion and Sediment Control Regulations (9VAC25-840). When properly implemented, the approved ESC plan has been determined to ' adequately address the following effluent limit guidelines: 1. Controls the volume and velocity of stormwater runoff within the site to minimize soil erosion; 2. Controls stormwater discharges, including peak flow rates and total stormwater volume, to minimize erosion at outlets and to minimize downstream channel and stream bank erosion; 3. Minimizes the amount of soil exposed during the construction activity; 4. Minimizes the disturbance of steep slopes; 5. Minimizes sediment discharges from the site in a manner that addresses (i) the amount, frequency, intensity, and duration of precipitation, (ii)the nature of resulting stormwater runoff, and (iii) soil characteristics, including the range of soil particle sizes present on the site; 6. Provides and maintains natural buffers around surface waters, directs stormwater to vegetated areas to increase sediment removal, and maximized infiltration, unless infeasible; 7. Minimizes soil compaction and, unless infeasible, preserves topsoil; 8. Ensures that stabilization of disturbed areas will be initiated immediately whenever any clearing, grading, or excavating, or other land-disturbing activities have permanently ceased on any portion of the site, or temporarily ceased on any portion of the site and will not resume for a period exceeding 14 days; VALLEY f ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad 9. Utilizes outlet structures that withdraw stormwater from the surface (i.e., above the permanent pool or wet storage water surface elevation), unless infeasible, when discharging from sediment basins or sediment traps. The following individual(s) will implement and maintain the control measures identified in the ESC plan (if other than the Operator or Delegated Authority): Name(s): Company: Stormwater Management Plan A Stormwater Management Plan (SWM) plan was developed as a required component of the SWPPP and was approved as authorized by the Virginia Stormwater Management Program Regulations (9VAC25-870). The SWM plan includes supporting documentation from the Drainage Report found in Tab 19 of the SWPPP binder. The following individual(s) will implement and maintain the control measures identified in the SWM plan (if other than the Operator or Delegated Authority): Name(s): '411) Company: Pollution Prevention Plan A Pollution Prevention Plan sheet has been provided as a required component of the ECP and addresses many of the required elements of the Pollution Prevention Plan as required by the GCP. The other required elements are addressed in Tab 8 of the SWPPP Binder. The individuals responsible for implementing and maintaining the control measures identified in the Pollution Prevention Plan are listed in Tab 8. VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com • STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Total Maximum Daily Load (TMDL) Requirements All projects requiring coverage under the GCP are subject to the following requirements associated with discharges to impaired waters, surface waters with an applicable TMDL waste load allocation established and approved prior to the term of this GCP, or exceptional waters: 1. Identify the impaired water(s), approved TMDL(s), pollutants of concern, and exceptional waters identified in 9VAC25-260-30.A.3.c, when applicable; a. Provide clear direction that: (i) Permanent or temporary soil stabilization shall be applied to denuded areas within seven days after final grade is reached of any portion of the site; (ii) Nutrients shall be applied in accordance with manufacturer's recommendations or an approved nutrient management plan and shall not be applied during rainfall events; and (iii) A modified inspection schedule shall be implemented in accordance with Part I B.4 or Part I B.S. These requirements are addressed on the Pollution Prevention Plan sheet of the ECP and in Tab 8 of the SWPPP Binder. The following individual(s) will implement and maintain these control measures (if other than the Operator or Delegated Authority): Name(s): Company: VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540)434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Other Incorporated Plans The Consultant will add language briefly describing any other plans that will be used to address the project requirements (i.e., plans for off-site borrow or disposal plans, regional stormwater management plans, etc.) OR [ ] No other plans are incorporated by reference at time of plan approval. Location Plan Title Approval Date Purpose VALLEY I ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad 8 . POLLUTION PREVENTION PLAN t„„, VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad 1. Identify potential pollutant-generating activities and pollutants expected to be exposed to stormwater; 2. Describe the location where the potential pollutant generating activity will occur, or if identified on the ECP, reference the ECP; 3. Identify all authorized non-stormwater discharges that are or will be comingled with stormwater discharges from the construction activity, including any applicable support activity; 4. Identify the person responsible for implementing the pollution prevention practice(s) for each pollutant generating activity, if other than the person listed as the qualified personnel; 5. Describe pollution prevention procedures and practices that will be implemented to: a. Prevent and respond to leaks, spills and other releases including(i) procedures for expeditiously stopping, containing, and cleaning up spills, leaks and other releases; and (ii) procedures for reporting leaks, spills, and other releases; b. Prevent the discharge of spilled or leaked fuels and chemicals from vehicle fueling and maintenance activities (e.g., providing secondary containment such as spill berms, decks, spill containment pallets, providing cover where appropriate, and having spill kits readily available); c. Prevent the discharge of soaps, detergents, solvents, and wash water from construction materials, including the cleanup of stucco, paint, form release oils, and curing compounds (e.g., providing (i) cover (e.g., plastic sheeting or temporary roofs) to prevent contact with stormwater; (ii) collection and proper disposal in a manner to contact with stormwater; and (iii) a similarly effective means designed to prevent discharge of these pollutants; d. Minimize the discharge of pollutants from equipment and vehicle washing, wheel wash water, and other types of washing (e.g., locating activities away from surface waters and stormwater inlets or conveyance and directing wash waters to sediment basins/traps, using filtration devices such as filter bags or sand filters or using similarly effective controls); e. Direct concrete wash water into a leak-proof container or leak-proof settling basin. The container or basin must be designed so that no overflows can occur due to inadequate sizing or precipitation. Hardened concrete wastes must be removed and disposed of in a manner consistent with the handling of other construction wastes. Liquid concrete wastes must be removed and VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad disposed of in a manner consistent with the handling of other construction wash waters and shall not be discharged to surface waters; f. Minimize the discharge of pollutants from storage, handling, and disposal of construction products, materials, and wastes, including (i) building products such as asphalt sealants, copper flashing, roofing materials, adhesives, concrete admixtures; (ii) pesticides, herbicides, insecticides, fertilizers, and landscape materials; and (iii) construction and domestic wastes such as packaging materials, scrap construction materials, masonry products, timber, pipe and electrical cuttings, plastics, styrofoam, concrete, and other trash or building materials; g. Prevent discharges of fuels, oils, and other petroleum products, hazardous or toxic waste, and sanitary wastes; and h. Address any other discharges from potential pollutant generating activity not addressed above. 6. Describe procedures for providing pollution prevention awareness of all applicable wastes, including any wash water, disposal practices, and applicable disposal locations of such wastes, to personnel in order to comply with the conditions of the GCP. The information required in Items 1, 2, and 4 can be found in this section of the SWPPP. The information required in Item 3 can be found in this section of the SWPPP. The information required in Items 5 and 6 can be found on the Pollution Prevention Plan Sheet included as a required component of the ECP. ti VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Pollution Prevention Practices: (1) Clearing, grading, excavating and un-stabilized areas - Utilize erosion and sediment controls to prevent sediment laden or turbid runoff from leaving the construction site. Dispose of clearing debris at acceptable disposal sites. Apply permanent or temporary stabilization, sodding and/or mulching to denuded areas in accordance with the erosion and sediment control specifications and the general VPDES permit for discharges of stormwater from construction activities. (2) Paving operations - Cover storm drain inlets during paving operations and utilize pollution prevention materials such as drip pans and absorbent/oil dry for all paving machines to limit leaks and spills of paving materials and fluids. (3) Concrete washout and cement waste - Direct concrete wash water into a leak-proof container or leak-proof settling basin as shown in Figure 10.1. Hardened concrete wastes shall be removed and disposed of in a manner consistent with the handling of other construction wastes. Concrete pours will not be conducted during or before an anticipated storm event. Installation: The washout area will be constructed before concrete pours occur at the site. Maintenance and Inspection: The washout areas will be inspected daily to ensure that all concrete washing is being discharged into the washout area, no leaks or tears are present, and to identify when concrete wastes need to be removed. The *4400, washout areas will be cleaned out once the area is filled to 75 percent of the holding capacity. Once the area's holding capacity has been reached, the concrete wastes will be allowed to harden; the concrete will be broken up, removed, and taken to an appropriate disposal site. The plastic sheeting will be replaced if tears occur during removal of concrete wastes from the washout area. (4) Structure construction, stucco, painting and cleaning - Enclose, cover or berm building material storage areas if susceptible to contaminated stormwater runoff. Conduct painting operations consistent with local air quality and OSHA regulations. Mix paint indoors, in a containment area or in a flat unpaved area. Prevent the discharge of soaps, solvents, detergents and wash water from construction materials, including the clean-up of stucco paint, form release oils and curing compounds. (5) Dewatering operations- Construction site dewatering from building footings or other sources may not be discharged without treatment. Sediment laden or turbid water shall be filtered, settled or similarly treated prior to discharge. (6) Material delivery and storage - Designate areas of the construction site for material delivery and storage. Place near construction entrances, away from waterways, and avoid transport near drainage paths or waterways. VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad (7) Material use during building process - Use materials only where and when needed to complete the construction activity. Follow manufacturer's instructions regarding uses, protective equipment, ventilation, flammability and mixing of chemicals. (8) Solid waste disposal - Designate a waste collection area on the construction site that does not receive a substantial amount of runoff from upland areas and does not drain directly to a waterway. Ensure that containers have lids so they can be covered before periods of rain, and keep containers in a covered area whenever possible. Schedule waste collection to prevent the containers from overfilling. (9) Sanitary waste - Prevent the discharge of sanitary waste by providing convenient and well-maintained portable sanitary facilities. Locate sanitary facilities in a convenient location away from waterways. (10) Landscaping operations - Maintain as much existing vegetation as practicable. Apply permanent or temporary stabilization, sodding and/or mulching to denuded areas in accordance with the erosion and sediment control specifications and the general VPDES permit for discharges of stormwater from construction activities. Apply nutrients in accordance with manufacturer's recommendations and not during rainfall events. (11) Others-If applicable, describe your Pollution Prevention Practice. { ti VALLEY ENGINEERING { IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Concrete Washout CONCRETE WASHOUT DETAIL N.T.S. BELOW GRADE CONCRETE WASHOUT AREA CONCRETE 0 0 0 0 0 0 WASHOUT AREA O v ef .. ' NOTES Io 10' 1. THE FACILITY -. " + MUST BE LINED �-- MIN. ;. A WITH B MIL 0 10.0' ''i-.IF' r�: PLASTIC LINING I MIN. . -' THAT IS FREE f�0 +'I FROM HOLES, Lt TEARS.OR OTHER ., • s DEFECTS THAT MIGHT SAND BAGS Q ��'' - COMPROMISE THE - MATERIAL'S Q 0 0 0 0 0 IMPERMEABILITY 2. THE LINING MUST SECTION A-A BE ANCHORED i18' WITH STAPLES(2' M/N. SPACING)OR 18" 3'MIN. .. SANDBAGS. MIN. d 3. SIDE SLOPES , —s 10 MILS PLASTIC MUST BE 1:1 11 — f (HORIZONTAL:VERTICAL) liarl -.0--10'MIN. OR FLATTER. 4. STONE ACCESS ABOVE GRADE CONCRETE WASHOUT AREA MUST BE PROVIDED WOOD OR o • • • B • o • • g, .. +:4th?► "1'. B BETWEEN THE METAL STAKES e T '4P40"110114.ilk ,. +; STREET AND THE (2 PER BALE) 10' " ! +• CONCRETE MIN. ' I �'� + WASHOUT AREA. ifiepil+ �III5. A"CONCRETE • C _it ' ;. C WASHOUT SIGN t o.0' • epi gp - si MUST BE MW. 4,1204#o �': INSTALLED WITHIN 1 •r ',•. ` r 30 FEET OF THE i 4 sv S'"+' WASHOUT t,�0. ., t FACILITY. THE s ��. SIGN MUST BE NO IL ��;. °� !i SMALLER THAN 2' • .• r, TALL BY 4'WIDE. A �* SECTION B-B SECTION C-C } 3'MIN. / ,r..„„.,-, na / r-.t. 3'MIN. iF�i, , ....J rj rj _Jo �7, :71E i1LF'1 VALLEY ENGINEERING iiiirrov IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Spill Prevention & Response Most spills can be cleaned up following manufacturer specifications. Absorbent/oil dry, sealable containers, plastic bags, and shovels/brooms are suggested minimum spill response items that should be available at this location. 1st 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. VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Emergency Contacts: Normal Working Hours DEQ Blue Ridge Regional Office (Roanoke) 540-562-6700 DEQ Blue Ridge Regional Office (Lynchburg) 434-582-5120 DEQ Northern Regional Office 703-583-3800 DEQ Piedmont Regional Office 804-527-5020 DEQ Southwest Regional Office 276-676-4800 DEQ Tidewater Regional Office 757-518-2000 DEQ Valley Regional Office 540-574-7800 Nights, Holidays & Weekends VA Dept. of Emergency Management 804-674-2400 24 Hour Reporting Service Local Contacts Local Fire Department (434) 970-3245 Local Police Department (434) 296-5807 VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad r, { J VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com a Steel "�3 y o _ m mn3 a = T 1 b m` a _ " — O `G A m n_i w=GD D S VU 1.! 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(1) I e o D b c/ % / �kk� 2 ® _ 0 I— ei003 JO azaaJjquv x x sand@; tuaadp oM m Z - _ m < aagA mim@p5m|�� x x c \ / \ J&@m ys@M u wdinb A�q Q77a& x x x / \ L �. &mom o a #ey AV x x Z » $ \ spun duo 6 jnoJO ' a uio &as� up X — \ ƒ § § / 0m / � $ _ § J&Smd � &mom x Q \ \ ƒ sD!Wq)$ 1 x \ / To sm|o a %�agBQ %s®1 x x x x x / - / / 25gaJ e| al p2 2 0 in_ LLI // mega HO X X ƒ a) spgmaHJO samaAad // co 0- . s seq pue sppe) Rd x x < %maw Aea H X X 2Ama 'uap4nN x wau!p S x x x et ) III El III El Ill Uin_ / b \ e \) \o t ? ,,,- F.-3 / f P 2 3 " C cu 2e L ro-El in DC ttcnEk32 u � : C CD 6= 0 ° 2 \ EG / 2 ' § E \ S G t \2 # 5 ro 3 a C a e U C a m m x CD 0 C@ 2 a) m 0- IDD.Dtn 00 2 \ .A CL -6 ZI_ - k � \ / / E % ° E \/ ± 2 [ CT) CL 22 � / ƒ . k O \ Cb �(a 0- o E\ = D E@ G » v)$ cr < /ba) o 7 ) �� _ / m 2100D JO @Z@alpluti x x x x x U sAe&medpoM x x x Z \ aumgaJ m$ adoe x \ \ / !asap | S x x x x 3p¥ gsem uwdinb A�gJoapq A x x x x x © ƒ / LU '2 0 qqDU o Jo Aeyds x x x Z > in sp n dwo 6 un m 'ua|o %a| as Lp x x x _ Le, ,c2) % / � m / � § J S@H Jo &mom x x x Z \ S = m�!ua)$ 1 x x x x U / f a eC 7 Sm|o JO %w q O '�el x x X x CD \ \ ssnaae�,ae X G in_ LU /7 8888 AO IO x x x E 0 = E mmq aH � P S x x x % 2 o ^ 0- ci/ s s� p e sppe) Hd x x x x a) mmaw AAe H x X X x / 2G$@J 'uamfN x x x x X / waw!p S x X c ) ❑ ❑ ❑ ❑ ❑ ❑ UO- El 7 To cam / \ m A o % o § ° % § / E in % S t < -0 E D 0_ 0 2 § 2 2 4 9 E 2 /Ti 3 / o § / m % C7 -o o @ » t 5 2 y ro k \ CL -4-, -0 V) 5 20 > Z Q CL t Z I oTo IQ Iwo w = Ir c ., p_ 0 � a) Z , ' '� � c O 0 a c o J L O co c v ...v Q co ce a) 4- o cr `/ L c MU) cc 0 I— CD 4ueloon AO azaaunuv l7 SanDenaasaad pooh Z Q W CC euasoaa�l AO !asap 'aullose9 Ir W 00 o CO aaaem ysem luawdlnba Aneaq JO apyaA w o03 v in aaaanuoj AO lleydsy Z spunodwon 6uunn JO 'quangos 'Sanlsaypy — Ln0' f Li- c Ja;said AO S4UIed z it a cno aSIeD!wagJ DIXol W _ c To sp!IoS .10 'Slagaa 'yseai o co C _, sasnatA JO euapes a o a W o in aseao AO lip 0_ a) CE sapinlgaaH JO sappnsad J o N -C U CO saseq pue spine) Hd < Qa C CD sleiaN MeaH 6 > aazll!1Jad 'S4uaulnN luaLulpas 4, C C _ ❑ El va ar c ro 'd C C7 > u u U c Q v aa) aai ro }, D L L a. 5 5 5 • • �j STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Identification of Non Storm Water Discharges All efforts are to be made to minimize non-storm water discharges. On-site inspections will include observations for non-storm water discharges. Activities that may result in discharges will be monitored and controlled as needed. Authorized non-storm water discharges include: • Discharges from fire-fighting activities. • Fire hydrant flushing. • Water used to control dust. • Foundation or footing drains where flows are not contaminated with process materials such as solvents. The discharge of non-storm water is authorized under the following conditions: • The discharge does not cause or contribute to a violation of any water quality standard. • The discharge does not violate any provision of the General Permit. • The discharge is not prohibited by the applicable Basin Plan • The SWPPP includes and implements BMPs required by the General Permit to prevent or reduce the contact of the non-storm water discharge with construction materials or equipment • The discharge does not contain toxic constituents in toxic amounts or (other) significant quantities of pollutants. • The sampling information is reported in the Annual Report. If any of the above conditions are not satisfied, the discharge is not authorized by the General Permit and not permitted by this SWPPP. Notify the local DEQ office of any anticipated non- storm water discharges not already authorized by the General Permit or another NPDES permit, to determine whether a separate NPDES permit is necessary. Expected Non-Storm Water Discharges and Controls Allowable non storm water discharges anticipated to be encountered in this project include the following: Fire Hydrant Flushing In the event there is a need to flush the fire hydrant the person performing the operation will ascertain from the owner, contractor of the water line, or, fire department that there are no VALLEY I ENGINEERING ,, IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad chemicals or other pollutants contained in the water. The flushed water will be diverted away from disturbed soils and into the storm drain system via a paved surface or lined channel so that erosion, scour and sediment laden discharges will be avoided. Contractor will place gravel bag check dams in the drainage swale to slow the velocity of the discharge. Contractor will verify that velocity dissipaters are installed, maintained and functioning prior to the discharge. Contractor will monitor discharged water and cease operations in the event sediment or other pollutants are being discharged as a result of the fire hydrant flushing. Responsible party: Underground contractor, Water department, fire department Waters to Control Dust Dust control will be implemented when wind exceeds 15 MPH or when there is visible dust generated from the site via a small diameter(3/4"to 1")fire or garden hose or with a water truck depending on the area being serviced. Water to be used for dust suppression shall be non- chlorinated. All efforts will be made not to over-apply the water spray to avoid any surface run off. In the event there is surface run off it will be controlled with the use of perimeter silt fence. Any discharges from the property will be observed and operations ceased if levels of sediment in the discharge pose a negative impact on the drainage system or receiving waters. Responsible party: QSO & all trades are responsible to control dust for their operations. Water Including Uncontaminated Water Line Flushing Domestic water lines will be flushed prior to completion. The owner or contractor of the water line will confirm that there are no chemicals or other pollutants contained in the water. Most of SiO the discharge will infiltrate into the ground do to the permeability of existing soils. Any run off will be diverted away from disturbed soils and into the storm drain system via a paved surface or lined channel so that erosion, scour and sediment laden discharges will be avoided. Contractor will place gravel bag check dams in the drainage swale to slow the velocity of the discharge. Contractor will verify that velocity dissipaters are installed, maintained and functioning prior to the discharge. Contractor will monitor discharged water and cease operations in the event sediment or other pollutants are being discharged as a result of the uncontaminated water line flushing. Responsible party: QSO & Underground water utility contractor Routine external building wash downs without detergents Building siding may be washed down prior to the application of paint. The contractor will use the least amount of water possible to wash the buildings. Any residues including calking or adhesives will be removed and properly disposed of prior to the wash down. Contractor will use a spray nozzle that will shut off and stop the flow of water when not in use. Contractor will inspect inlet protection to be sure it is in place and functional prior to wash down. Sediment controls will be installed at the low end of the drainage swales in an area where it will prevent the water from discharging directly into the inlets. Inlets will be in place and functional. Responsible party: QSO & Painting contractor VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad .r Uncontaminated air conditioning or compressor condensate The discharges from air conditioning condensate is expected to be seasonal and at a minimum. Waters will be diverted into the landscaped and permeable areas so as not to be discharged into the storm drain system. The discharges will be monitored and if there is a chance of discharge to the storm drain system, BMPs will be installed to divert the water to a permeable area. Responsible party: QSO Landscape Irrigation Irrigation water will be sprayed on permeable surfaces only. Landscape irrigation areas will be monitored to prevent over watering. Watering times and schedules will be adjusted in the event there is surface run off from the irrigated areas. Responsible party: QSO & Landscape and irrigation contractor. Any changes in construction that will produce other allowable non storm water discharges will be identified. The SWPPP will be amended and the appropriate erosion and sediment controls will be implemented. Compliance with the General Permit does not relieve the project of other potentially applicable discharge requirements of the various other plan requirements. The following non-stormwater discharges are authorized from the site. • External building wash down • Uncontaminated foundation or footer drains • Uncontaminated excavation dewatering • Landscape irrigation. Location Map Refer to approved Construction Plans titled, "Sentara Martha Jefferson Hospital Helipad". Contractor to mark-up a full size plan sheet and post at a location that inspectors can find. Responsible Personnel Refer to SWPPP Plan VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad 9 .TMDL INFORMATION VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad J VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad In accordance with Part II A.5 of the General VPDES Permit for Discharges of Stormwater from Construction Activities the SWPPP must: 1. Identify the impaired water(s), approved TMDL(s), pollutants of concern, and exceptional waters identified in 9VAC25-260-30.A.3.c; and 2. Provide clear direction that: a. Permanent or temporary soil stabilization shall be applied to denuded areas within seven days after final grade is reached on any portion of the site; b. Nutrients shall be applied in accordance with manufacturer's recommendations or an approved nutrient management plan and shall not be applied during rainfall events; and c. A modified inspection schedule shall be implemented in accordance with Part I B.4 or Part I B.5 of the General VPDES Permit for Discharges of Stormwater from Construction Activities. The information required by Item 1 can be found in Table 9.1 and 9.2. The information required by Items 2.a and 2.b can be found on the ESC/ESA plan sheet included as a required component of the ECP. %✓ The information required by Item 2.c can be found on the Pollution Prevention Plan Sheet included as a required component of the ECP. VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com MIL STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Table 9.1 — Identification of the Impaired Waters the Project Discharges into ^` ,"�y ;o# .T� ✓ rY � [ S' y, f#'F'a ,[[FF,�� wF'' F.., �?t a � ��5 rrx ° x ✓ ,}F F s ! xr SFr ,,,,, s to Rivanna River Benthic YES Table 9.2— Identification of the Surface Waters with Applicable TMDL Waste load Allocations the Project Discharges into the project W to P' ftutat is of r rn ar e to the ,y; trbcly? Rivanna River Benthic YES VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg,Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad 10 . SWPPP AMENDMENTS MODIFICATIONS AND UPDATES VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com wow STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad 1. The operator or their designee shall amend the SWPPP whenever there is a change in the design, construction, operation, or maintenance that has a significant effect on the discharge of pollutants to surface waters and that has not been previously addressed in the SWPPP. 2. The SWPPP must be amended if, during inspections or investigations by the operator's qualified personnel, or by local, state, or federal officials, it is determined that the existing control measures are ineffective in minimizing pollutants in discharges from the construction activity. Revisions to the SWPPP shall include additional or modified control measures designed and implemented to correct problems identified. If approval by the VESCP authority, VSMP authority, or department is necessary for the control measure, revisions to the SWPPP shall be completed no later than seven calendar days following approval. Implementation of these additional of modified control measures must be accomplished as described in Section 13.3, part 11. 3. The SWPPP must clearly identify the contractor(s) that will implement and maintain each control measure identified in the SWPPP. The SWPPP shall be amended to identify any new contractor that will implement and maintain a control measure. 4. The operator or their designee shall update the SWPPP no later than seven days following any modification to its implementation. All modifications or updates to the SWPPP shall be noted and shall include the following items; a. A record of dates when: (1) Major grading activities occur; (2)Construction activities temporarily or permanently cease on a portion of the site; and (3)Stabilization measures are initiated. b. Documentation of replaced or modified controls where periodic inspections or other information have indicated that the controls have been used inappropriately or incorrectly and where modified as soon as possible; c. Areas that have reached final stabilization and where no further SWPPP inspection requirements apply; d. All properties that are no longer under the legal control of the operator and the dates on which the operator no longer had legal control over each property; e. The date of any prohibited discharges, the discharge volume released, and what actions were taken to minimize the impact of the release; f. Measures taken to prevent the reoccurrence of any prohibited discharge; and , , VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad g. Measures taken to address any evidence identified as a result of an inspection. 5. Amendments, modifications, or updates to the SWPPP shall be signed in accordance with Section 18.10 of this chapter. The following Amendment, Modification, and Update Log form must be used to document all amendments, modification, and updates. site VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg,Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Grading &Stabilization Activities Log Date Date Date Description of the Description of the Grading Grading Stabilization p Grading Activity Stabilization Measure Activity Activity` Measures Initiated (including location) Ceased Initiated (including location) 10.0 SWPPP Modification & Update Log Modification Description of the Modification/Update Modification Prepared By Date (name &title) VALLEY ENGINEERING IDEAS4411010., MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com rommommorummir I STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad *110 VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad 11 . PUBLIC NOTICE AVAILABILITY AND IMPLEMENTATION OF THE SWPPP VALLEY I ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com mow STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad In accordance with Part H C of the General VPDES Permit for Discharges of Striae Stormwater from Construction Activities: Upon commencement of land disturbance, the operator shall post conspicuously a copy of the notice of coverage letter near the main entrance of the construction activity. For linear projects, the operator shall post the notice of coverage letter at a publically accessible location near an active part of the construction project. The operator shall maintain the posted information until termination of general permit coverage. In accordance with Part II D of the General VPDES Permit for Discharges of Stormwater from Construction Activities: Operators with day-to-day operational control over SWPPP implementation shall have a copy of the SWPPP available at a central location on-site for use by those identified as having responsibilities under the SWPPP whenever they are on the construction site. The operator shall make the SWPPP and all amendments, modifications, and updates available upon request to the department, the VSMP authority, the EPA, the VESCP authority, local government officials, or the operator of a municipal separate storm sewer system receiving discharges from the construction activity. If an on-site location is unavailable to store the SWPPP when no personnel are present, notice of the SWPPP's location must be posted near the main entrance of the construction site. The operator shall make the SWPPP available for public review in an electronic format or in hard copy. Information for public access to the SWPPP shall be posted and maintained in accordance with Part II C. If not provided electronically, public access to the SWPPP may be arranged upon request at a time and at a publicly accessible location convenient to the operator or his designee but shall be no less than once per month and shall be during normal business hours. Information not required to be contained within the SWPPP by this general permit is not required to be released. VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com NIL STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad In accordance with Part II E of the General VPDES Permit for Discharges of Stormwater from Construction Activities: The operator shall implement the SWPPP and subsequent amendments, modifications, and updates from commencement of land disturbance until termination of general permit coverage. All control measures must be properly maintained in effective operating condition in accordance with good engineering practices and, where applicable, manufacturer specifications. If a site inspection identifies a control measure that is not operating effectively, corrective action(s) shall be completed as soon as practicable, but no later than seven days after discovery or a longer period as established by the VSMP authority, to maintain the continued effectiveness of the control measures. If site inspections identify an existing control measure that needs to be modified or if an additional control measure is necessary for any reason, implementation shall be completed prior to the next anticipated measurable storm event. If implementation prior to the next anticipated measurable storm event is impracticable, then alternative control measures shall be implemented as soon as practicable, but no later than seven days after discovery or a longer period as established by the VSMP authority. VALLEY I ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg,Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad 12 . SWPPP INSPECTIONS VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com r1111r► STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad VALLEYHNGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg,Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad In accordance with Part I B.4.d and Part II F of the General VPDES Permit for Discharges of Stormwater from Construction Activities: 1. Personnel responsible for on-site and off-site inspections. Inspections required by this general permit shall be conducted by the qualified personnel identified by the operator in the SWPPP. The operator is responsible for insuring that the qualified personnel conduct the inspection. 2. The applicable SWPPP inspection requirements specified in Part II F 2 shall be amended as follows: a. Inspections shall be conducted at a frequency of (i) at least once every four business days or (ii) at least once every five business days and no later than 48 hours following a measurable storm event. In the event that a measurable storm event occurs when there are more than 48 hours between business days, the inspection shall be conducted on the next business day, and b. Representative inspections used by utility line installation, pipeline construction, or other similar linear construction activities shall inspect all outfalls discharging to surface waters identified as impaired or for which a TMDL waste load allocation has been established and approved prior to the term of this general permit. Norr 3. Inspection requirements. a. As part of the inspection, the qualified personnel shall: (1) Record the date and time of the inspection and when applicable the date and rainfall amount of the last measurable storm event; (2) Record the information and a description of any discharges occurring at the time of the inspection; (3) Record any land-disturbing activities that have occurred outside of the approved erosion and sediment control plan; (4) Inspect the following for installation in accordance with the approved erosion and sediment control plan, identification of any maintenance needs, and evaluation of effectiveness in minimizing sediment discharge, including whether the control has been inappropriately or incorrectly used: (a) All perimeter erosion and sediment controls, such as silt fence; (b) Soil stockpiles, when applicable, and borrow areas for stabilization or sediment trapping measures; (c) Completed earthen structures, such as dams, dikes, ditches, and diversions for stabilization; VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax(540) 432-0685 www.valleyesp.com mow STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad (d) Cut and fill slopes; (e) Sediment basins and traps, sediment barriers, and other measures installed to control sediment discharge from stormwater; (f) Temporary or permanent channel, flume, or other slope drain structures installed to convey concentrated runoff down cut and fill slopes; (g) Storm inlets that have been made operational to ensure that sediment laden stormwater does not enter without first being filtered or similarly treated; and (h) Construction vehicle access routes that intersect or access paved roads for minimizing sediment tracking; (5) Inspect areas that have reached final grade or that will remain dormant for more than 14 days for initiation of stabilization activities; (6) Inspect areas that have reached final grade or that will remain dormant for more than 14 days for completion of stabilization activities within seven days of reaching grade or stopping work; (7) Inspect for evidence that the approved erosion and sediment control plan, "agreement in lieu of a plan," or erosion and sediment control plan prepared in accordance with department approved annual standards and specifications has not been properly implemented. This includes but is not limited to: (a) Concentrated flows of stormwater in conveyances such as rills, rivulets or channels that have not been filtered, settled, or similarly treated prior to discharge , or evidence thereof; (b) Sediment laden or turbid flows of stormwater that have not been filtered or settled to remove sediments prior to discharge; (c) Sediment deposition in areas that drain to unprotected stormwater inlets or catch basins that discharge to surface waters. Inlets and catch basins with failing sediments controls due to improper installation, lack of maintenance, or inadequate design are considered unprotected; (d) Sediment deposition on any property (including public and private streets) outside of the construction activity covered by this general permit; (e) Required stabilization has not been initiated or completed on portions of the site; (f) Sediment basins without adequate wet or dry storage volume or sediment basins that allow the discharge of stormwater from below the surface of the wet storage portion of the basin; VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg,Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad (g) Sediment traps without adequate wet or dry storage or sediment traps e that allow the discharge of stormwater from below the surface of the wet storage portion of the trap; and (h) Land disturbance outside of the approved area to be disturbed; (8) Inspect pollutant generating activities identified in the pollution prevention plan for the proper implementation, maintenance and effectiveness of the procedures and practices; (9) Identify any pollutant generating activities not identified in the pollution prevention plan; and (10) Identify and document the presence of any evidence of the discharge of pollutants prohibited by this general permit. 2. Inspection report. Each inspection report shall include the following items: a. The date and time of the inspection and when applicable, the date and rainfall amount of the last measurable storm event; b. Summarized findings of the inspection; c. The location(s) of prohibited discharges; d. The location(s) of control measures that require maintenance; e. The location(s) of control measures that failed to operate as designed or proved inadequate or inappropriate for a particular location; f. The location(s) where any evidence identified under Part II F 3 a (7) exists; `w? g. The location(s) where any additional control measure is needed that did not exist at the time of inspection; h. A list of corrective actions required (including any changes to the SWPPP that are necessary ) as a result of the inspection or to maintain permit compliance; i. Documentation of any corrective actions required from a previous inspection that have not been implemented; and j. The date and signature of the qualified personnel and the operator or its duly authorized representative. The inspection report and any actions taken in accordance with Part II must be retained by the operator as part of the SWPPP for at least three years from the date that general permit coverage expires or is terminated. The inspection report shall identify any incidents of noncompliance. Where an inspection report does not identify any incidents of noncompliance, the report shall contain a certification that the construction activity is in compliance with the SWPPP and this general permit. The report shall be signed in accordance with Part III K of this general permit. VALLEY I ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Inspections &Corrective Action Log (make additional copies as necessary) Qualified Inspector Company/Organization: Name: Telephone Number: Qualifications: Inspection Schedule Discharges to surface waters: ❑ Once every 5 business days; or ❑ Once every 10 business days and no later than 48 hours following a measurable storm event. Discharges to impaired waters, surface waters within a TMDL watershed, or exceptional waters: ❑ Once every 4 business days; or ❑ Once every 5 business days and no later than 48 hours following a measurable storm event. Inspection Date Measurable Storm Event Date & Rainfall Amount of Last Measurable Storm Event (if applicable) VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg,Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad ,41100, Date Management In Compliance Corrective Action Needed; Date Practices (BMPs) with SWPPP? Responsible Party Corrective Action Taken Erosion & Sediment Controls ❑ Yes ❑ No (Section 4.0) Pollution Prevention Practices ❑ Yes ❑ No (Section 5.0) Stormwater Management ❑ Yes ❑ No Controls ❑ NA (Section 6.0) Certification "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on lore my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Operator Name: • Signature: Date: Inspector Name: Signature: Date: ,,, VALLEY I ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com r STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Sign in Sheet Name Date Activity Signature VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg,Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad (- VSMP INSPECTION REPORT EROSIONS&SEDIMENT CONTROL `- '4rm' Project: Notice of Coverage posted? IIISWPPP available for review? IIINO III Number: YES ❑NO YES Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once every Measureable Amount four business days Storm Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion and sediment control plan Describe any maintenance Have controls needs or other deficiencies been installed in Are controls that were identified and the effectively Inspection requirements: accordance with minimizing sediment location of the deficiencies the approved ES (e.g. have controls been Inspector? discharges? inappropriately ppropriately or Iincorrectly used?) 111111.lAll perimeter erosion and sediment controls (silt ❑YES ❑NO ❑YES ❑NO fence, etc.) Soil stockpiles and borrow areas(for ID YES ❑NO ❑YES ❑NO stabilization or sediment trapping measures) Completed earthen structures, such as dams, ❑YES ❑NO ❑YES ❑NO dikes, ditches, and diversions for stabilization Cut and fill slopes ❑YES ❑NO ❑YES ❑NO Sediment basins and traps, sediment barriers, and other measures (installed to control ❑YES ❑NO ❑YES ❑NO sediment discharges from storm water) Temporary or permanent channels,flumes, or other slope drain structures (installed to convey ❑YES ❑NO ❑YES ❑NO concentrated runoff down cut and fill slopes) Storm inlets (to ensure that sediment laden storm water does not enter without first being ❑YES ❑NO ❑YES ❑NO filtered or similarly treated) Construction entrances and access routes (for ❑YES ❑NO ❑YES ❑NO minimizing mud/sediment tracking) IHave construction activities begun on areas that have reached final grade or that will remain dormant for more than 14 days? ❑ YES ❑ NO Were stabilization activities completed within seven days of reaching final grade or stopping work on YES NO areas that have reached final grade or that will remain dormant for more than 14 days? ❑ ❑ STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Inspect for the presence of the following: Present? Location - 11 Concentrated flows of stormwater in conveyances (such as rills, rivulets ❑ YES ❑ or channels)that have not been filtered, settled, or similarly treated prior to discharge, (or evidence thereof) NO Sediment laden runoff that has not been filtered or settled to remove ❑ YES ❑ sediments prior to discharge NO Sediment deposition in areas that drain to unprotected stormwater inlets ❑ YES ❑ or catch basins that discharge to surface waters. NO Inlets and catch basins with failing sediment controls due to improper ❑ YES ❑ installation, lack of maintenance, or inadequate design NO Sediment deposition on any property(including public and private ❑ YES ❑ streets) outside of the construction activity covered by the general permit NO Required stabilization (initiated or completed on portions of the site?) ❑ YES ❑ NO Sediment basins/traps without adequate wet or dry storage volume ❑ YES ❑ NO Sediment basins where the riser appears to be leaking, water appears to be leaving the basin around the barrel pipe (rather than through it), or ❑ YES ❑ the dewatering device appears to be dewatering basin from below the NO water surface Sediment traps that allow stormwater to discharge from below the ❑ YES ❑ surface of the wet storage portion of the trap NO Land disturbance outside of the approved limits of disturbance ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ Other(describe) NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Signature: Date: STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Name: Title: �— 444i✓ (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) VSMP INSPECTION REPORT PLLUTION PREVENTION CONTROLS Project: GCP Number: Notice of Coverage posted? ❑ SWPPP available for review? YES ❑NO ❑YES ❑NO Inspection Inspection Conducted By DatefTime (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once Measureable Amount every four business days Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion 1110,,/and sediment control plan Inspect the pollution prevention controls associated with the pollutant generating activities identified in the Pollution Prevention Plan Describe any maintenance Inspect the pollution prevention controls Have the controls Are controls needs or other deficiencies associated with the pollution generating been properly effectively that were identified and the activities identified in Section 8.1 of the implemented as minimizing location of the deficiencies SWPPP outlined on the pollutant (e.g. have controls been PPP sheet? discharges? inappropriately or incorrectly used) Clearing, grading or excavating ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Paving operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Concrete washout and concrete1=1N/A ❑ YES ❑ NO ❑ YES ❑ waste disposal NO Structure construction, stucco, ❑ N/A ❑ YES ❑ NO ❑ YES ❑ painting or cleaning NO Dewatering operations ❑ N/A ❑ YES ❑ NO ❑ YES El NO Material delivery and storage ❑ N/A ❑ YES ❑ NO ❑ YES El NO Material use during building ❑ N/A ❑ YES ❑ NO ❑ YES El NO ySolid waste disposal ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO r , STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Sanitary waste disposal (porta- ❑ N/A ❑ YES ❑ NO ❑ YES EI johns) NO Landscaping operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Vehicle Fueling or Maintenance ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Other(describe) ❑ YES ❑ NO ❑ YES ❑ NO Other(describe) YES❑ YES ❑ NO ❑ El NO Other(describe) ❑ YES ❑ NO ❑ YES ❑ NO Other(describe) YES❑ YES El NO ❑ 1:1 NO Other(describe) ❑ YES ❑ NO El YES ❑ NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control so; measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Signature: Date: Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad VSMP INSPECTION REPORT EROSIONS& SEDIMENT CONTROL *.liiiri'' Project: Notice of Coverage posted? ❑ SWPPP available for review? ❑ GCP Number: YES ❑NO YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once every Measureable Amount four business days Storm Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion and sediment control plan Describe any maintenance Have controls needs or other deficiencies been installed in Are controls that were identified and the effectively Inspection requirements: accordance with minimizing sediment location of the deficiencies the approved ES (e. have controls been Inspector? discharges? gnappropriately or incorrectly used?) All perimeter erosion and sediment controls(silt ❑YES ❑NO ❑YES ❑NO fence, etc.) Soil stockpiles and borrow areas(for El YES ❑NO I=1 YES ❑NO stabilization or sediment trapping measures) Completed earthen structures, such as dams, ❑YES ❑NO ❑YES ❑NO dikes, ditches, and diversions for stabilization Cut and fill slopes ❑YES ❑NO ❑YES ❑NO Sediment basins and traps, sediment barriers, and other measures (installed to control ❑YES ❑NO ❑YES ❑NO sediment discharges from storm water) Temporary or permanent channels,flumes, or other slope drain structures (installed to convey ❑YES ❑NO ❑YES ❑NO concentrated runoff down cut and fill slopes) Storm inlets (to ensure that sediment laden storm water does not enter without first being ❑YES ❑NO ❑YES ❑NO filtered or similarly treated) Construction entrances and access routes (for ❑YES ❑NO ❑YES ❑NO minimizing mud/sediment tracking) IHave construction activities begun on areas that have reached final grade or that will remain dormant for more than 14 days? ❑ YES ❑ NO Were stabilization activities completed within seven days of reaching final grade or stopping work on ❑ YES ❑ NO ereas that have reached final grade or that will remain dormant for more than 14 days? III STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Inspect for the presence of the following: I Present? I Location Concentrated flows of stormwater in conveyances (such as rills, rivulets ❑ YES ❑ or channels)that have not been filtered, settled, or similarly treated prior NO to discharge, (or evidence thereof) Sediment laden runoff that has not been filtered or settled to remove ❑ YES ❑ sediments prior to discharge NO Sediment deposition in areas that drain to unprotected stormwater inlets ❑ YES ❑ or catch basins that discharge to surface waters. NO Inlets and catch basins with failing sediment controls due to improper ❑ YES ❑ installation, lack of maintenance, or inadequate design NO Sediment deposition on any property (including public and private ❑ YES ❑ streets)outside of the construction activity covered by the general permit NO Required stabilization (initiated or completed on portions of the site?) ❑ YES ❑ NO Sediment basins/traps without adequate wet or dry storage volume ❑ YES ❑ NO Sediment basins where the riser appears to be leaking, water appears to be leaving the basin around the barrel pipe (rather than through it), or ❑ YES ❑ the dewatering device appears to be dewatering basin from below the NO water surface Sediment traps that allow stormwater to discharge from below the ❑ YES ❑ surface of the wet storage portion of the trap NO Land disturbance outside of the approved limits of disturbance ❑ YES ❑ �,, NO ❑ YES ❑ NO El YES ❑ Other(describe) NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Signature: Date: STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad �— Name: Title: �— (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) VSMP INSPECTION REPORT PLLUTION PREVENTION CONTROLS Project: GCP Number: Notice of Coverage posted? ❑ SWPPP available for review? YES ❑NO p YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once Measureable Amount every four business days Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion and sediment control plan Inspect the pollution prevention controls associated with the pollutant generating activities identified in the Pollution Prevention Plan Describe any maintenance Inspect the pollution prevention controls Have the controls Are controls needs or other deficiencies associated with the pollution generating been properly effectively that were identified and the activities identified in Section 8.1 of the implemented as minimizing location of the deficiencies SWPPP outlined on the pollutant (e.g. have controls been PPP sheet? discharges? inappropriately or incorrectly used) Clearing, grading or excavating ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Paving operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Concrete washout and concrete N/A ❑ YES ❑ NO El YES (=Iwaste disposal NO Structure construction, stucco, ❑ N/A ❑ YES ❑ NO ❑ YES ❑ painting or cleaning NO Dewatering operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Material delivery and storage ❑ N/A 1=1YES ❑ NO ❑ YES ❑ NO Material use during building ❑ N/A ❑ YES ❑ NO El YES ❑ 1 rorocess NO Solid waste disposal ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Sanitary waste disposal (porta- ❑ N/A YES❑ ❑ NO ❑ YES ❑ johns) NO Landscaping operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Vehicle Fueling or Maintenance ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Other(describe) ❑ YES ❑ NO ❑ YES ❑ NO Other(describe) ❑ YES ❑ NO ❑ YES Li NO Other(describe) ❑ YES ❑ NO ❑ YES ❑ NO Other(describe) YES ❑ YES ❑ NO ❑ ❑ NO Other(describe) ❑ YES ❑ NO ❑ YES ❑ NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were } prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Signature: Date: Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad VSMP INSPECTION REPORT EROSIONS &SEDIMENT CONTROL ,-- - Project: GCP Number: ❑NO YESYES ❑NO Notice of Coverage ted? ❑ SWPPP available review? ❑ Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once every Measureable Amount four business days Storm Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion and sediment control plan Describe any maintenance Have controls Are controls needs or other deficiencies been installed in that were identified and the effectively Inspection requirements: accordance with minimizing sediment location of the deficiencies the approved ES (e.g. have controls been Inspector? discharges? inappropriately or incorrectly used?) All perimeter erosion and sediment controls(silt ❑YES ❑NO ❑YES ❑NO fence, etc.) Soil stockpiles and borrow areas (for ❑YES ❑NO ❑YES ❑NO stabilization or sediment trapping measures) Completed earthen structures, such as dams, ❑YES ❑NO ❑YES ❑NO dikes, ditches, and diversions for stabilization Cut and fill slopes ❑YES ❑NO ❑YES ❑NO Sediment basins and traps, sediment barriers, and other measures (installed to control ❑YES ❑NO ❑YES ❑NO sediment discharges from storm water) Temporary or permanent channels,flumes, or other slope drain structures (installed to convey ❑YES ❑NO ❑YES ❑NO concentrated runoff down cut and fill slopes) Storm inlets (to ensure that sediment laden stormwater does not enter without first being ❑YES ❑NO ❑YES ❑NO filtered or similarly treated) Construction entrances and access routes (for EYES ❑NO ❑YES ❑NO minimizing mud/sediment tracking) IHave construction activities begun on areas that have reached final grade or that will remain ❑ YES ❑ NO dormant for more than 14 days? Vere stabilization activities completed within seven days of reaching final grade or stopping work on ❑ YES ❑ NO %Irdreas that have reached final grade or that will remain dormant for more than 14 days? immummoommon STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Inspect for the presence of the following: I Present? I Location Concentrated flows of stormwater in conveyances (such as rills, rivulets ❑ YES ❑ or channels)that have not been filtered, settled, or similarly treated prior NO to discharge, (or evidence thereof) Sediment laden runoff that has not been filtered or settled to remove ❑ YES ❑ sediments prior to discharge NO Sediment deposition in areas that drain to unprotected stormwater inlets ❑ YES ❑ or catch basins that discharge to surface waters. NO Inlets and catch basins with failing sediment controls due to improper ❑ YES ❑ installation, lack of maintenance, or inadequate design NO Sediment deposition on any property(including public and private ❑ YES LI streets) outside of the construction activity covered by the general permit NO Required stabilization (initiated or completed on portions of the site?) EI YES 1=I NO Sediment basins/traps without adequate wet or dry storage volume ❑ YES ❑ NO Sediment basins where the riser appears to be leaking, water appears to be leaving the basin around the barrel pipe (rather than through it), or ❑ YES ❑ the dewatering device appears to be dewatering basin from below the NO water surface Sediment traps that allow stormwater to discharge from below the ❑ YES ❑ surface of the wet storage portion of the trap NO Land disturbance outside of the approved limits of disturbance EI YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ Other(describe) NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Signature: Date: STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad r—„,— Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) VSMP INSPECTION REPORT PLLUTION PREVENTION CONTROLS Project: GCP Number: Notice of Coverage posted? ❑ SWPPP available for review? YES ❑NO ❑YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once Measureable Amount everyfour business days Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred iutside the approved erosion bend sediment control plan Inspect the pollution prevention controls associated with the pollutant generating activities identified in the Pollution Prevention Plan Describe any maintenance Inspect the pollution prevention controls Have the controls Are controls needs or other deficiencies associated with the pollution generating been properly effectively that were identified and the activities identified in Section 8.1 of the implemented as minimizing location of the deficiencies SWPPP outlined on the pollutant (e.g. have controls been PPP sheet? discharges? inappropriately or incorrectly used) Clearing, grading or excavating ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Paving operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Concrete washout and concrete N/A ❑ YES ❑ NO ❑ YES ❑ waste disposal NO Structure construction, stucco, ❑ N/A ❑ YES ❑ NO ❑ YES E painting or cleaning NO Dewatering operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Material delivery and storage ❑ N/A ❑ YES 1:1NO ❑ YES ❑ NO Material use during building ❑ N/A YES ❑ NO ❑ YES ❑ process NO Solid waste disposal 0 N/A LIYES 1:1NO 0 YES NO E 1111111111111. STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Sanitary waste disposal (porta- El❑ N/A ❑ YES ❑ NO YES ❑ johns) NO411111110 Landscaping operations ❑ N/A ❑ YES ❑ NO El YES ❑ NO Vehicle Fueling or Maintenance ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Other(describe) ❑ YES ❑ NO ❑ YES ❑ NO Other(describe) YES YES ❑ NO ❑ ❑ NO Other(describe) YES❑ YES ❑ NO ❑ ❑ NO Other(describe) ill❑ YES ❑ NO YES ❑ NO Other(describe) ❑ YES ❑ NO 111 YES ❑ NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been I implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Signature: Date: Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad r.... VSMP INSPECTION REPORT EROSIONS&SEDIMENT CONTROL Orr/ Project: Notice of Coverage posted? ❑ SWPPP available for review? ❑ GCP Number: YES ❑NO YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once every Measureable Amount four business days Storm Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion and sediment control plan Describe any maintenance Have controls Are controls needs or other deficiencies been installed in that were identified and the effectively Inspection requirements: accordance with minimizing sediment location of the deficiencies the approved ES (e.g. have controls been Inspector? discharges? p inappropriately or incorrectly used?) All perimeter erosion and sediment controls(silt ❑YES ❑NO ❑YES ❑NO fence, etc.) Soil stockpiles and borrow areas (for ❑YES ❑NO ❑YES ❑NO stabilization or sediment trapping measures) Completed earthen structures, such as dams, ❑YES ❑NO ❑YES ❑NO dikes, ditches, and diversions for stabilization Cut and fill slopes p YES ❑NO ❑YES ❑NO Sediment basins and traps, sediment barriers, and other measures (installed to control ❑YES ❑NO ❑YES ❑NO sediment discharges from storm water) Temporary or permanent channels,flumes, or other slope drain structures (installed to convey ❑YES ❑NO ❑YES ❑NO concentrated runoff down cut and fill slopes) Storm inlets (to ensure that sediment laden storm water does not enter without first being ❑YES ❑NO ❑YES ❑NO filtered or similarly treated) Construction entrances and access routes (for ❑YES ❑NO ❑YES ❑NO minimizing mud/sediment tracking) IHave construction activities begun on areas that have reached final grade or that will remain dormant for more than 14 days? ❑ YES ❑ NO Were stabilization activities completed within seven days of reaching final grade or stopping work on YES NO reas that have reached final grade or that will remain dormant for more than 14 days? ❑ ❑ ■► STORMWATER POLLUTION PREVENTION PLAN___.3 ' Sentara Martha Jefferson Hospital Helipad Inspect for the presence of the following: I Present? I Location Concentrated flows of stormwater in conveyances (such as rills, rivulets ❑ YES ❑ or channels)that have not been filtered, settled, or similarly treated prior NO to discharge, (or evidence thereof) Sediment laden runoff that has not been filtered or settled to remove ❑ YES ❑ sediments prior to discharge NO Sediment deposition in areas that drain to unprotected stormwater inlets ❑ YES ❑ or catch basins that discharge to surface waters. NO Inlets and catch basins with failing sediment controls due to improper ❑ YES ❑ installation, lack of maintenance, or inadequate design NO Sediment deposition on any property (including public and private ❑ YES ❑ streets) outside of the construction activity covered by the general permit NO Required stabilization (initiated or completed on portions of the site?) ❑ YES III NO Sediment basins/traps without adequate wet or dry storage volume 111 YES ❑ NO Sediment basins where the riser appears to be leaking, water appears to be leaving the basin around the barrel pipe (rather than through it), or ❑ YES ❑ the dewatering device appears to be dewatering basin from below the NO water surface Sediment traps that allow stormwater to discharge from below the ❑ YES ❑ surface of the wet storage portion of the trap NO Land disturbance outside of the approved limits of disturbance ❑ YES ❑ NO4414 El ❑ NO ❑ YES I=1 Other(describe) NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes , to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." iisif Signature: Date: STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad r� Name: Title:Loo �— (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) VSMP INSPECTION REPORT PLLUTION PREVENTION CONTROLS Project: GCP Number: Notice of Coverage posted? ❑ SWPPP available for review? YES ❑NO ❑YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once Measureable Amount every four business days Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred iutside the approved erosion dnd sediment control plan Inspect the pollution prevention controls associated with the pollutant generating activities identified in the Pollution Prevention Plan Describe any maintenance Inspect the pollution prevention controls Have the controls Are controls needs or other deficiencies associated with the pollution generating been properly effectively that were identified and the activities identified in Section 8.1 of the implemented as minimizing location of the deficiencies SWPPP outlined on the pollutant (e.g. have controls been PPP sheet? discharges? inappropriately or incorrectly used) Clearing, grading or excavating ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Paving operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Concrete washout and concrete ❑ N/A ❑ YES ❑ NO ❑ YES ❑ waste disposal NO Structure construction, stucco, ❑ N/A ❑ YES ❑ NO ❑ YES ❑ painting or cleaning NO Dewatering operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Material delivery and storage ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Material use during building ❑ N/A YES ❑ NO ❑ YES ❑ tiSolid irocess NO waste disposal p N/A ❑ YES ❑ NO ❑ YES ❑ NO EMI STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Sanitary waste disposal (porta- YES❑ YES ❑ NO ❑ YES ❑ johns) NO Landscaping operations ElN/A ❑ YES EINO ❑ YES ❑ NO Vehicle Fueling or Maintenance ❑ N/A ❑ YES ElNO ❑ YES EI NO Other(describe) ❑ YES ❑ NO ❑ YES ❑ NO Other(describe) YES YES DI NO ❑ ❑ NO Other(describe) YES YES ❑ NO ❑ ❑ NO Other(describe) YES YES ❑ NO ❑ ❑ NO Other(describe) 0 YES ❑ NO ❑ YES El NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Signature: Date: Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) J STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad ,---- VSMP INSPECTION REPORT EROSIONS& SEDIMENT CONTROL Project: GCP Number: ❑NO YESYES ❑NO Notice of Coverage ted? ❑ SWPPP available for review? ❑ Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once every Measureable Amount four business days Storm Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion and sediment control plan Describe any maintenance Have controls Are controls needs or other deficiencies been installed in that were identified and the effectively Inspection requirements: accordance with minimizing sediment location of the deficiencies the approved ES (e. have controls been Inspector? discharges? gnappropriately or Iincorrectly used?) All perimeter erosion and sediment controls(silt ❑YES ❑NO ❑YES ❑NO fence, etc.) Soil stockpiles and borrow areas (for ❑YES ❑NO El YES ❑NO stabilization or sediment trapping measures) Completed earthen structures, such as dams, ❑YES ❑NO ❑YES ❑NO dikes, ditches, and diversions for stabilization Cut and fill slopes ❑YES ❑NO ❑YES ❑NO Sediment basins and traps, sediment barriers, and other measures (installed to control ❑YES ❑NO ❑YES ❑NO sediment discharges from storm water) Temporary or permanent channels,flumes, or other slope drain structures (installed to convey ❑YES ❑NO ❑YES ❑NO concentrated runoff down cut and fill slopes) Storm inlets (to ensure that sediment laden storm water does not enter without first being ❑YES ❑NO ❑YES ❑NO filtered or similarly treated) Construction entrances and access routes (for ❑YES LI NO ❑YES ❑NO minimizing mud/sediment tracking) IHave construction activities begun on areas that have reached final grade or that will remain ❑ YES ❑ NO dormant for more than 14 days? Were stabilization activities completed within seven days of reaching final grade or stopping work on YES NO reas that have reached final grade or that will remain dormant for more than 14 days? ❑ ❑ STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Inspect for the presence of the following: I Present? I Location Concentrated flows of stormwater in conveyances (such as rills, rivulets ❑ YES ❑ or channels)that have not been filtered, settled, or similarly treated prior NO to discharge, (or evidence thereof) Sediment laden runoff that has not been filtered or settled to remove ❑ YES ❑ sediments prior to discharge NO Sediment deposition in areas that drain to unprotected stormwater inlets ❑ YES ❑ or catch basins that discharge to surface waters. NO Inlets and catch basins with failing sediment controls due to improper ❑ YES ❑ installation, lack of maintenance, or inadequate design NO Sediment deposition on any property(including public and private ❑ YES ❑ streets)outside of the construction activity covered by the general permit NO Required stabilization (initiated or completed on portions of the site?) El YES 111 NO Sediment basins/traps without adequate wet or dry storage volume ❑ YES ❑ NO Sediment basins where the riser appears to be leaking, water appears to be leaving the basin around the barrel pipe (rather than through it), or ❑ YES ❑ the dewatering device appears to be dewatering basin from below the NO water surface Sediment traps that allow stormwater to discharge from below the ❑ YES ❑ surface of the wet storage portion of the trap NO Land disturbance outside of the approved limits of disturbance ❑ YES ❑ NO ❑ YES ElNO ❑ YES ❑ Other(describe) NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the, possibility of fine and imprisonment for knowing violations." Signature: Date: STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) VSMP INSPECTION REPORT PLLUTION PREVENTION CONTROLS Project: GCP Number: Notice of Coverage posted? ❑ SWPPP available for review? YES ❑NO ❑YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once Measureable Amount every four business days Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion %„sand sediment control plan Inspect the pollution prevention controls associated with the pollutant generating activities identified in the Pollution Prevention Plan Describe any maintenance Inspect the pollution prevention controls Have the controls Are controls needs or other deficiencies associated with the pollution generating been properly effectively that were identified and the activities identified in Section 8.1 of the implemented as minimizing location of the deficiencies SWPPP outlined on the pollutant (e.g. have controls been PPP sheet? discharges? inappropriately or incorrectly used) Clearing, grading or excavating ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Paving operations 0 N/A ❑ YES ❑ NO ❑ YES ❑ NO Concrete washout and concrete ❑ N/A ❑ YES ❑ NO ❑ YES ❑ waste disposal NO Structure construction, stucco, ❑ N/A ❑ YES ❑ NO El YES ❑ painting or cleaning NO Dewatering operations ❑ N/A ❑ YES EINO ❑ YES ❑ NO Material delivery and storage ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Material use during building ❑ YES ❑ orocess EI N/A ❑ YES ❑ NO NO Solid waste disposal ❑ N/A ❑ YES ❑ NO ❑ YES p NO L. STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Sanitary waste disposal (porta- YES❑ N/A YES❑ ❑ NO ❑ ❑ johns) NO ❑ YES ❑ Landscaping operations ❑ N/A ❑ YES ❑ NO NO Vehicle Fueling or Maintenance ElN/A ❑ YES ElNO ❑ YES ❑ NO Other(describe) ❑ YES ❑ NO ❑ YES ❑ NO Other(describe) 0 YES ❑ ❑ YES ❑ NO NO Other(describe) 0 YES ❑ NO ❑ YES El NO Other(describe) ElYES ❑ NO ❑ YES El NO Other(describe) ❑ YES ElElYES ❑ NO NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Signature: Date: Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad VSMP INSPECTION REPORT EROSIONS& SEDIMENT CONTROL 4iii✓ Project: Notice of Coverage posted? ❑ SWPPP available for review? ❑ GCP Number: YES ❑NO YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once every Measureable days Amount four business Storm Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion and sediment control plan Describe any maintenance Have controls needs or other deficiencies been installed in Are controls that were identified and the effectively Inspection requirements: accordance with minimizing sediment location of the deficiencies the approved ES (e. have controls been Inspector? discharges? gnappropriately or incorrectly used?) All perimeter erosion and sediment controls (silt ❑YES ❑NO ❑YES ❑NO fence, etc.) Soil stockpiles and borrow areas (for ❑YES ❑NO ❑YES ❑NO stabilization or sediment trapping measures) Completed earthen structures, such as dams, ❑YES ❑NO ❑YES ❑NO dikes, ditches, and diversions for stabilization Cut and fill slopes ❑YES ❑NO ❑YES ❑NO Sediment basins and traps, sediment barriers, and other measures (installed to control ❑YES ❑NO ❑YES ❑NO sediment discharges from storm water) Temporary or permanent channels,flumes, or other slope drain structures (installed to convey ❑YES ❑NO ❑YES ❑NO concentrated runoff down cut and fill slopes) Storm inlets (to ensure that sediment laden storm water does not enter without first being ❑YES ❑NO ❑YES ❑NO filtered or similarly treated) Construction entrances and access routes (for ❑YES ❑NO ❑YES ❑NO minimizing mud/sediment tracking) IHave construction activities begun on areas that have reached final grade or that will remain ❑ YES ❑ NO dormant for more than 14 days? Vere stabilization activities completed within seven days of reaching final grade or stopping work on ❑ YES ❑ NO Srelreas that have reached final grade or that will remain dormant for more than 14 days? i STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Inspect for the presence of the following: I Present? I Location Concentrated flows of stormwater in conveyances (such as rills, rivulets YES ❑ or channels)that have not been filtered, settled, or similarly treated prior NO to discharge, (or evidence thereof) Sediment laden runoff that has not been filtered or settled to remove ❑ YES ❑ sediments prior to discharge NO 5 Sediment deposition in areas that drain to unprotected stormwater inlets ❑ YES ❑ or catch basins that discharge to surface waters. NO Inlets and catch basins with failing sediment controls due to improper ❑ YES ❑ installation, lack of maintenance, or inadequate design NO k Sediment deposition on any property(including public and private ❑ YES ❑ streets) outside of the construction activity covered by the general permit NO Required stabilization (initiated or completed on portions of the site?) EI YES Els NO Sediment basins/traps without adequate wet or dry storage volume ❑ YES EI NO Sediment basins where the riser appears to be leaking, water appears to be leaving the basin around the barrel pipe (rather than through it), or ❑ YES ❑ the dewatering device appears to be dewatering basin from below the NO water surface , Sediment traps that allow stormwater to discharge from below the El YES ❑ surface of the wet storage portion of the trap NO Land disturbance outside of the approved limits of disturbance 111 YES ❑ NO El ❑ NO ❑ YES El Other(describe) NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." ' Signature: Date: STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) VSMP INSPECTION REPORT PLLUTION PREVENTION CONTROLS Project: GCP Number: Notice of Coverage posted? ❑ SWPPP available for review? YES ❑NO ❑YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once Measureable Amount everyfour business days Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion ‘06nd sediment control plan Inspect the pollution prevention controls associated with the pollutant generating activities identified in the Pollution Prevention Plan Describe any maintenance Inspect the pollution prevention controls Have the controls Are controls needs or other deficiencies associated with the pollution generating been properly effectively that were identified and the activities identified in Section 8.1 of the implemented as minimizing location of the deficiencies SWPPP outlined on the pollutant (e.g. have controls been PPP sheet? discharges? inappropriately or incorrectly used) Clearing, grading or excavating ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Paving operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Concrete washout and concrete N/A ❑ YES ❑ NO El YES ❑ waste disposal NO Structure construction, stucco, ❑ N/A ❑ YES ❑ NO Li YES ❑ painting or cleaning NO Dewatering operations ❑ N/A ❑ YES LiNO ❑ YES ❑ NO Material delivery and storage ❑ N/A ElYES ❑ NO ❑ YES ❑ NO Material use during building ❑ N/A ❑ YES ❑ NO 1=1 YES ❑ process NO Solid waste disposal ❑ N/A ❑ YES 0 NO 111 YES NO 111 STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Sanitary waste disposal (porta- 0❑ N/A ❑ YES ❑ NO YES El johns) NO Landscaping operations ElN/A ❑ YES ❑ NO 111 YES ❑ NO Vehicle Fueling or Maintenance ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Other(describe) ❑ YES ❑ NO ❑ YES ❑ NO Other(describe) ❑ YES ❑ NO ❑ YES ❑ NO Other(describe) YES❑ YES ❑ NO ❑ ❑ NO Other(describe) ❑ YES ❑ ❑ YES ❑ NO NO Other(describe) ElYES ❑ NO ❑ YES 1:1 NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time _ 1;of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Signature: Date: Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad VSMP INSPECTION REPORT EROSIONS&SEDIMENT CONTROL Project: GCP Number: ❑ YES Notice of Coverage posted?OYES ❑NO ❑ SWPPP available for review? ❑ Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once every Measureable days Amount four business Storm Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion and sediment control plan Describe any maintenance Have controls Are controls needs or other deficiencies been installed in that were identified and the effectively Inspection requirements: accordance with minimizing sediment location of the deficiencies the approved ES (e.g. have controls been Inspector? discharges? inappropriately or incorrectly used?) All perimeter erosion and sediment controls (silt ❑YES ❑NO ❑YES ❑NO fence, etc.) Soil stockpiles and borrow areas (for ❑YES ❑NO ❑YES ❑NO stabilization or sediment trapping measures) Completed earthen structures, such as dams, ❑YES ❑NO ❑YES ❑NO dikes, ditches, and diversions for stabilization Cut and fill slopes ❑YES ❑NO ❑YES ❑NO Sediment basins and traps, sediment barriers, and other measures (installed to control ❑YES ❑NO ❑YES ❑NO sediment discharges from storm water) Temporary or permanent channels,flumes, or other slope drain structures (installed to convey ❑YES ❑NO ❑YES ❑NO concentrated runoff down cut and fill slopes) Storm inlets (to ensure that sediment laden stormwater does not enter without first being ❑YES ❑NO ❑YES ❑NO filtered or similarly treated) Construction entrances and access routes (for ❑YES ❑NO ❑YES ❑NO minimizing mud/sediment tracking) IHave construction activities begun on areas that have reached final grade or that will remain ❑ YES ❑ NO dormant for more than 14 days? 'Were stabilization activities completed within seven days of reaching final grade or stopping work on YES NO areas that have reached final grade or that will remain dormant for more than 14 days? ❑ ❑ STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Inspect for the presence of the following: I Present? I Location Concentrated flows of stormwater in conveyances (such as rills, rivulets ❑ YES ❑ or channels)that have not been filtered, settled, or similarly treated prior NO to discharge, (or evidence thereof) Sediment laden runoff that has not been filtered or settled to remove ❑ YES ❑ sediments prior to discharge NO Sediment deposition in areas that drain to unprotected stormwater inlets ❑ YES ❑ or catch basins that discharge to surface waters. NO Inlets and catch basins with failing sediment controls due to improper ❑ YES ❑ installation, lack of maintenance, or inadequate design NO Sediment deposition on any property(including public and private ❑ YES ❑ streets)outside of the construction activity covered by the general permit NO Required stabilization (initiated or completed on portions of the site?) Di YES ❑ E NO Sediment basins/traps without adequate wet or dry storage volume 1:1 YES Di NO Sediment basins where the riser appears to be leaking, water appears to be leaving the basin around the barrel pipe (rather than through it), or ❑ YES ❑ the dewatering device appears to be dewatering basin from below the NO water surface Sediment traps that allow stormwater to discharge from below the ❑ YES ❑ surface of the wet storage portion of the trap NO Land disturbance outside of the approved limits of disturbance ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ Other(describe) NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s)required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including they possibility of fine and imprisonment for knowing violations." Signature: Date: STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Name: Title: 161.0 (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) VSMP INSPECTION REPORT PLLUTION PREVENTION CONTROLS Project: GCP Number: Notice of Coverage posted? ❑ SWPPP available for review? YES ❑NO ❑YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once Measureable Amount every four business days Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion iwend sediment control plan Inspect the pollution prevention controls associated with the pollutant generating activities identified in the Pollution Prevention Plan Describe any maintenance Inspect the pollution prevention controls Have the controls Are controls needs or other deficiencies associated with the pollution generating been properly effectively that were identified and the activities identified in Section 8.1 of the implemented as minimizing location of the deficiencies SWPPP outlined on the pollutant (e.g. have controls been PPP sheet? discharges? inappropriately or incorrectly used) Clearing, grading or excavating ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Paving operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Concrete washout and concrete ❑ N/A ❑ YES ❑ NO ❑ YES ❑ waste disposal NO Structure construction, stucco, ❑ N/A ❑ YES ❑ NO ❑ YES ❑ painting or cleaning NO Dewatering operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Material delivery and storage ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Material use during building ❑ N/A YES ❑ NO ❑ YES 111process NO Solid waste disposal ❑ N/A ❑ YES ❑ NO ❑ YES ❑ I NO STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Sanitary waste disposal (porta- ❑ N/A ❑ YES ❑ NO El YES ❑ johns) NO Landscaping operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Vehicle Fueling or Maintenance ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Other(describe) ❑ YES ❑ NO ❑ YES ❑ NO Other(describe) YES❑ YES ❑ NO ❑ ❑ NO Other(describe) ❑ YES ❑ NO ❑ YES ❑ } NO Other(describe) Li YES ❑ NO ❑ YES ❑ NO Other(describe) ❑ YES ❑ NO ❑ YES ❑ NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the 1 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." Signature: Date: Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad VSMP INSPECTION REPORT EROSIONS &SEDIMENT CONTROL 11.1"°' Project: GCP Number: Notice of Coverage posted? ❑ SWPPP available for review? ❑ YES ❑NO YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once every Measureable Amount four business Storm Event days Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion and sediment control plan Describe any maintenance Have controls Are controls needs or other deficiencies been installed in that were identified and the effectively Inspection requirements: accordance with minimizing sediment location of the deficiencies the approved ES (e.g. have controls been Inspector? discharges? p inappropriately or incorrectly used?) All perimeter erosion and sediment controls(silt ❑YES ❑NO ❑YES ❑NO fence, etc.) Soil stockpiles and borrow areas (for ❑YES ❑NO ❑YES ❑NO stabilization or sediment trapping measures) Completed earthen structures, such as dams, ❑YES ❑NO ❑YES ❑NO dikes, ditches, and diversions for stabilization Cut and fill slopes ❑YES ❑NO ❑YES ❑NO Sediment basins and traps, sediment barriers, and other measures (installed to control ❑YES ❑NO ❑YES ❑NO sediment discharges from storm water) Temporary or permanent channels,flumes, or other slope drain structures (installed to convey ❑YES ❑NO ❑YES ❑NO concentrated runoff down cut and fill slopes) Storm inlets (to ensure that sediment laden storm water does not enter without first being ❑YES ❑NO ❑YES ❑NO filtered or similarly treated) Construction entrances and access routes (for ❑YES ❑NO ❑YES ❑NO minimizing mud/sediment tracking) IHave construction activities begun on areas that have reached final grade or that will remain ❑ YES ❑ NO dormant for more than 14 days? Vere stabilization activities completed within seven days of reaching final grade or stopping work on ❑ YES ❑ NO 4reas that have reached final grade or that will remain dormant for more than 14 days? STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Inspect for the presence of the following: I Present? I Location Concentrated flows of stormwater in conveyances (such as rills, rivulets ❑ YES ❑ or channels)that have not been filtered, settled, or similarly treated prior NO to discharge, (or evidence thereof) Sediment laden runoff that has not been filtered or settled to remove ❑ YES ❑ sediments prior to discharge NO Sediment deposition in areas that drain to unprotected stormwater inlets ❑ YES ❑ or catch basins that discharge to surface waters. NO Inlets and catch basins with failing sediment controls due to improper ❑ YES ❑ installation, lack of maintenance, or inadequate design NO Sediment deposition on any property(including public and private ❑ YES ❑ streets) outside of the construction activity covered by the general permit NO Required stabilization (initiated or completed on portions of the site?) El YES ❑ ?: NO Sediment basins/traps without adequate wet or dry storage volume El YES ❑ a NO Sediment basins where the riser appears to be leaking, water appears to be leaving the basin around the barrel pipe (rather than through it), or ❑ YES ❑ 1 the dewatering device appears to be dewatering basin from below the NO water surface Sediment traps that allow stormwater to discharge from below the ❑ YES ❑ surface of the wet storage portion of the trap NO Land disturbance outside of the approved limits of disturbance ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES El Other(describe) NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Signature: Date: STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad �— Name: Title: �— (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) VSMP INSPECTION REPORT PLLUTION PREVENTION CONTROLS Project: GCP Number: Notice of Coverage posted? ❑ SWPPP available for review? YES ❑NO ❑YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once Measureable Amount every four business days Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion and sediment control plan Inspect the pollution prevention controls associated with the pollutant generating activities identified in the Pollution Prevention Plan Describe any maintenance Inspect the pollution prevention controls Have the controls Are controls needs or other deficiencies associated with the pollution generating been properly effectively that were identified and the activities identified in Section 8.1 of the implemented as minimizing location of the deficiencies SWPPP outlined on the pollutant (e.g. have controls been PPP sheet? discharges? inappropriately or incorrectly used) Clearing, grading or excavating ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Paving operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Concrete washout and concrete N/A ❑ YES ❑ NO ❑ YES ❑ waste disposal NO Structure construction, stucco, ❑ YES ❑ painting or cleaning ❑ N/A ❑ YES ❑ NO NO Dewatering operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Material delivery and storage ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Material use during building ❑ YES ❑ process ❑ N/A ❑ YES ❑ NO NO Solid waste disposal ❑ N/A 0 YES ❑ NO 0 YES 0 STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Sanitary waste disposal (porta- ❑ N/A ❑ YES 111 NO ❑ YES 1=1 johns) NO ❑ YES ❑ Landscaping operations ❑ N/A ❑ YES ❑ NO NO Vehicle Fueling or Maintenance LIN/A 1=1YES ❑ NO ❑ YES 111 NO Other(describe) ❑ YES ❑ NO ❑ YES ❑ NO Other(describe) 111 YES ❑ NO ❑ YES 1=1 NO Other(describe) ❑ YES LINO El YES El NO Other(describe) E1 YES ❑ NO ❑ YES Li NO Other(describe) 0❑ YES 1=1 NO YES ❑ NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general , permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s)required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Signature: Date: Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad VSMP INSPECTION REPORT EROSIONS&SEDIMENT CONTROL `-_ Project: Notice of Coverage posted? ❑ SWPPP available for review? El Number: YES ❑NO YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once every Measureable Amount four business days Storm Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion and sediment control plan Describe any maintenance Have controls needs or other deficiencies been installed in Are controls that were identified and the effectively Inspection requirements: accordance with minimizing sediment location of the deficiencies the approved ES (e.g. have controls been Inspector? discharges? nappropriately or incorrectly used?) All perimeter erosion and sediment controls (silt ❑YES ❑NO OYES ❑NO fence, etc.) Soil stockpiles and borrow areas(for ❑YES ❑NO ❑YES ❑NO stabilization or sediment trapping measures) Completed earthen structures, such as dams, El YES ❑NO El YES ❑NO dikes, ditches, and diversions for stabilization Cut and fill slopes ❑YES ❑NO ❑YES ❑NO Sediment basins and traps, sediment barriers, and other measures (installed to control ❑YES ❑NO ❑YES ❑NO sediment discharges from storm water) Temporary or permanent channels,flumes, or other slope drain structures (installed to convey ❑YES ❑NO ❑YES ❑NO concentrated runoff down cut and fill slopes) Storm inlets (to ensure that sediment laden stormwater does not enter without first being ❑YES ❑NO ❑YES ❑NO filtered or similarly treated) Construction entrances and access routes (for ❑YES ❑NO ❑YES ❑NO minimizing mud/sediment tracking) I Have construction activities begun on areas that have reached final grade or that will remain III YES ❑ NO dormant for more than 14 days? Were stabilization activities completed within seven days of reaching final grade or stopping work on ❑ YES ❑ NO areas that have reached final grade or that will remain dormant for more than 14 days? STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Inspect for the presence of the following: I Present? I Location Concentrated flows of stormwater in conveyances (such as rills, rivulets ❑ YES ❑ or channels) that have not been filtered, settled, or similarly treated prior NO to discharge, (or evidence thereof) Sediment laden runoff that has not been filtered or settled to remove ❑ YES ❑ sediments prior to discharge NO Sediment deposition in areas that drain to unprotected stormwater inlets ❑ YES ❑ or catch basins that discharge to surface waters. NO Inlets and catch basins with failing sediment controls due to improper ❑ YES ❑ installation, lack of maintenance, or inadequate design NO Sediment deposition on any property(including public and private ❑ YES ❑ streets) outside of the construction activity covered by the general permit NO Required stabilization (initiated or completed on portions of the site?) ❑ YES ❑ NO Sediment basins/traps without adequate wet or dry storage volume ❑ YES ❑ NO Sediment basins where the riser appears to be leaking, water appears to be leaving the basin around the barrel pipe (rather than through it), or ❑ YES ❑ the dewatering device appears to be dewatering basin from below the NO water surface Sediment traps that allow stormwater to discharge from below the ❑ YES ❑ surface of the wet storage portion of the trap NO Land disturbance outside of the approved limits of disturbance ❑ YES ❑ NOI*411f ❑ YES ❑ NO ID YES ❑ Other(describe) NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection } List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been I implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the.,, possibility of fine and imprisonment for knowing violations." Signature: Date: STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad r- Name: Title: �— (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) VSMP INSPECTION REPORT PLLUTION PREVENTION CONTROLS Project: GCP Number: Notice of Coverage posted? ❑ SWPPP available for review? YES ❑NO ❑YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once Measureable Amount every four business days Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion end sediment control plan Inspect the pollution prevention controls associated with the pollutant generating activities identified in the Pollution Prevention Plan Describe any maintenance Inspect the pollution prevention controls Have the controls Are controls needs or other deficiencies associated with the pollution generating been properly effectively that were identified and the activities identified in Section 8.1 of the implemented as minimizing location of the deficiencies SWPPP outlined on the pollutant (e.g. have controls been PPP sheet? discharges? inappropriately or incorrectly used) Clearing, grading or excavating ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Paving operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Concrete washout and concrete N/A ❑ YES ❑ NO ❑ YES ❑ waste disposal NO Structure construction, stucco, ❑ N/A ❑ YES ❑ NO ❑ YES ❑ painting or cleaning NO Dewatering operations ❑ N/A ❑ YES ❑ NO ❑ Y NO El Material delivery and storage ❑ N/A ❑ YES ❑ NO ❑ YES El NO Material use during building ❑ N/A YES ❑ NO ❑ YES ❑ rorocess NO ttioSolid waste disposal ❑ N/A ❑ YES ❑ NO ❑ YES NO 0 STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Sanitary waste disposal (porta- 1=1 N/A I=1 YES El NO El YES El johns) NO 411111) Landscaping operations EIN/A ❑ YES ❑ NO EI YES El NO Vehicle Fueling or Maintenance ❑ N/A LiYES ❑ NO El YES ❑ NO Other(describe) ❑ YES Li NO ❑ YES ❑ NO Other(describe) ElYES Li NO ❑ YES 111 NO Other(describe) YES YES ❑ NO ❑ El NO Other(describe) ❑ YES ❑ NO I=1 YES ❑ NO Other(describe) El YES El NO ID YES 111 NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s)required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Signature: Date: Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad VSMP INSPECTION REPORT EROSIONS& SEDIMENT CONTROL ,--- Project: GCP Number: ❑NO YESYES ❑ Notice of Coverage ted? ❑ SWPPP available for eeview? El O Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once every Measureable Amount four business days Storm Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion and sediment control plan Describe any maintenance Have controls needs or other deficiencies been installed in Are controls that were identified and the effectively Inspection requirements: accordance with minimizing sediment location of the deficiencies the approved ES (e.g. have controls been Inspector? discharges? inappropriately or incorrectly used?) All perimeter erosion and sediment controls (silt ❑YES ❑NO ❑YES ❑NO fence, etc.) Soil stockpiles and borrow areas(for ❑YES LINO ❑YES ❑NO stabilization or sediment trapping measures) Completed earthen structures, such as dams, ❑YES ❑NO El YES ❑NO dikes, ditches, and diversions for stabilization Cut and fill slopes ❑YES ❑NO ❑YES ❑NO Sediment basins and traps, sediment barriers, and other measures (installed to control ❑YES ❑NO ❑YES ❑NO sediment discharges from storm water) Temporary or permanent channels,flumes, or other slope drain structures (installed to convey ❑YES ❑NO ❑YES ❑NO concentrated runoff down cut and fill slopes) Storm inlets (to ensure that sediment laden storm water does not enter without first being ❑YES ❑NO ❑YES ❑NO filtered or similarly treated) Construction entrances and access routes (for EI YES ❑NO EI YES ❑NO minimizing mud/sediment tracking) IHave construction activities begun on areas that have reached final grade or that will remain dormant for more than 14 days? ❑ YES ❑ NO S 'Were stabilization activities completed within seven days of reaching final grade or stopping work on YES NO otireas that have reached final grade or that will remain dormant for more than 14 days? ❑ ❑ STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Inspect for the presence of the following: Present? Location Concentrated flows of stormwater in conveyances (such as rills, rivulets ❑ YES ❑ s or channels) that have not been filtered, settled, or similarly treated prior NO to discharge, (or evidence thereof) Sediment laden runoff that has not been filtered or settled to remove ❑ YES ❑ sediments prior to discharge NO Sediment deposition in areas that drain to unprotected stormwater inlets ❑ YES ❑ or catch basins that discharge to surface waters. NO Inlets and catch basins with failing sediment controls due to improper ❑ YES ❑ installation, lack of maintenance, or inadequate design NO Sediment deposition on any property(including public and private ❑ YES ❑ streets) outside of the construction activity covered by the general permit NO Required stabilization (initiated or completed on portions of the site?) ❑ YES 1=1 NO Sediment basins/traps without adequate wet or dry storage volume El YESNO ❑ Sediment basins where the riser appears to be leaking, water appears to be leaving the basin around the barrel pipe (rather than through it), or ❑ YES ❑ the dewatering device appears to be dewatering basin from below the NO water surface Sediment traps that allow stormwater to discharge from below the ❑ YES ❑ surface of the wet storage portion of the trap NO Land disturbance outside of the approved limits of disturbance ❑ YES ❑ NO 1LIY ES ❑ NO Li YES ❑ Other(describe) NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary)as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Signature: Date: STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) VSMP INSPECTION REPORT PLLUTION PREVENTION CONTROLS Project: GCP Number: Notice of Coverage posted? ❑ SWPPP available for review? YES ❑NO ❑YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once Measureable Amount every four business days Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion %wind sediment control plan Inspect the pollution prevention controls associated with the pollutant generating activities identified in the Pollution Prevention Plan Describe any maintenance Inspect the pollution prevention controls Have the controls Are controls needs or other deficiencies associated with the pollution generating been properly effectively that were identified and the activities identified in Section 8.1 of the implemented as minimizing location of the deficiencies SWPPP outlined on the pollutant (e.g. have controls been PPP sheet? discharges? inappropriately or incorrectly used) Clearing, grading or excavating ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Paving operations ❑ N/A ❑ YES ❑ NO E YES ❑ NO Concrete washout and concrete N/A ❑ YES ❑ NO ❑ YES ❑ waste disposal NO Structure construction, stucco, ❑ N/A ❑ YES ❑ NO ❑ YES ❑ painting or cleaning NO Dewatering operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Material delivery and storage ❑ N/A 1=1YES ❑ NO ❑ YES El NO Material use during building ❑ N/A YES ❑ NO 1E1 YES ❑ orocess NO '411reSolid waste disposal ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Sanitary waste disposal (porta- YES El ❑ YES ❑ NO ❑ YES ❑ johns) NO ❑ YES ❑ Landscaping operations ❑ N/A ❑ YES ❑ NO NO Vehicle Fueling or Maintenance ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO it Other(describe) ❑ YES ❑ NO ❑ YES ❑ NO Other(describe) YES❑ YES ❑ NO ❑ ❑ NO ti Other(describe) YES❑ YES ❑ NO ❑ ❑ NO Other(describe) YES YES ❑ NO ❑ ❑ NO Other(describe) YES YES ❑ NO ❑ 111 NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been { implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Signature: Date: Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad VSMP INSPECTION REPORT EROSIONS&SEDIMENT CONTROL `- ko"'` Project: GCP Number: YES ❑NoYES ❑ Notice of age posted? ❑ SWPPP available for Oeview? ❑ Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once every Measureable Amount four business days Storm Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion and sediment control plan Describe any maintenance Have controls Are controls needs or other deficiencies been installed in that were identified and the effectively Inspection requirements: accordance with minimizing sediment location of the deficiencies the approved ES (e.g. have controls been Inspector? discharges? p inappropriately or incorrectly used?) All perimeter erosion and sediment controls(silt ❑YES ❑NO ❑YES ❑NO fence, etc.) Soil stockpiles and borrow areas (for ❑YES ❑NO ❑YES ❑NO stabilization or sediment trapping measures) Completed earthen structures, such as dams, ❑YES ❑NO ❑YES ❑NO dikes, ditches, and diversions for stabilization Cut and fill slopes ❑YES ❑NO ❑YES ❑NO Sediment basins and traps, sediment barriers, and other measures (installed to control ❑YES ❑NO ❑YES ❑NO sediment discharges from stormwater) Temporary or permanent channels,flumes, or other slope drain structures (installed to convey ❑YES ❑NO ❑YES ❑NO concentrated runoff down cut and fill slopes) Storm inlets (to ensure that sediment laden stormwater does not enter without first being ❑YES ❑NO ❑YES ❑NO filtered or similarly treated) Construction entrances and access routes (for ❑YES ❑NO ❑YES ❑NO minimizing mud/sediment tracking) IHave construction activities begun on areas that have reached final grade or that will remain ❑ YES ❑ NO dormant for more than 14 days? Were stabilization activities completed within seven days of reaching final grade or stopping work on YES NO r+areas that have reached final grade or that will remain dormant for more than 14 days? ❑ ❑ STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Inspect for the presence of the following: I Present? I Location Concentrated flows of stormwater in conveyances (such as rills, rivulets ❑ YES ❑ or channels)that have not been filtered, settled, or similarly treated prior NO to discharge, (or evidence thereof) Sediment laden runoff that has not been filtered or settled to remove ❑ YES ❑ sediments prior to discharge NO Sediment deposition in areas that drain to unprotected stormwater inlets ❑ YES ❑ or catch basins that discharge to surface waters. NO Inlets and catch basins with failing sediment controls due to improper ❑ YES ❑ installation, lack of maintenance, or inadequate design NO Sediment deposition on any property(including public and private ❑ YES ❑ streets) outside of the construction activity covered by the general permit NO Required stabilization (initiated or completed on portions of the site?) El YES ❑ NO Sediment basins/traps without adequate wet or dry storage volume ❑ YES ❑ NO Sediment basins where the riser appears to be leaking, water appears to be leaving the basin around the barrel pipe (rather than through it), or ❑ YES ❑ the dewatering device appears to be dewatering basin from below the NO water surface Sediment traps that allow stormwater to discharge from below the ❑ YES ❑ surface of the wet storage portion of the trap NO sof Land disturbance outside of the approved limits of disturbance ❑ YES El NO ❑ YES ❑ NO El YES EI Other(describe) NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the„ possibility of fine and imprisonment for knowing violations." 411114 Signature: Date: STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad r � Name: Title: •►' (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) VSMP INSPECTION REPORT PLLUTION PREVENTION CONTROLS Project: GCP Number: Notice of Coverage posted? ❑ SWPPP available for review? YES ❑NO ❑YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall El Not applicable since inspection frequency is at least once Measureable Amount every four business days Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred -utside the approved erosion Send sediment control plan Inspect the pollution prevention controls associated with the pollutant generating activities identified in the Pollution Prevention Plan Describe any maintenance Inspect the pollution prevention controls Have the controls Are controls needs or other deficiencies associated with the pollution generating been properly effectively that were identified and the activities identified in Section 8.1 of the implemented as minimizing location of the deficiencies SWPPP outlined on the pollutant (e.g. have controls been PPP sheet? discharges? inappropriately or incorrectly used) Clearing, grading or excavating ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Paving operations ❑ N/A ❑ YES ❑ NO ❑ YES El NO Concrete washout and concrete N/A ❑ YES ❑ NO ❑ YES ❑ waste disposal NO Structure construction, stucco, ❑ N/A YES ❑ NO ❑ YES ❑ painting or cleaning NO Dewatering operations ❑ N/A ❑ YES ❑ NO ❑ YES El NO Material delivery and storage ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Material use during building ❑ N/A ❑ YES ❑ NO ❑ YES Elirocess NO Solid waste disposal ❑ N/A ❑ YES ❑ NO ❑ YES NO ❑ mb STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Sanitary waste disposal (porta- ElN/A El YES ❑ NO ❑ YES ❑ johns) NO Landscaping operations ❑ N/A ❑ YES ❑ NO ❑ YES O ❑ Vehicle Fueling or Maintenance ❑ N/A ❑ YES ❑ NO YES ❑ ' NO �. Other(describe) ❑ YES ❑ NO El YES ❑ NO Other(describe) El❑ YES ❑ NO YES ❑ NO Other(describe) YES❑ YES ❑ NO ❑ El NO Other(describe) YES❑ YES El NO ❑ ❑ NO Other(describe) YES YES ❑ NO ❑ ❑ NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Signature: Date: Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad VSMP INSPECTION REPORT EROSIONS&SEDIMENT CONTROL SW Project: GCP Number: Notice of Coverage posted? ❑ SWPPP available for review? ❑ YES ❑NO YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once every Measureable Amount four business days Storm Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion and sediment control plan Describe any maintenance Have controls needs or other deficiencies been installed in Are controls that were identified and the effectively Inspection requirements: accordance with minimizing sediment location of the deficiencies the approved ES (e.g. have controls been Inspector? discharges? nappropriately or incorrectly used?) All perimeter erosion and sediment controls (silt ❑YES ❑NO ❑YES ❑NO fence, etc.) Soil stockpiles and borrow areas(for ❑YES ❑NO ❑YES ❑NO stabilization or sediment trapping measures) Completed earthen structures, such as dams, ❑YES ❑NO ❑YES ❑NO dikes, ditches, and diversions for stabilization Cut and fill slopes ❑YES ❑NO ❑YES ❑NO Sediment basins and traps, sediment barriers, and other measures (installed to control ❑YES Li NO ❑YES ❑NO sediment discharges from storm water) Temporary or permanent channels,flumes, or other slope drain structures (installed to convey ❑YES ❑NO ❑YES ❑NO concentrated runoff down cut and fill slopes) Storm inlets (to ensure that sediment laden storm water does not enter without first being ❑YES ❑NO ❑YES ❑NO filtered or similarly treated) Construction entrances and access routes (for ❑YES ❑NO ❑YES ❑NO minimizing mud/sediment tracking) IHave construction activities begun on areas that have reached final grade or that will remain 1:1 YES ❑ NO dormant for more than 14 days? Vere stabilization activities completed within seven days of reaching final grade or stopping work on YES NO +'rareas that have reached final grade or that will remain dormant for more than 14 days? El YES ( STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Inspect for the presence of the following: I Present? I Location Concentrated flows of stormwater in conveyances (such as rills, rivulets ❑ YES ❑ z or channels)that have not been filtered, settled, or similarly treated prior NO to discharge, (or evidence thereof) Sediment laden runoff that has not been filtered or settled to remove ❑ YES ❑ sediments prior to discharge NO Sediment deposition in areas that drain to unprotected stormwater inlets ❑ YES ❑ or catch basins that discharge to surface waters. NO Inlets and catch basins with failing sediment controls due to improper ❑ YES ❑ installation, lack of maintenance, or inadequate design NO Sediment deposition on any property(including public and private ❑ YES ❑ streets) outside of the construction activity covered by the general permit NO Required stabilization (initiated or completed on portions of the site?) ❑ YES ❑ NO ❑ YES ❑ Sediment basins/traps without adequate wet or dry storage volume NO Sediment basins where the riser appears to be leaking, water appears to be leaving the basin around the barrel pipe (rather than through it), or ❑ YES ❑ the dewatering device appears to be dewatering basin from below the NO water surface Sediment traps that allow stormwater to discharge from below the ❑ YES ❑ surface of the wet storage portion of the trap NO Land disturbance outside of the approved limits of disturbance ❑ YES ❑ NO • ❑ YES ❑ NO ❑ YES ❑ Other(describe) NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary)as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the,. possibility of fine and imprisonment for knowing violations." Signature: Date: STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad i 1 Name: Title: Nir•+' (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) VSMP INSPECTION REPORT PLLUTION PREVENTION CONTROLS Project: GCP Number: Notice of Coverage posted? ElSWPPP available for review? YES ❑NO ❑YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once Measureable Amount every four business days Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion %,rend sediment control plan Inspect the pollution prevention controls associated with the pollutant generating activities identified in the Pollution Prevention Plan Describe any maintenance Inspect the pollution prevention controls Have the controls Are controls needs or other deficiencies associated with the pollution generating been properly effectively that were identified and the activities identified in Section 8.1 of the implemented as minimizing location of the deficiencies SWPPP outlined on the pollutant (e.g. have controls been PPP sheet? discharges? inappropriately or incorrectly used) Clearing, grading or excavating ❑ N/A ❑ YES ❑ NO El YES El NO Paving operations ❑ N/A ❑ YES ❑ NO ❑ YES El NO Concrete washout and concrete N/A ❑ YES ❑ NO ❑ YES ❑ waste disposal NO Structure construction, stucco, ❑ YES ❑ painting or cleaning ❑ N/A DYES ❑ NO NO Dewatering operations ❑ N/A ElYES ❑ NO ❑ YES ❑ NO Material delivery and storage ❑ N/A ❑ YES ElNO El YES ❑ NO Material use during building ❑ N/A ❑ YES ❑ NO El YES Elprocess NO Niiir Solid waste disposal ❑ N/A ❑ YES ❑ NO El YES ❑ NO STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Sanitary waste disposal (porta- ❑ N/A ❑ YES ❑ NO ❑ YES El johns) NO Landscaping operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Vehicle Fueling or Maintenance ❑ N/A ❑ YES ❑ NO ❑ YES NO ❑ Other(describe) ❑ YES ❑ NO ❑ YES ❑ NO Other(describe) 0❑ YES ❑ NO YES ❑ NO Other(describe) YES❑ YES ❑ NO ❑ ❑ NO Other(describe) ❑ YES ❑ ❑ YES ❑ NO NO Other(describe) ❑ YES ❑ NO LI YES ❑ NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Signature: Date: Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad r_._ __,.._ VSMP INSPECTION REPORT EROSIONS&SEDIMENT CONTROL Project: GCP Number: ❑NO YESYESfor❑NONotice of Coverage ❑ SWPPP available review? ❑ Inspection Inspection Conducted By DatefTime (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once every Measureable days Amount four business Storm Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion and sediment control plan Describe any maintenance Have controls Are controls needs or other deficiencies been installed in that were identified and the effectively Inspection requirements: accordance with minimizing sediment location of the deficiencies the approved ES (e.g. have controls been Inspector? discharges? nappropriately or incorrectly used?) All perimeter erosion and sediment controls (silt ❑YES ❑NO El YES ❑NO fence, etc.) Soil stockpiles and borrow areas(for ❑YES ❑NO ❑YES ❑NO stabilization or sediment trapping measures) Completed earthen structures, such as dams, ❑YES ❑NO ❑YES ❑NO dikes, ditches, and diversions for stabilization Cut and fill slopes ❑YES ❑NO p YES ❑NO Sediment basins and traps, sediment barriers, and other measures (installed to control ❑YES ❑NO ❑YES ❑NO sediment discharges from storm water) Temporary or permanent channels,flumes, or other slope drain structures (installed to convey ❑YES ❑NO ❑YES ❑NO concentrated runoff down cut and fill slopes) Storm inlets (to ensure that sediment laden storm water does not enter without first being 0 YES ❑NO ❑YES ❑NO filtered or similarly treated) Construction entrances and access routes (for ❑YES ❑NO El YES ❑NO minimizing mud/sediment tracking) Have construction activities begun on areas that have reached final grade or that will remainI I:1 YES ❑ NO dormant for more than 14 days? 'Vere stabilization activities completed within seven days of reaching final grade or stopping work on YES NO reas that have reached final grade or that will remain dormant for more than 14 days? ❑ ❑ STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Inspect for the presence of the following: I Present? l__ Location Concentrated flows of stormwater in conveyances (such as rills, rivulets ❑ YES ❑ or channels)that have not been filtered, settled, or similarly treated prior NO to discharge, (or evidence thereof) Sediment laden runoff that has not been filtered or settled to remove ❑ YES ❑ sediments prior to discharge NO Sediment deposition in areas that drain to unprotected stormwater inlets ❑ YES ❑ or catch basins that discharge to surface waters. NO Inlets and catch basins with failing sediment controls due to improper ❑ YES ❑ installation, lack of maintenance, or inadequate design NO Sediment deposition on any property(including public and private ❑ YES ❑ streets) outside of the construction activity covered by the general permit NO Required stabilization (initiated or completed on portions of the site?) ❑ YES ❑NO Sediment basins/traps without adequate wet or dry storage volume ❑ YESNO ❑ i Sediment basins where the riser appears to be leaking, water appears to be leaving the basin around the barrel pipe (rather than through it), or ❑ YES ❑ the dewatering device appears to be dewatering basin from below the NO water surface Sediment traps that allow stormwater to discharge from below the ❑ YES ❑ surface of the wet storage portion of the trap NO Land disturbance outside of the approved limits of disturbance ❑ YES El NO ElYES ❑ NO ❑ YES El Other(describe) NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary)as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the, possibility of fine and imprisonment for knowing violations." 40? Signature: Date: STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad r- Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) VSMP INSPECTION REPORT PLLUTION PREVENTION CONTROLS Project: GCP Number: Notice of Coverage posted? ❑ SWPPP available for review? YES ❑NO ❑YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once Measureable Amount everyfour business days Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion '1`,rand sediment control plan Inspect the pollution prevention controls associated with the pollutant generating activities identified in the Pollution Prevention Plan Describe any maintenance Inspect the pollution prevention controls Have the controls Are controls needs or other deficiencies associated with the pollution generating been properly effectively that were identified and the activities identified in Section 8.1 of the implemented as minimizing location of the deficiencies SWPPP outlined on the pollutant (e.g. have controls been PPP sheet? discharges? inappropriately or incorrectly used) Clearing, grading or excavating ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Paving operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Concrete washout and concrete N/A ❑ YES ❑ NO ❑ YES ❑ waste disposal NO Structure construction, stucco, ❑ N/A ❑ YES ❑ NO ❑ YES ❑ painting or cleaning NO Dewatering operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Material delivery and storage ElN/A ❑ YES ❑ NO ❑ YES ❑ NO Material use during building ❑ N/A ❑ YES ❑ NO E YES ❑ process NO Solid waste disposal ❑ N/A El YES 0 NO El YES 0 rum.. STORM WATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Sanitary waste disposal (porta- El YES 0 0 N/A 0 YES NO johns) NO YES Landscaping operations 0 N/A El YES El NO 0 0 NO YES 0 Vehicle Fueling or Maintenance El N/A Ei YES 0 NO El NO Other(describe) YES El NO YES 0 NO Other(describe) 0 YES 0 YES El NO NO fl Other(describe) 0 YES El 0 YES NO NO Other(describe) YES 0 YES 0 NO LI NO Other(describe) YES YES 0 NO fl NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been I implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Signature: Date: Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad VSMP INSPECTION REPORT EROSIONS&SEDIMENT CONTROL *411.0 Project: GCP Number: Notice of Coverage posted? ❑ SWPPP available for review? ❑ YES ❑NO YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once every Measureable Amount four business days Storm Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion and sediment control plan Describe any maintenance Have controls needs or other deficiencies been installed in Are controls that were identified and the effectively Inspection requirements: accordance with minimizing sediment location of the deficiencies the approved ES (e.g. have controls been Inspector? I discharges? inappropriately or 'llaripe i incorrectly used?) All perimeter erosion and sediment controls (silt ❑YES ❑NO ❑YES ❑NO fence, etc.) Soil stockpiles and borrow areas (for ❑YES ❑NO ❑YES ❑NO stabilization or sediment trapping measures) Completed earthen structures, such as dams, ❑YES ❑NO ❑YES ❑NO dikes, ditches, and diversions for stabilization Cut and fill slopes ❑YES ❑NO ❑YES ❑NO Sediment basins and traps, sediment barriers, and other measures (installed to control ❑YES ❑NO ❑YES ❑NO sediment discharges from storm water) Temporary or permanent channels,flumes, or other slope drain structures (installed to convey ❑YES ❑NO ❑YES ❑NO concentrated runoff down cut and fill slopes) Storm inlets (to ensure that sediment laden stormwater does not enter without first being ❑YES ❑NO ❑YES ❑NO filtered or similarly treated) Construction entrances and access routes (for ❑YES ❑NO ❑YES ❑NO minimizing mud/sediment tracking) IHave construction activities begun on areas that have reached final grade or that will remain ❑ YES ❑ NO dormant for more than 14 days? Vere stabilization activities completed within seven days of reaching final grade or stopping work on ❑ YES ❑ NO areas that have reached final grade or that will remain dormant for more than 14 days? STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Inspect for the presence of the following: I Present? I Location Concentrated flows of stormwater in conveyances (such as rills, rivulets ❑ YES ❑ or channels)that have not been filtered, settled, or similarly treated prior NO to discharge, (or evidence thereof) Sediment laden runoff that has not been filtered or settled to remove ❑ YES ❑ sediments prior to discharge NO Sediment deposition in areas that drain to unprotected stormwater inlets ❑ YES ❑ or catch basins that discharge to surface waters. NO Inlets and catch basins with failing sediment controls due to improper ❑ YES ❑ installation, lack of maintenance, or inadequate design NO Sediment deposition on any property(including public and private ❑ YES ❑ streets)outside of the construction activity covered by the general permit NO Required stabilization (initiated or completed on portions of the site?) ❑ YES ❑ NO Sediment basins/traps without adequate wet or dry storage volume El YES ❑ NO Sediment basins where the riser appears to be leaking, water appears to be leaving the basin around the barrel pipe (rather than through it), or ❑ YES ❑ the dewatering device appears to be dewatering basin from below the NO water surface Sediment traps that allow stormwater to discharge from below the ❑ YES ❑ surface of the wet storage portion of the trap NO Land disturbance outside of the approved limits of disturbance ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ Other(describe) NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s)required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including th . possibility of fine and imprisonment for knowing violations." Signature: Date: STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad r--- Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) VSMP INSPECTION REPORT PLLUTION PREVENTION CONTROLS Project: GCP Number: Notice of Coverage posted? ❑ SWPPP available for review? YES ❑NO ❑YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once Measureable Amount every four business days Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred iutside the approved i110006nd sediment control plan Inspect the pollution prevention controls associated with the pollutant generating activities identified in the Pollution Prevention Plan Describe any maintenance Inspect the pollution prevention controls Have the controls Are controls needs or other deficiencies associated with the pollution generating been properly effectively that were identified and the activities identified in Section 8.1 of the implemented as minimizing location of the deficiencies SWPPP outlined on the pollutant (e.g. have controls been PPP sheet? discharges? inappropriately or incorrectly used) Clearing, grading or excavating ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Paving operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Concrete washout and concrete N/A ❑ YES ❑ NO El YES El disposal NO Structure construction, stucco, ❑ N/A YES ❑ NO El YES E painting or cleaning NO Dewatering operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Material delivery and storage ❑ N/A ❑ YES ElNO ❑ YES ❑ NO Material use during building ❑ N/A ❑ YES ❑ NO ❑ YES ❑ Irocess NO )P.'Solid waste disposal ElN/A [11YES ElNO ❑ YES ❑ NO I. f° , , , STORM WATER POLLUTION PREVENTION PLAN , , Sentara Martha Jefferson Hospital Helipad ' Sanitary waste disposal (porta- 0 YES 0 , 0 N/A 0 YES 0 NO j johns) NO Landscaping operations LIN/A 0 YES EI NO 0 YES 0 NO , i ; Vehicle Fueling or Maintenance EI N/A 0 YES 0 NO 0 YES 0 i NO > , , Other(describe) EI YES El NO 0 YES 0 , , , NO . ; Other(describe) 0 YES 0 ' EI YES 0 NO , NO I Other(describe) 0 YES 0 : : 0 YES EI NO NO , i Other(describe) 0 YES 0 = 0 YES LINO , , NO t Other(describe) LI YES 0 NO NO i ! ; Identify the material(s)and document the location or presence of any evidence of pollutant ; discharges that are not authorized by the general , , permit ' Identify the location(s)where any additional control measures are needed that did not exist at the time kili of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Signature: Date: , Name: Title: i ' (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) , j , , STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad �— VSMP INSPECTION REPORT EROSIONS&SEDIMENT CONTROL Noir, Project: GCP Number: Notice of Coverage posted? ❑ SWPPP available for review? El YES ❑NO YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once every Measureable Amount four business days Storm Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion and sediment control plan Describe any maintenance Have controls needs or other deficiencies been installed in Are controls that were identified and the effectively Inspection requirements: accordance with minimizing sediment location of the deficiencies the approved ES (e.g. have controls been Inspector? discharges? p inappropriately or tibe ( incorrectly used?) All perimeter erosion and sediment controls(silt Li YES ❑NO YES ❑NO fence, etc.) Soil stockpiles and borrow areas(for ❑YES ❑NO El YES ❑NO stabilization or sediment trapping measures) Completed earthen structures, such as dams, YES ❑NO El YES ❑NO dikes, ditches, and diversions for stabilization Cut and fill slopes ❑YES ❑NO ❑YES ❑NO Sediment basins and traps, sediment barriers, and other measures (installed to control ❑YES ❑NO ❑YES ❑NO sediment discharges from storm water) Temporary or permanent channels,flumes, or other slope drain structures (installed to convey ❑YES ❑NO ❑YES ❑NO concentrated runoff down cut and fill slopes) Storm inlets (to ensure that sediment laden storm water does not enter without first being ❑YES ❑NO ❑YES ❑NO filtered or similarly treated) Construction entrances and access routes (for ❑YES ❑NO ❑YES ❑NO minimizing mud/sediment tracking) Have construction activities begun on areas that have reached final grade or that will remain ❑ YES ❑ NO dormant for more than 14 days? Vere stabilization activities completed within seven days of reaching final grade or stopping work on YESNO areas that have reached final grade or that will remain dormant for more than 14 days? ❑ ❑ STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Inspect for the presence of the following: I Present? L.. Location Concentrated flows of stormwater in conveyances (such as rills, rivulets or channels)that have not been filtered, settled, or similarly treated prior El YES NO El to discharge, (or evidence thereof) Sediment laden runoff that has not been filtered or settled to remove ❑ YES ❑ sediments prior to discharge NO Sediment deposition in areas that drain to unprotected stormwater inlets ❑ YES ❑ or catch basins that discharge to surface waters. NO Inlets and catch basins with failing sediment controls due to improper ❑ YES ❑ installation, lack of maintenance, or inadequate design NO Sediment deposition on any property(including public and private ❑ YES ❑ streets) outside of the construction activity covered by the general permit NO Required stabilization (initiated or completed on portions of the site?) ❑ YES El NO Sediment basins/traps without adequate wet or dry storage volume ❑ YES ❑ 1 NO Sediment basins where the riser appears to be leaking, water appears to be leaving the basin around the barrel pipe (rather than through it), or ❑ YES ❑ the dewatering device appears to be dewatering basin from below the NO water surface Sediment traps that allow stormwater to discharge from below the ❑ YES ❑ surface of the wet storage portion of the trap NO Land disturbance outside of the approved limits of disturbance El YES El NO NINO ❑ YES ❑ NO ❑ YES ❑ Other(describe) NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including th,, possibility of fine and imprisonment for knowing violations." Signature: Date: STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad �— Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) VSMP INSPECTION REPORT PLLUTION PREVENTION CONTROLS Project: GCP Number: Notice of Coverage posted? ❑ SWPPP available for review? YES ❑NO ❑YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once Measureable Amount every four business days Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred iutside the approved erosion tikiotnd sediment control plan Inspect the pollution prevention controls associated with the pollutant generating activities identified in the Pollution Prevention Plan Describe any maintenance Inspect the pollution prevention controls Have the controls Are controls needs or other deficiencies associated with the pollution generating been properly effectively that were identified and the activities identified in Section 8.1 of the implemented as minimizing location of the deficiencies SWPPP outlined on the pollutant (e.g. have controls been PPP sheet? discharges? inappropriately or incorrectly used) Clearing, grading or excavating ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Paving operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Concrete washout and concrete ❑ N/A ❑ YES ❑ NO EI YES ❑ waste disposal NO Structure construction, stucco, ElN/A ❑ YES ❑ NO ❑ YES ❑ painting or cleaning NO Dewatering operations EIN/A EIYES EINO ❑ YES ❑ NO Material delivery and storage ElN/A ❑ YES ❑ NO ❑ YES ❑ NO Material use during building ❑ N/A ❑ YES ❑ NO ❑ YES ❑ YSolid -�rocess NO waste disposal ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Ir. 1 STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad i Sanitary waste disposal (porta- ❑ N/A ❑ YES ❑ NO ❑ YES ❑ johns) NO *41111) Landscaping operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Vehicle Fueling or Maintenance ❑ N/A ❑ YES ❑ NO ❑ YES O Li Other(describe) ❑ YES ❑ NO ❑ YES NO ❑ f ( t Other(describe) ❑ YES ❑ NO ❑ YES ❑ NO t Other(describe) ❑ YES ❑ NO ❑ YES ❑ € NO i Other(describe) ❑ YES ❑ NO ❑ YES ❑ NO Other(describe) 0❑ YES ❑ NO YES ❑ NO i I Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection 140; List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been I implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Signature: Date: Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) , STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad r— VSMP INSPECTION REPORT EROSIONS &SEDIMENT CONTROL �— Project: GCP Number: Notice of Coverage posted? ❑ SWPPP available for review? ❑ YES ❑NO YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once every Measureable Amount four business days Storm Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion and sediment control plan Describe any maintenance Have controls Are controls needs or other deficiencies been installed in effectively that were identified and the Inspection requirements: accordance with minimizing sediment location of the deficiencies the approved ES (e.g. have controls been Inspector? discharges? inappropriately or incorrectly used?) All perimeter erosion and sediment controls(silt ❑YES ❑NO ❑YES ❑NO fence, etc.) Soil stockpiles and borrow areas(for ❑YES ❑NO ❑YES ❑NO stabilization or sediment trapping measures) Completed earthen structures, such as dams, ❑YES ❑NO ❑YES ❑NO dikes, ditches, and diversions for stabilization Cut and fill slopes ❑YES ❑NO ❑YES ❑NO Sediment basins and traps, sediment barriers, and other measures (installed to control ❑YES ❑NO ❑YES ❑NO sediment discharges from storm water) Temporary or permanent channels,flumes, or other slope drain structures (installed to convey ❑YES ❑NO ❑YES ❑NO concentrated runoff down cut and fill slopes) Storm inlets (to ensure that sediment laden storm water does not enter without first being ❑YES ❑NO ❑YES ❑NO filtered or similarly treated) Construction entrances and access routes (for YES ❑NO ❑YES ❑NO minimizing mud/sediment tracking) Have construction activities begun on areas that have reached final grade or that will remain ❑ YES ❑ NO dormant for more than 14 days? Vere stabilization activities completed within seven days of reaching final grade or stopping work on YES NO reas that have reached final grade or that will remain dormant for more than 14 days? ❑ ❑ STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Inspect for the presence of the following: I Present? I Location Concentrated flows of stormwater in conveyances (such as rills, rivulets ❑ YES ❑ or channels) that have not been filtered, settled, or similarly treated prior NO to discharge, (or evidence thereof) Sediment laden runoff that has not been filtered or settled to remove ❑ YES ❑ sediments prior to discharge NO Sediment deposition in areas that drain to unprotected stormwater inlets ❑ YES ❑ or catch basins that discharge to surface waters. NO Inlets and catch basins with failing sediment controls due to improper ❑ YES ❑ installation, lack of maintenance, or inadequate design NO Sediment deposition on any property(including public and private ❑ YES ❑ streets) outside of the construction activity covered by the general permit NO Required stabilization (initiated or completed on portions of the site?) ❑ YES ❑ NO Sediment basins/traps without adequate wet or dry storage volume ❑ YES ❑ NO Sediment basins where the riser appears to be leaking, water appears to be leaving the basin around the barrel pipe (rather than through it), or ❑ YES ❑ the dewatering device appears to be dewatering basin from below the NO water surface Sediment traps that allow stormwater to discharge from below the ❑ YES ❑ surface of the wet storage portion of the trap NO • Land disturbance outside of the approved limits of disturbance ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ Other(describe) NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Signature: Date: STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) VSMP INSPECTION REPORT PLLUTION PREVENTION CONTROLS Project: GCP Number: Notice of Coverage posted? ❑ SWPPP available for review? YES ❑NO p YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once Measureable Amount every four business days Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion 'end sediment control plan Inspect the pollution prevention controls associated with the pollutant generating activities identified in the Pollution Prevention Plan Describe any maintenance Inspect the pollution prevention controls Have the controls Are controls needs or other deficiencies associated with the pollution generating been properly effectively that were identified and the activities identified in Section 8.1 of the implemented as minimizing location of the deficiencies SWPPP outlined on the pollutant (e.g. have controls been PPP sheet? discharges? inappropriately or incorrectly used) Clearing, grading or excavating ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Paving operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Concrete washout and concrete N/A ❑ YES ❑ NO ❑ YES ❑ waste disposal NO Structure construction, stucco, ❑ N/A ❑ YES ❑ NO ❑ YES ❑ painting or cleaning NO Dewatering operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Material delivery and storage ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Material use during building ❑ N/A YES ❑ NO 1=I YES ❑ process NO lir Solid waste disposal ❑ N/A 1=1YES ❑ NO ❑ YES ❑ NO rri► � STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Sanitary waste disposal (porta- II]YES❑ ❑ NO II] YES El johns) NO Landscaping operations ❑ N/A ElYES ❑ NO El YES ❑ o NO LI YES ❑ Vehicle Fueling or Maintenance ❑ N/A ❑ YES ❑ NO NO Other(describe) ❑ YES ❑ NO ❑ YES ❑ NO Other(describe) ❑ YES ❑ NO ❑ YES ❑ NO Other(describe) ElYES ❑ NO 111 YES ❑ n NO Other(describe) YES YES ❑ NO ❑ ❑ NO Other(describe) El YES ❑ NO El YES El NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Signature: Date: Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad �— VSMP INSPECTION REPORT EROSIONS&SEDIMENT CONTROL Project: GCP Number: Notice of Coverage posted? ❑ SWPPP available for review? ❑ YES ❑NO YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once every Measureable Amount four business days Storm Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion and sediment control plan Describe any maintenance Have controls needs or other deficiencies been installed in Are controls that were identified and the effectively Inspection requirements: accordance with minimizing sediment location of the deficiencies the approved ES (e. have controls been Inspector? discharges? gnappropriately or incorrectly used?) All perimeter erosion and sediment controls(silt ❑YES ❑NO YES ❑NO fence, etc.) Soil stockpiles and borrow areas(for ❑YES ❑NO ❑YES ❑NO stabilization or sediment trapping measures) Completed earthen structures, such as dams, YES ❑NO YES ❑NO dikes, ditches, and diversions for stabilization Cut and fill slopes ❑YES ❑NO ❑YES ❑NO Sediment basins and traps, sediment barriers, and other measures (installed to control ❑YES ❑NO ❑YES ❑NO sediment discharges from storm water) Temporary or permanent channels,flumes, or other slope drain structures (installed to convey ❑YES ❑NO ❑YES ❑NO concentrated runoff down cut and fill slopes) Storm inlets (to ensure that sediment laden storm water does not enter without first being ❑YES ❑NO ❑YES ❑NO filtered or similarly treated) Construction entrances and access routes (for ❑YES ❑NO ❑YES ❑NO minimizing mud/sediment tracking) Have construction activities begun on areas that have reached final grade or that will remain ❑ YES ❑ NO dormant for more than 14 days? Vere stabilization activities completed within seven days of reaching final grade or stopping work on YES NO reas that have reached final grade or that will remain dormant for more than 14 days? ❑ ❑ STORM WATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Inspect for the presence of the following: Present? Location Concentrated flows of stormwater in conveyances (such as rills, rivulets YES [1] or channels)that have not been filtered, settled, or similarly treated prior NO to discharge, (or evidence thereof) Sediment laden runoff that has not been filtered or settled to remove YES LI sediments prior to discharge NO Sediment deposition in areas that drain to unprotected stormwater inlets EI YES LI or catch basins that discharge to surface waters. NO Inlets and catch basins with failing sediment controls due to improper LI YES Ei installation, lack of maintenance, or inadequate design NO Sediment deposition on any property(including public and private L YES LI streets) outside of the construction activity covered by the general permit NO Required stabilization (initiated or completed on portions of the site?) [I YES EI NO Sediment basins/traps without adequate wet or dry storage volume LI YESNO Sediment basins where the riser appears to be leaking, water appears to be leaving the basin around the barrel pipe (rather than through it), or El YES Ei the dewatering device appears to be dewatering basin from below the NO water surface Sediment traps that allow stormwater to discharge from below the lj YES El surface of the wet storage portion of the trap NO ‘04) Land disturbance outside of the approved limits of disturbance LI YES LI NO I EYES El YES NO Other(describe) NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Signature: Date: • STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad �— Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) VSMP INSPECTION REPORT PLLUTION PREVENTION CONTROLS Project: GCP Number: Notice of Coverage posted? ❑ SWPPP available for review? YES ❑NO ❑YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once Measureable Amount every four business days Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion rind sediment control plan Inspect the pollution prevention controls associated with the pollutant generating activities identified in the Pollution Prevention Plan Describe any maintenance Inspect the pollution prevention controls Have the controls Are controls needs or other deficiencies associated with the pollution generating been properly effectively that were identified and the activities identified in Section 8.1 of the implemented as minimizing location of the deficiencies SWPPP outlined on the pollutant (e.g. have controls been PPP sheet? discharges? inappropriately or incorrectly used) Clearing, grading or excavating ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Paving operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Concrete washout and concrete N/A ❑ YES ❑ NO ❑ YES ❑ waste disposal NO Structure construction, stucco, ❑ N/A ❑ YES ❑ NO ❑ YES ❑ painting or cleaning NO Dewatering operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Material delivery and storage ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Material use during building ❑ N/A YES❑ ❑ NO ❑ YES ❑ process NO olid waste disposal ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO ■r► i STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Sanitary waste disposal (porta- 0❑ N/A ❑ YES ❑ NO YES ❑ johns) NO ❑ YES ❑ Landscaping operations ❑ N/A ❑ YES ❑ NO NO Vehicle Fueling or Maintenance ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Other(describe) ❑ YES ❑ NO ❑ YES ❑ y NO Other(describe) ❑ YES ❑ ❑ YES ❑ NO NO Other(describe) ❑ YES ❑ NO ❑ YES ❑ NO Other(describe) ❑ YES ❑ NO ❑ YES ❑ NO Other(describe) 0❑ YES ❑ NO YES ❑ NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance } Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Signature: Date: Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad in— VSMP INSPECTION REPORT EROSIONS &SEDIMENT CONTROL ,--- "t' Project: GCP Number: 0N YESYES ❑NO Notice of Cove ated? ❑ SWPPP available for review? ❑ Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once every Measureable Amount four business days Storm Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion and sediment control plan Describe any maintenance Have controls needs or other deficiencies been installed in Are controls that were identified and the effectively Inspection requirements: accordance with minimizing sediment location of the deficiencies the approved ES (e.g. have controls been Inspector? discharges? inappropriately or incorrectly used?) All perimeter erosion and sediment controls(silt ❑YES ❑NO ❑YES ❑NO fence, etc.) Soil stockpiles and borrow areas(for El YES ❑NO El YES ❑NO stabilization or sediment trapping measures) Completed earthen structures, such as dams, ❑YES ❑NO El YES ❑NO dikes, ditches, and diversions for stabilization Cut and fill slopes ❑YES ❑NO ❑YES ❑NO Sediment basins and traps, sediment barriers, and other measures (installed to control ❑YES ❑NO ❑YES ❑NO sediment discharges from storm water) Temporary or permanent channels,flumes, or other slope drain structures (installed to convey ❑YES ❑NO ❑YES ❑NO concentrated runoff down cut and fill slopes) Storm inlets (to ensure that sediment laden storm water does not enter without first being ❑YES ❑NO ❑YES ❑NO filtered or similarly treated) Construction entrances and access routes (for El YES ❑NO ❑YES ❑NO minimizing mud/sediment tracking) IHave construction activities begun on areas that have reached final grade or that will remain ❑ YES ❑ NO dormant for more than 14 days? Were stabilization activities completed within seven days of reaching final grade or stopping work on YES NO +`areas that have reached final grade or that will remain dormant for more than 14 days? ❑ ❑ STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Inspect for the presence of the following: I Present? Location Concentrated flows of stormwater in conveyances (such as rills, rivulets or channels)that have not been filtered, settled, or similarly treated prior YES ❑ to discharge, (or evidence thereof) NO Sediment laden runoff that has not been filtered or settled to remove ❑ YES ❑ sediments prior to discharge NO Sediment deposition in areas that drain to unprotected stormwater inlets ❑ YES ❑ or catch basins that discharge to surface waters. NO Inlets and catch basins with failing sediment controls due to improper ❑ YES ❑ installation, lack of maintenance, or inadequate design NO Sediment deposition on any property(including public and private ❑ YES ❑ streets) outside of the construction activity covered by the general permit NO ❑ YES ❑ Required stabilization (initiated or completed on portions of the site?) NO Sediment basins/traps without adequate wet or dry storage volume ❑ YESNO ❑ Sediment basins where the riser appears to be leaking, water appears to be leaving the basin around the barrel pipe (rather than through it), or ❑ YES ❑ the dewatering device appears to be dewatering basin from below the NO water surface Sediment traps that allow stormwater to discharge from below the ❑ YES ❑ surface of the wet storage portion of the trap NO Land disturbance outside of the approved limits of disturbance ❑ YES 111 NO ❑ YES ❑ NO ❑ YES ❑ Other(describe) NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s)required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Signature: Date: STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Name: Title:kkuise (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) VSMP INSPECTION REPORT PLLUTION PREVENTION CONTROLS Project: GCP Number: Notice of Coverage posted? ❑ SWPPP available for review? YES ❑NO ❑YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once Measureable Amount every four business days Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred iutside the approved erosion ' ,,rand sediment control plan Inspect the pollution prevention controls associated with the pollutant generating activities identified in the Pollution Prevention Plan Describe any maintenance Inspect the pollution prevention controls Have the controls Are controls needs or other deficiencies associated with the pollution generating been properly effectively that were identified and the activities identified in Section 8.1 of the implemented as minimizing location of the deficiencies SWPPP outlined on the pollutant (e.g. have controls been PPP sheet? discharges? inappropriately or incorrectly used) Clearing, grading or excavating ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Paving operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Concrete washout and concrete N/A ❑ YES ❑ NO ❑ YES ❑ waste disposal NO Structure construction, stucco, ❑ YES ❑ painting or cleaning ❑ N/A DYES ❑ NO NO Dewatering operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Material delivery and storage ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Material use during building ❑ YES ❑ �rocess ❑ N/A ❑ YES ❑ NO NO Solid waste disposal ❑ N/A ❑ YES 0 NO ❑ YES El MIL. STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Sanitary waste disposal (porta- ElN/A ❑ YES ❑ NO ❑ YES El johns) NO vied) ': Landscaping operations ElN/A ❑ YES 1=1NO ❑ YES NO ❑ Vehicle Fueling or Maintenance ElN/A ❑ YES ❑ NO ❑ YES El NO Other(describe) ❑ YES ❑ NO ❑ YES I=1 1 Other(describe) 0 YES ❑ NO ❑ YES Li NO ! Other(describe) ❑ YES ❑ NO ❑ YES ❑ NO Other(describe) YES ❑ NO 111 YES ❑ ❑ NO Other(describe) 111YES ❑ NO III YES ❑ NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Signature: Date: Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) j STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad VSMP INSPECTION REPORT EROSIONS &SEDIMENT CONTROL *kr' Project: GCP Number: Notice of Coverage posted? ❑ SWPPP available for review? El YES ❑NO YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once every Measureable Amount four business days Storm Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion and sediment control plan Describe any maintenance Have controls needs or other deficiencies been installed in Are controls that were identified and the effectively Inspection requirements: accordance with minimizing sediment location of the deficiencies the approved ES (e.g. have controls been Inspector? discharges? inappropriately or IOW incorrectly used?) All perimeter erosion and sediment controls (silt ❑YES ❑NO El YES ❑NO fence, etc.) Soil stockpiles and borrow areas (for El YES ❑NO LI YES ❑NO stabilization or sediment trapping measures) Completed earthen structures, such as dams, ❑YES ❑NO ❑YES ❑NO dikes, ditches, and diversions for stabilization Cut and fill slopes ❑YES ❑NO ❑YES ❑NO Sediment basins and traps, sediment barriers, and other measures (installed to control ❑YES ❑NO ❑YES ❑NO sediment discharges from storm water) Temporary or permanent channels,flumes, or other slope drain structures (installed to convey ❑YES ❑NO ❑YES ❑NO concentrated runoff down cut and fill slopes) Storm inlets (to ensure that sediment laden storm water does not enter without first being ❑YES ❑NO ❑YES ❑NO filtered or similarly treated) Construction entrances and access routes (for El YES ❑NO ❑YES ❑NO minimizing mud/sediment tracking) IHave construction activities begun on areas that have reached final grade or that will remain ❑ YES ❑ NO dormant for more than 14 days? Vere stabilization activities completed within seven days of reaching final grade or stopping work on YES NO reas that have reached final grade or that will remain dormant for more than 14 days? ❑ ❑ mow STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Inspect for the presence of the following: I Present? I Location Concentrated flows of stormwater in conveyances (such as rills, rivulets ❑ YES ❑ or channels)that have not been filtered, settled, or similarly treated prior NO x to discharge, (or evidence thereof) Sediment laden runoff that has not been filtered or settled to remove ❑ YES ❑ sediments prior to discharge NO Sediment deposition in areas that drain to unprotected stormwater inlets ❑ YES ❑ ¢ or catch basins that discharge to surface waters. NO Inlets and catch basins with failing sediment controls due to improper ❑ YES ❑ installation, lack of maintenance, or inadequate design NO Sediment deposition on any property(including public and private ❑ YES ❑ streets) outside of the construction activity covered by the general permit NO ` Required stabilization (initiated or completed on portions of the site?) ❑ YES ❑ NOc Sediment basins/traps without adequate wet or dry storage volume ❑ YES ❑ NO Sediment basins where the riser appears to be leaking, water appears to be leaving the basin around the barrel pipe (rather than through it), or ❑ YES ❑ i the dewatering device appears to be dewatering basin from below the NO water surface Sediment traps that allow stormwater to discharge from below the ❑ YES ❑ surface of the wet storage portion of the trap NO 4. Land disturbance outside of the approved limits of disturbance El YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ Other(describe) NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Signature: Date: STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad �- Name: Title: 460' (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) VSMP INSPECTION REPORT PLLUTION PREVENTION CONTROLS Project: GCP Number: Notice of Coverage posted? ❑ SWPPP available for review? YES ❑NO ❑YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once Measureable Amount every four business days Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred iutside the approved erosion %wind sediment control plan Inspect the pollution prevention controls associated with the pollutant generating activities identified in the Pollution Prevention Plan Describe any maintenance Inspect the pollution prevention controls Have the controls Are controls needs or other deficiencies associated with the pollution generating been properly effectively that were identified and the activities identified in Section 8.1 of the implemented as minimizing location of the deficiencies SWPPP outlined on the pollutant (e.g. have controls been PPP sheet? discharges? inappropriately or incorrectly used) Clearing, grading or excavating ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Paving operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Concrete washout and concrete N/A ❑ YES ❑ NO ❑ YES ❑ waste disposal NO Structure construction, stucco, ❑ N/A YES ❑ NO ❑ YES ❑ painting or cleaning NO Dewatering operations ❑ N/A ❑ YES ❑ NO ❑ YES EI NO Material delivery and storage ❑ N/A ❑ YES EINO ❑ YES EI NO Material use during building ❑ N/A YES ❑ NO ❑ YES ❑ irocess NO (Solid waste disposal ElN/A ❑ YES ❑ NO EI YES ❑ NO t STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Sanitary waste disposal (porta- El❑ N/A ❑ YES ❑ NO YES El johns) NOJ ' Landscaping operations ❑ N/A ElYES ❑ NO ❑ YES NO II El Vehicle Fueling or Maintenance ElN/A ❑ YES ElNO ❑ YES ❑ NO Other(describe) ❑ YES ❑ NO ❑ YES ❑ t NO Other(describe) ❑ YES El NO ❑ YES ❑ NO s Other(describe) 0❑ YES El NO YES ❑ t NO t il Other(describe) 0❑ YES ❑ NO YES ❑ NO Other(describe) ❑ YES ❑ NO ❑ YES El NO i Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit i Identify the location(s)where any additional control i measures are needed that did not exist at the time of the inspection iiii) List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Signature: Date: Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad 1 VSMP INSPECTION REPORT EROSIONS&SEDIMENT CONTROL Project: GCP Number: YES ❑NOYES ❑ Notice of Coverage ted? ❑ SWPPP available for Oeview? ❑ Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once every Measureable Amount four business days Storm Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred outside the approved erosion and sediment control plan Describe any maintenance Have controls needs or other deficiencies been installed in Are controls that were identified and the effectively Inspection requirements: accordance with minimizing sediment location of the deficiencies the approved ES (e.g. have controls been Inspector? discharges? inappropriately or Slie incorrectly used?) All perimeter erosion and sediment controls(silt fence, etc.) ❑YES ❑NO ❑YES ❑NO Soil stockpiles and borrow areas (for ❑YES ❑NO ❑YES ❑NO stabilization or sediment trapping measures) Completed earthen structures, such as dams, ❑YES ❑NO ❑YES ❑NO dikes, ditches, and diversions for stabilization Cut and fill slopes ❑YES ❑NO ❑YES ❑NO Sediment basins and traps, sediment barriers, and other measures (installed to control ❑YES ❑NO ❑YES ❑NO sediment discharges from stormwater) Temporary or permanent channels,flumes, or other slope drain structures (installed to convey ❑YES ❑NO ❑YES ❑NO concentrated runoff down cut and fill slopes) Storm inlets (to ensure that sediment laden stormwater does not enter without first being ❑YES ❑NO ❑YES ❑NO filtered or similarly treated) Construction entrances and access routes (for ❑YES ❑NO ❑YES ❑NO minimizing mud/sediment tracking) IHave construction activities begun on areas that have reached final grade or that will remain dormant for more than 14 days? ❑ YES ❑ NO Were stabilization activities completed within seven days of reaching final grade or stopping work on YES NO areas that have reached final grade or that will remain dormant for more than 14 days? ❑ ❑ I 1 STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Inspect for the presence of the following: I Present? I Location -3 I Concentrated flows of stormwater in conveyances (such as rills, rivulets ❑ YES ❑ it or channels)that have not been filtered, settled, or similarly treated prior NO to discharge, (or evidence thereof) Sediment laden runoff that has not been filtered or settled to remove ❑ YES ❑ sediments prior to discharge NO Sediment deposition in areas that drain to unprotected stormwater inlets ❑ YES ❑ or catch basins that discharge to surface waters. NO Inlets and catch basins with failing sediment controls due to improper ❑ YES ❑ installation, lack of maintenance, or inadequate design NO I Sediment deposition on any property(including public and private ❑ YES ❑ streets) outside of the construction activity covered by the general permit NO B Required stabilization (initiated or completed on portions of the site?) ❑ YES ❑ NO P Sediment basins/traps without adequate wet or dry storage volume ❑ YES ❑ NO Sediment basins where the riser appears to be leaking, water appears to be leaving the basin around the barrel pipe (rather than through it), or ❑ YES ❑ the dewatering device appears to be dewatering basin from below the NO water surface Sediment traps that allow stormwater to discharge from below the ❑ YES ❑ surface of the wet storage portion of the trap NO 1 Land disturbance outside of the approved limits of disturbance 111 YES 111 NO I ❑ YES 1=1❑ YES ❑ NO Other(describe) NO i IIdentify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit I i Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection , List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from i a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, 3 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." to Signature: Date: STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) VSMP INSPECTION REPORT PLLUTION PREVENTION CONTROLS Project: GCP Number: Notice of Coverage posted? ❑ SWPPP available for review? YES ❑NO ❑YES ❑NO Inspection Inspection Conducted By Date/Time (must be the Qualified Personnel identified in the SWPPP) Date of Last Rainfall ❑ Not applicable since inspection frequency is at least once Measureable Amount every four business days Storm Event Record the information and a description of any discharges occurring at the time of the inspection Record any land-disturbing activities that have occurred iutside the approved erosion iiirtind sediment control plan Inspect the pollution prevention controls associated with the pollutant generating activities identified in the Pollution Prevention Plan Describe any maintenance Inspect the pollution prevention controls Have the controls Are controls needs or other deficiencies associated with the pollution generating been properly effectively that were identified and the activities identified in Section 8.1 of the implemented as minimizing location of the deficiencies SWPPP outlined on the pollutant (e.g. have controls been PPP sheet? discharges? inappropriately or incorrectly used) Clearing, grading or excavating ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Paving operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Concrete washout and concrete N/A ❑ YES ❑ NO ❑ YES ❑ waste disposal NO Structure construction, stucco, ❑ N/A ❑ YES ❑ NO ❑ YES ❑ painting or cleaning NO Dewatering operations ElN/A ❑ YES ❑ NO 1=1 YES ❑ NO Material delivery and storage ❑ N/A ❑ YES ❑ NO El YES ❑ NO Material use during building ❑ N/A ❑ YES ❑ NO ❑ YES ❑ YSolid irocess NO waste disposal ❑ N/A 0 YES ❑ NO ❑ YES NO 0 STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad Sanitary waste disposal (porta- 0❑ N/A ❑ YES ❑ NO YES ❑ johns) NO Landscaping operations ❑ N/A ❑ YES ❑ NO ❑ YES ❑ E NO Vehicle Fueling or Maintenance ❑ N/A ❑ YES ❑ NO ❑ YES ❑ NO Other(describe) ❑ YES ❑ NO ❑ YES ❑ NO Other(describe) ❑ YES ❑ NO ❑ YES ❑ NO Other(describe) YES ❑ YES ❑ NO ❑ ❑ NO Other(describe) YES YES ❑ NO ❑ ❑ NO Other(describe) YES❑ YES ❑ NO ❑ ❑ NO Identify the material(s)and document the location or presence of any evidence of pollutant discharges that are not authorized by the general permit Identify the location(s)where any additional control measures are needed that did not exist at the time of the inspection tit"; List the corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance Document any corrective action(s) required from a previous inspection that have not been implemented "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Signature: Date: Name: Title: (must be either the Operator or Delegated Authority, not necessarily the person who conducted the inspection) STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad 13 . CORRECTIVE ACTION VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com NNW STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad SC' 15 VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad In accordance with Part II F.4 of the General VPDES Permit for Discharges of Stormwater from Construction Activities, documentation of any corrective actions taken be retained by the operator as part of the SWPPP for at least three years from the date that general permit coverage expires or is terminated. In accordance with Part II G of the General VPDES Permit for Discharges of Stormwater from Construction Activities: The operator shall implement the corrective action(s) identified as a result of an inspection as soon as practicable but no later than seven days after discovery or a longer period as approved by the VSMP authority. If approval of a corrective action by a regulatory authority (e.g., VSMP authority, VESCP authority, or the department) is necessary, additional control measures shall be implemented to minimize pollutants in stormwater discharges until such approvals can be obtained. The operator may be required to remove accumulated sediment deposits located outside of the construction activity covered by this general permit as soon as practicable in order to minimize environmental impacts. The operator shall notify the VSMP authority and the department as well as obtain all Iti.r applicable federal, state, and local authorizations, approvals, and permits prior to the removal of sediments accumulated in surface waters including wetlands. VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad ,4400 Corrective Action Log SWPPP Revision Documentation Form Company Number Date Author Representative Signature 0 1 2 3 4 5 6 7 8 9 *41) 10 11 12 13 14 15 16 17 18 19 20 VALLEY ENGINEERING Nomie IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad 14 . REGISTRATION STATEMENT FOR THE PROJECT VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com ( STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad ( { { VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.corn 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:Sentara Martha Jefferson Hospital Contact:Michael Spatz, HRIM,CHFM Mailing Address:500 Martha Jefferson Drive City:Charlotesville State:VA Zip:22911 Phone:(434)654-7038 Email address(if available):MrSpatz@sentara.com Indicate if DEQ may transmit general permit correspondence electronically: Yes❑ No❑✓ 2. Existing General Permit Registration Number(for renewals only): 3. Name and Location of the Construction Activity: Name:Sentara Martha Jefferson Hospital Address(if available):500 Martha Jefferson Drive City:Charlottesville State:VA Zip:22911 County(if not located within a City):Albemarle Latitude(decimal degrees):38.021446 Longitude(decimal degrees):78.443953 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): 111000,4. Status of the Construction Activity(check only one): Federal ❑ State ❑ Public❑ Private ❑✓ 5. Nature of the Construction Activity(e.g.,commercial, industrial,residential,agricultural,oil and gas,etc.): medical 6. Name of the Receiving Water(s)and Hydrologic Unit Code(HUC): Name:Rivanna River-Carroll Creek Name: HUC:JR17 HUC: 7. If the discharge is through a Municipal Separate Storm Sewer System (MS4),the name of the MS4 operator: 8. Estimated Project Start and Completion Date: Start Date(mm/dd/yyyy): Completion Date(mm/dd/yyyy): 9. Total Land Area of Development(to the nearest one-hundredth acre):40.25 Estimated Area to be Disturbed(to the nearest one-hundredth acre):0.99 10. Is the area to be disturbed part of a larger common plan of development or sale? Yes❑ 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 my knowledge and belief true, accurate, and complete. I am aware that there are significant penalties for submitting false information including the possibility of fine and imprisonment for knowing violations." Printed Name: Title: swe Signature: Date: (Please sign in INK. This Certification must be signed by the appropriate person associated with the operator identified in Item#1.) 01/2014 Page 1 of 1 c E ti 2 F 3 Y k k t i 4 1 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,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 stomiwater 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. %ohilerith a stormwater pollution prevention plan for the site or other state ermit 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 II r E y, f C L L { T' f t; f r a s e i S 9 { f k j E 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. ,.IS4 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. Ytem 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 �> E k K t 6 tl p k S i f t i { 3 DEPARTMENT OF ENVIRONMENTAL QUALITY CONSTRUCTION ACTIVITY OPERATOR PERMIT FEE FORM (Please Type or Print All Information) Instructions: Applicants for a Construction Activity Individual Permit are required to pay permit application fees. Fees are also required for registration for coverage under a Construction Activity General Permit. Fees must be paid when applications for state permit issuance, reissuance, modification or transfer are submitted. Applications will be considered incomplete if the proper fee is not paid and will not be processed until the fee is received. The fee schedule for state permits is included with this form. Fees for state permit issuance, reissuance, maintenance, modification and transfer are included. Once you have determined the fee for the type of application you are submitting, complete this form. The original copy of the form and your check or money order payable to "Treasurer of Virginia" should be mailed to: Department of Environmental Quality Receipts Control P.O. Box 1104 Richmond,VA 23218 A copyof this form and a copyof your check or money order should accompany the permit application (or registration statement). You should retain a copy for your records. Construction Activity Operator: Name:Sentara Martha Jefferson Hospital Contact: Michael Spatz, HRIM, CHFM mailing Address:500 Martha Jefferson Drive City: Charlottesville State:VA Zip:22911 Phone: (434) 654-7038 Email address (if available): MrSpatz@Sentara.com Name and Location of the Construction Activity: Name: Sentara Martha Jefferson Hospital Helipad City: Charlottesville State: VA Zip:22911 County:Albemarle Type of State Permit: ❑ Construction Activity Individual Permit ❑✓ Construction Activity General Permit (from Fee Schedule) Type of Action: ❑✓ New Issuance ❑ Reissuance ❑ Maintenance ❑ Modification ❑ Transfer Amount of Fee Submitted (from Fee Schedule): $2,700.00 Existing General Permit Registration Number(if applicable): FOR DEQ USE ONLY Date: DC#: 01/2014 Page 1 of 1 t 3 } j x S i CONSTRUCTION ACTIVITY PERMIT FEE SCHEDULE A. Individual Permits. The fee for filing a state permit application for a Construction Activity Individual Permit issued by the Board is as follows: (NOTE: Individual permittees pay an annual permit maintenance fee instead of a reapplication fee. The permittee is billed separately by DEQ for the annual permit maintenance fee.) TYPE OF STATE PERMIT ISSUANCE Individual Permit for Discharges from Construction Activities $15,000 B. Registration Statements. The fee for filing a state permit application (registration statement) for coverage under a Construction Activity General Permit issued by the Board, including a state or federal agency that does not administer a project in accordance with approved annual standards and specifications, is as follows: TYPE OF STATE PERMIT ISSUANCE General/Stormwater Management-Small Construction Activity/Land Clearing (Areas within common plans $290 of development or sale with land-disturbance acreage less than one acre) General/Stormwater Management-Small Construction Activity/Land Clearing (Sites or areas within common plans of development or sale with land-disturbance acreage equal to or greater than one acre and $2,700 less than five acres) General/Stormwater Management-Large Construction Activity/Land Clearing (Sites or areas within common plans of development or sale with land-disturbance acreage equal to or greater than five acres and $3,400 less than 10 acres) General/Stormwater Management-Large Construction Activity/Land Clearing (Sites or areas within common plans of development or sale with land-disturbance acreage equal to or greater than 10 acres and $4,500 less than 50 acres) tokime General/Stormwater Management-Large Construction Activity/Land Clearing (Sites or areas within common plans of development or sale with land-disturbance acreage equal to or greater than 50 acres and $6,100 less than 100 acres) General/Stormwater Management-Large Construction Activity/Land Clearing (Sites or areas within $9,600 common plans of development or sale with land-disturbance acreage equal to or greater than 100 acres) The fee for filing a state permit application (registration statement)for coverage under a Construction Activity General Permit issued by the Board for a state or federal agency that administers a project in accordance with approved annual standards and specifications is as follows: TYPE OF STATE PERMIT ISSUANCE Construction General/Stormwater Management—Phase I Land Clearing("Large"Construction Activity— $750 Sites or common plans of development or sale equal to or greater than 5 acres) Construction General/Stormwater Management—Phase II Land Clearing("Small"Construction Activity— $450 Sites or common plans of development or sale equal to or greater than 1 acre and less than 5 acres) �1rr� 01/2014 Page 1 of 2 r 5 } s S f K a i i { i i t t C. State Permit Modification or Transfer Fees. The following fees apply to the modification or transfer of a Construction Activity Individual Permit or a Construction Activity General Permit issued by the Board. The fee assessed shall be based on the total disturbed acreage of the construction activity. In addition to the state permit modification fee, modifications resulting in an increase in total disturbed acreage shall pay the difference in the initial Construction Activity General Permit fee paid and the Construction Activity 3eneral Permit fee that would have applied for the total disturbed acreage in Section B above. TYPE OF STATE PERMIT MODIFICATION General/Stormwater Management—Small Construction Activity/Land Clearing (Areas within common $20 plans of development or sale with land disturbance acreage less than one acre) General/Stormwater Management—Small Construction Activity/Land Clearing (Sites or areas within common plans of development or sale with land-disturbance acreage equal to or greater than one and less $200 than five acres) General/Stormwater Management—Large Construction Activity/Land Clearing (Sites or areas within common plans of development or sale with land-disturbance acreage equal to or greater than five acres and $250 less than 10 acres) General/Stormwater Management—Large Construction Activity/Land Clearing (Sites or areas within common plans of development or sale with land-disturbance acreage equal to or greater than 10 acres and $300 less than 50 acres) General/Stormwater Management—Large Construction Activity/Land Clearing (Sites or areas within common plans of development or sale with land-disturbance acreage equal to or greater than 50 acres and $450 less than 100 acres) General/Stormwater Management—Large Construction Activity/Land Clearing (Sites or areas within $700 common plans of development or sale with land-disturbance acreage equal to or greater than 100 acres) Individual Permit for Discharges from Construction Activities $5,000 NflirsiD. State Permit Maintenance Fees. The following annual state permit maintenance fees apply to each state permit identified below, including expired permits that have been administratively continued. No annual state permit maintenance fee is required for coverage under a Construction Activity General Permit for a state or federal agency that administers a project in accordance with approved annual standards and specifications. TYPE OF STATE PERMIT MAINTENANCE General/Stormwater Management—Small Construction Activity/Land Clearing (Areas within common $50 plans of development or sale with land disturbance acreage less than one acre) General/Stormwater Management—Small Construction Activity/Land Clearing (Sites or areas within common plans of development or sale with land-disturbance acreage equal to or greater than one and less $400 than five acres) General/Stormwater Management—Large Construction Activity/Land Clearing (Sites or areas within common plans of development or sale with land-disturbance acreage equal to or greater than five acres and $500 less than 10 acres) General/Stormwater Management—Large Construction Activity/Land Clearing (Sites or areas within common plans of development or sale with land-disturbance acreage equal to or greater than 10 acres and $650 less than 50 acres) General/Stormwater Management—Large Construction Activity/Land Clearing(Sites or areas within common plans of development or sale with land-disturbance acreage equal to or greater than 50 acres and $900 less than 100 acres) General/Stormwater Management—Large Construction Activity/Land Clearing (Sites or areas within $1,400 common plans of development or sale with land-disturbance acreage equal to or greater than 100 acres) Individual Permit for Discharges from Construction Activities $3,000 01/2014 Page 2 of 2 r r i x s 7 r } f k 3 8 i F S 1 STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad 15 . NOTICE OF COVERAGE FOR THE PROJECT VALLEY ( ENGINEERING iroe IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad v VALLEY I ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad 16 . GENERAL VSMP PERMIT FOR DISCHAGES OF STORMWATER FROM CONSTRUCTION ACTIVITES VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg,Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com a ®4ir vow COMMONWEALTH of VIRGINIA DEPARTMENT OF ENVIRONMENTAL QUALITY General Permit No.: VAR10 Effective Date: July 1, 2014 Expiration Date: June 30, 2019 GENERAL VPDES PERMIT FOR DISCHARGES OF STORMWATER FROM CONSTRUCTION ACTIVITIES AUTHORIZATION TO DISCHARGE UNDER THE VIRGINIA STORMWATER MANAGEMENT PROGRAM AND THE VIRGINIA STORMWATER MANAGEMENT ACT In compliance with the provisions of the Clean Water Act, as amended, and pursuant to the Virginia Stormwater Management Act and regulations adopted pursuant thereto, operators of construction activities are authorized to discharge to surface waters within the boundaries of the Commonwealth of Virginia, except those specifically named in State Water Control Board regulations that prohibit such discharges. The authorized discharge shall be in accordance with this cover page, Part I - Discharge Authorization and Special Conditions, Part II - Stormwater Pollution Prevention Plan, and Part III - Conditions Applicable to All VPDES Permits as set forth herein. Stare General Permit No.:VAR10 Page 1 of 21 PART I DISCHARGE AUTHORIZATION AND SPECIAL CONDITIONS A. Coverage under this general permit. 1. During the period beginning with the date of coverage under this general permit and lasting until the general permit's expiration date, the operator is authorized to discharge stormwater from construction activities. 2. This general permit also authorizes stormwater discharges from support activities (e.g., concrete or asphalt batch plants, equipment staging yards, material storage areas, excavated material disposal areas, borrow areas) located on-site or off-site provided that: a. The support activity is directly related to the construction activity that is required to have general permit coverage for discharges of stormwater from construction activities; b. The support activity is not a commercial operation, nor does it serve multiple unrelated construction activities by different operators; c. The support activity does not operate beyond the completion of the last construction activity it supports; d. The support activity is identified in the registration statement at the time of general permit coverage; e. Appropriate control measures are identified in a stormwater pollution prevention plan and implemented to address the discharges from the support activity areas; and f. All applicable state, federal, and local approvals are obtained for the support activity. B. Limitations on coverage. 1. Post-construction discharges. This general permit does not authorize stormwater discharges that originate from the site after construction activities have been completed and the site, including any support activity sites covered under the general permit registration, has undergone final stabilization. Post-construction industrial stormwater discharges may need to be covered by a separate VPDES permit. 2. Discharges mixed with nonstormwater. This general permit does not authorize discharges that are mixed with sources of nonstormwater, other than those discharges that are identified in Part I E (Authorized nonstormwater discharges)and are in compliance with this general permit. 3. Discharges covered by another state permit. This general permit does not authorize discharges of stormwater from construction activities that have been covered under an individual permit or required to obtain coverage under an alternative general permit. 4. Impaired waters and TMDL limitation. Discharges of stormwater from construction activities to surface waters identified as impaired in the 2012 § 305(b)/303(d) Water Quality Assessment Integrated Report or for which a TMDL wasteload allocation has been established and approved prior to the term of this general permit for (i) sediment or a sediment-related parameter (i.e., total suspended solids or turbidity)or(ii) nutrients (i.e., nitrogen or phosphorus)are not eligible for coverage under this general permit unless the operator develops, implements, and maintains a SWPPP that minimizes the pollutants of concern and, when applicable, is consistent with the assumptions and requirements of the approved TMDL wasteload allocations. In addition, the operator shall implement the following stile items: General Permit No.: VAR10 Page 2 of 21 a. The impaired water(s), approved TMDL(s), and pollutant(s) of concern, when applicable, shall be identified in the SWPPP; b. Permanent or temporary soil stabilization shall be applied to denuded areas within seven days after final grade is reached on any portion of the site; c. Nutrients shall be applied in accordance with manufacturer's recommendations or an approved nutrient management plan and shall not be applied during rainfall events; and d. The applicable SWPPP inspection requirements specified in Part II F 2 shall be amended as follows: (1) Inspections shall be conducted at a frequency of(i) at least once every four business days or (ii) at least once every five business days and no later than 48 hours following a measurable storm event. In the event that a measurable storm event occurs when there are more than 48 hours between business days, the inspection shall be conducted on the next business day; and (2) Representative inspections used by utility line installation, pipeline construction, or other similar linear construction activities shall inspect all outfalls discharging to surface waters identified as impaired or for which a TMDL wasteload allocation has been established and approved prior to the term of this general permit. 5. Exceptional waters limitation. Discharges of stormwater from construction activities not previously covered under the general permit issued in 2009 to exceptional waters identified in 9VAC25-260-30 A 3 c are not eligible for coverage under this general permit unless the operator implements the following: Sire a. The exceptional water(s)shall be identified in the SWPPP; b. Permanent or temporary soil stabilization shall be applied to denuded areas within seven days after final grade is reached on any portion of the site; c. Nutrients shall be applied in accordance with manufacturer's recommendations or an approved nutrient management plan and shall not be applied during rainfall events; and d. The applicable SWPPP inspection requirements specified in Part II F 2 shall be amended as follows: (1) Inspections shall be conducted at a frequency of(i) at least once every four business days or (ii) at least once every five business days and no later than 48 hours following a measurable storm event. In the event that a measurable storm event occurs when there are more than 48 hours between business days, the inspection shall be conducted on the next business day; and (2) Representative inspections used by utility line installation, pipeline construction, or other similar linear construction activities shall inspect all outfalls discharging to exceptional waters. 6. There shall be no discharge of floating solids or visible foam in other than trace amounts. C. Commingled discharges. Discharges authorized by this general permit may be commingled with other sources of stormwater that are not required to be covered under a state permit, so long as the commingled discharge is in compliance with this general permit. Discharges authorized by a separate Sire state or VPDES permit may be commingled with discharges authorized by this general permit so long as all such discharges comply with all applicable state and VPDES permit requirements. General Permit No.: VAR10 Page 3 of 21 D. Prohibition of nonstormwater discharges. Except as provided in Parts I A 2, I C, and I E, all discharges covered by this general permit shall be composed entirely of stormwater associated with construction activities. All other discharges including the following are prohibited: 1. Wastewater from washout of concrete; 2. Wastewater from the washout and cleanout of stucco, paint, form release oils, curing compounds, and other construction materials; 3. Fuels, oils, or other pollutants used in vehicle and equipment operation and maintenance; 4. Oils, toxic substances, or hazardous substances from spills or other releases; and 5. Soaps, solvents, or detergents used in equipment and vehicle washing. E. Authorized nonstormwater discharges. The following nonstormwater discharges from construction activities are authorized by this general permit when discharged in compliance with this general permit: 1. Discharges from firefighting activities; 2. Fire hydrant flushings; 3. Waters used to wash vehicles or equipment where soaps, solvents, or detergents have not been used and the wash water has been filtered, settled, or similarly treated prior to discharge; 4. Water used to control dust that has been filtered, settled, or similarly treated prior to discharge; 5. Potable water sources, including uncontaminated waterline flushings; 6. Routine external building wash down where soaps, solvents or detergents have not been used and the wash water has been filtered, settled, or similarly treated prior to discharge; 7. Pavement wash waters where spills or leaks of toxic or hazardous materials have not occurred (or where all spilled or leaked material has been removed prior to washing); where soaps, solvents, or detergents have not been used; and where the wash water has been filtered, settled, or similarly treated prior to discharge; 8. Uncontaminated air conditioning or compressor condensate; 9. Uncontaminated ground water or spring water; 10. Foundation or footing drains where flows are not contaminated with process materials such as solvents; 11. Uncontaminated excavation dewatering, including dewatering of trenches and excavations that have been filtered, settled, or similarly treated prior to discharge; and 12. Landscape irrigation. F. Termination of general permit coverage. 1. The operator of the construction activity shall submit a notice of termination in accordance with 9VAC25-880-60 to the VSMP authority after one or more of the following conditions have been met: 5 General Permit No.: VAR10 Page 4 of 21 a. Necessary permanent control measures included in the SWPPP for the site are in place and 'ore functioning effectively and final stabilization has been achieved on all portions of the site for which the operator is responsible. When applicable, long term responsibility and maintenance requirements shall be recorded in the local land records prior to the submission of a notice of termination; b. Another operator has assumed control over all areas of the site that have not been finally stabilized and obtained coverage for the ongoing discharge; c. Coverage under an alternative VPDES or state permit has been obtained; or d. For residential construction only, temporary soil stabilization has been completed and the residence has been transferred to the homeowner. 2. The notice of termination should be submitted no later than 30 days after one of the above conditions in subdivision 1 of this subsection is met. Authorization to discharge terminates at midnight on the date that the notice of termination is submitted for the conditions set forth in subdivisions 1 b through 1 d of this subsection. Termination of authorizations to discharge for the conditions set forth in subdivision 1 a of this subsection shall be effective upon notification from the department that the provisions of subdivision 1 a of this subsection have been met or 60 days after submittal of the notice of termination, whichever occurs first. 3. The notice of termination shall be signed in accordance with Part Ill K of this general permit. G. Water quality protection. 1. The operator must select, install, implement and maintain control measures as identified in the Skire SWPPP at the construction site that minimize pollutants in the discharge as necessary to ensure that the operator's discharge does not cause or contribute to an excursion above any applicable water quality standard. 2. If it is determined by the department that the operator's discharges are causing, have reasonable potential to cause, or are contributing to an excursion above any applicable water quality standard, the department, in consultation with the VSMP authority, may take appropriate enforcement action and require the operator to: a. Modify or implement additional control measures in accordance with Part II B to adequately address the identified water quality concerns; b. Submit valid and verifiable data and information that are representative of ambient conditions and indicate that the receiving water is attaining water quality standards; or c. Submit an individual permit application in accordance with 9VAC25-870-410 B 3. All written responses required under this chapter must include a signed certification consistent with Part III K. General Permit No.: VAR10 Page 5 of 21 PART II `Irk STORMWATER POLLUTION PREVENTION PLAN A stormwater pollution prevention plan (SWPPP) shall be developed prior to the submission of a registration statement and implemented for the construction activity, including any support activity, covered by this general permit. SWPPPs shall be prepared in accordance with good engineering practices. Construction activities that are part of a larger common plan of development or sale and disturb less than one acre may utilize a SWPPP template provided by the department and need not provide a separate stormwater management plan if one has been prepared and implemented for the larger common plan of development or sale. The SWPPP requirements of this general permit may be fulfilled by incorporating by reference other plans such as a spill prevention control and countermeasure (SPCC) plan developed for the site under§ 311 of the federal Clean Water Act or best management practices (BMP) programs otherwise required for the facility provided that the incorporated plan meets or exceeds the SWPPP requirements of Part II A. All plans incorporated by reference into the SWPPP become enforceable under this general permit. If a plan incorporated by reference does not contain all of the required elements of the SWPPP, the operator must develop the missing elements and include them in the SWPPP. Any operator that was authorized to discharge under the general permit issued in 2009, and that intends to continue coverage under this general permit, shall update its stormwater pollution prevention plan to comply with the requirements of this general permit no later than 60 days after the date of coverage under this general permit. A. Stormwater pollution prevention plan contents. The SWPPP shall include the following items: 1. General information. a. A signed copy of the registration statement, if required, for coverage under the general VPDES permit for discharges of stormwater from construction activities; b. Upon receipt, a copy of the notice of coverage under the general VPDES permit for discharges of stormwater from construction activities (i.e., notice of coverage letter); c. Upon receipt, a copy of the general VPDES permit for discharges of stormwater from construction activities; d. A narrative description of the nature of the construction activity, including the function of the project(e.g., low density residential, shopping mall, highway, etc.); e. A legible site plan identifying: (1) Directions of stormwater flow and approximate slopes anticipated after major grading activities; (2) Limits of land disturbance including steep slopes and natural buffers around surface waters that will not be disturbed; (3) Locations of major structural and nonstructural control measures, including sediment basins and traps, perimeter dikes, sediment barriers, and other measures intended to filter, settle, or similarly treat sediment, that will be installed between disturbed areas and the undisturbed vegetated areas in order to increase sediment removal and maximize stormwater infiltration; (4) Locations of surface waters; General Permit No.:VAR10 Page 6 of 21 'fir.►. (5) Locations where concentrated stormwater is discharged; (6) Locations of support activities, when applicable and when required by the VSMP authority, including but not limited to (i) areas where equipment and vehicle washing, wheel wash water, and other wash water is to occur; (ii) storage areas for chemicals such as acids, fuels, fertilizers, and other lawn care chemicals; (iii) concrete wash out areas; (iv) vehicle fueling and maintenance areas; (v) sanitary waste facilities, including those temporarily placed on the construction site; and (vi)construction waste storage; and (7) When applicable, the location of the on-site rain gauge or the methodology established in consultation with the VSMP authority used to identify measurable storm events for inspection purposes. 2. Erosion and sediment control plan. a. An erosion and sediment control plan approved by the VESCP authority as authorized under the Erosion and Sediment Control Regulations (9VAC25-840), an "agreement in lieu of a plan" as defined in 9VAC25-840-10 from the VESCP authority, or an erosion and sediment control plan prepared in accordance with annual standards and specifications approved by the department. Any operator proposing a new stormwater discharge from construction activities that is not required to obtain erosion and sediment control plan approval from a VESCP authority or does not adopt department-approved annual standards and specifications shall submit the erosion and sediment control plan to the department for review and approval. b. All erosion and sediment control plans shall include a statement describing the maintenance responsibilities required for the erosion and sediment controls used. /krr, c. A properly implemented approved erosion and sediment control plan, "agreement in lieu of a plan," or erosion and sediment control plan prepared in accordance with department-approved annual standards and specifications, that adequately: (1) Controls the volume and velocity of stormwater runoff within the site to minimize soil erosion; (2) Controls stormwater discharges, including peak flow rates and total stormwater volume, to minimize erosion at outlets and to minimize downstream channel and stream bank erosion; (3) Minimizes the amount of soil exposed during the construction activity; (4) Minimizes the disturbance of steep slopes; (5) Minimizes sediment discharges from the site in a manner that addresses (i) the amount, frequency, intensity, and duration of precipitation; (ii) the nature of resulting stormwater runoff; and (iii) soil characteristics, including the range of soil particle sizes present on the site; (6) Provides and maintains natural buffers around surface waters, directs stormwater to vegetated areas to increase sediment removal, and maximizes stormwater infiltration, unless infeasible; (7) Minimizes soil compaction and, unless infeasible, preserves topsoil; (8) Ensures that stabilization of disturbed areas will be initiated immediately whenever any clearing, grading, excavating, or other land-disturbing activities have permanently ceased on any portion of the site, or temporarily ceased on any portion of the site and will not resume for a period exceeding 14 days; and General Permit No.: VAR10 Page 7 of 21 (9) Utilizes outlet structures that withdraw stormwater from the surface (i.e., above the permanent pool or wet storage water surface elevation), unless infeasible, when discharging from sediment basins or sediment traps. 3. Stormwater management plan. a. New construction activities. A stormwater management plan approved by the VSMP authority as authorized under the Virginia Stormwater Management Program (VSMP) Regulation (9VAC25- 870), or an "agreement in lieu of a stormwater management plan" as defined in 9VAC25-870-10 from the VSMP authority, or a stormwater management plan prepared in accordance with annual standards and specifications approved by the department. Any operator proposing a new stormwater discharge from construction activities that is not required to obtain stormwater management plan approval from a VSMP authority or does not adopt department-approved annual standards and specifications shall submit the stormwater management plan to the department for review and approval. b. Existing construction activities. Any operator that was authorized to discharge under the general permit issued in 2009, and that intends to continue coverage under this general permit, shall ensure compliance with the requirements of 9VAC25-870-93 through 9VAC25-870-99 of the VSMP Regulation, including but not limited to the water quality and quantity requirements. The SWPPP shall include a description of, and all necessary calculations supporting, all post- construction stormwater management measures that will be installed prior to the completion of the construction process to control pollutants in stormwater discharges after construction operations have been completed. Structural measures should be placed on upland soils to the degree possible. Such measures must be designed and installed in accordance with applicable VESCP authority, VSMP authority, state, and federal requirements, and any necessary permits must be obtained. 4. Pollution prevention plan. A pollution prevention plan that addresses potential pollutant-generating activities that may reasonably be expected to affect the quality of stormwater discharges from the construction activity, including any support activity. The pollution prevention plan shall: a. Identify the potential pollutant-generating activities and the pollutant that is expected to be exposed to stormwater; b. Describe the location where the potential pollutant-generating activities will occur, or if identified on the site plan, reference the site plan; c. Identify all nonstormwater discharges, as authorized in Part I E of this general permit, that are or will be commingled with stormwater discharges from the construction activity, including any applicable support activity; d. Identify the person responsible for implementing the pollution prevention practice or practices for each pollutant-generating activity(if other than the person listed as the qualified personnel); e. Describe the pollution prevention practices and procedures that will be implemented to: (1) Prevent and respond to leaks, spills, and other releases including (i) procedures for expeditiously stopping, containing, and cleaning up spills, leaks, and other releases; and (ii) procedures for reporting leaks, spills, and other releases in accordance with Part III G; (2) Prevent the discharge of spilled and leaked fuels and chemicals from vehicle fueling and maintenance activities (e.g., providing secondary containment such as spill berms, decks, spill containment pallets, providing cover where appropriate, and having spill kits readily available); General Permit No.: VAR10 Page 8of21 (3) Prevent the discharge of soaps, solvents, detergents, and wash water from construction materials, including the clean-up of stucco, paint, form release oils, and curing compounds (e.g., providing (i) cover (e.g., plastic sheeting or temporary roofs) to prevent contact with stormwater; (ii) collection and proper disposal in a manner to prevent contact with stormwater; and (iii) a similarly effective means designed to prevent discharge of these pollutants); (4) Minimize the discharge of pollutants from vehicle and equipment washing, wheel wash water, and other types of washing (e.g., locating activities away from surface waters and stormwater inlets or conveyance and directing wash waters to sediment basins or traps, using filtration devices such as filter bags or sand filters, or using similarly effective controls); (5) Direct concrete wash water into a leak-proof container or leak-proof settling basin. The container or basin shall be designed so that no overflows can occur due to inadequate sizing or precipitation. Hardened concrete wastes shall be removed and disposed of in a manner consistent with the handling of other construction wastes. Liquid concrete wastes shall be removed and disposed of in a manner consistent with the handling of other construction wash waters and shall not be discharged to surface waters; (6) Minimize the discharge of pollutants from storage, handling, and disposal of construction products, materials, and wastes including (i) building products such as asphalt sealants, copper flashing, roofing materials, adhesives, and concrete admixtures; (ii) pesticides, herbicides, insecticides, fertilizers, and landscape materials; and (iii) construction and domestic wastes such as packaging materials, scrap construction materials, masonry products, timber, pipe and electrical cuttings, plastics, Styrofoam, concrete, and other trash or building materials; (7) Prevent the discharge of fuels, oils, and other petroleum products, hazardous or toxic wastes, Sae and sanitary wastes; and (8) Address any other discharge from the potential pollutant-generating activities not addressed above; and f. Describe procedures for providing pollution prevention awareness of all applicable wastes, including any wash water, disposal practices, and applicable disposal locations of such wastes, to personnel in order to comply with the conditions of this general permit. The operator shall implement the procedures described in the SWPPP. 5. SWPPP requirements for discharges to impaired waters, surface waters with an applicable TMDL wasteload allocation established and approved prior to the term of this general permit, and exceptional waters. The SWPPP shall: a. Identify the impaired water(s), approved TMDL(s), pollutant(s) of concern, and exceptional waters identified in 9VAC25-260-30 A 3 c, when applicable; b. Provide clear direction that: (1) Permanent or temporary soil stabilization shall be applied to denuded areas within seven days after final grade is reached on any portion of the site; (2) Nutrients shall be applied in accordance with manufacturer's recommendations or an approved nutrient management plan and shall not be applied during rainfall events; and (3) A modified inspection schedule shall be implemented in accordance with Part I B 4 or Part I B 1i.r 5. { General Permit No.: VAR10 Page 9 of 21 6. Qualified personnel. The name, phone number, and qualifications of the qualified personnel conducting inspections required by this general permit. 7. Delegation of authority. The individuals or positions with delegated authority, in accordance with Part Ill K, to sign inspection reports or modify the SWPPP. 8. SWPPP signature. The SWPPP shall be signed and dated in accordance with Part Ill K. B. SWPPP amendments, modification, and updates. 1. The operator shall amend the SWPPP whenever there is a change in the design, construction, operation, or maintenance that has a significant effect on the discharge of pollutants to surface waters and that has not been previously addressed in the SWPPP. 2. The SWPPP must be amended if, during inspections or investigations by the operator's qualified personnel, or by local, state, or federal officials, it is determined that the existing control measures are ineffective in minimizing pollutants in discharges from the construction activity. Revisions to the SWPPP shall include additional or modified control measures designed and implemented to correct problems identified. If approval by the VESCP authority, VSMP authority, or department is necessary for the control measure, revisions to the SWPPP shall be completed no later than seven calendar days following approval. Implementation of these additional or modified control measures must be accomplished as described in Part II G. 3. The SWPPP must clearly identify the contractor(s) that will implement and maintain each control measure identified in the SWPPP. The SWPPP shall be amended to identify any new contractor that will implement and maintain a control measure. 4. The operator shall update the SWPPP no later than seven days following any modification to its implementation. All modifications or updates to the SWPPP shall be noted and shall include the following items: a. A record of dates when: (1) Major grading activities occur; (2) Construction activities temporarily or permanently cease on a portion of the site; and (3) Stabilization measures are initiated; b. Documentation of replaced or modified controls where periodic inspections or other information have indicated that the controls have been used inappropriately or incorrectly and where modified as soon as possible; c. Areas that have reached final stabilization and where no further SWPPP or inspection requirements apply; d. All properties that are no longer under the legal control of the operator and the dates on which the operator no longer had legal control over each property; e. The date of any prohibited discharges, the discharge volume released, and what actions were taken to minimize the impact of the release; f. Measures taken to prevent the reoccurrence of any prohibited discharge; and g. Measures taken to address any evidence identified as a result of an inspection required under Part II F. General Permit No.: VAR10 Page 10 of 21 Sire 5. Amendments, modifications, or updates to the SWPPP shall be signed in accordance with Part III K. C. Public Notification. Upon commencement of land disturbance, the operator shall post conspicuously a copy of the notice of coverage letter near the main entrance of the construction activity. For linear projects, the operator shall post the notice of coverage letter at a publicly accessible location near an active part of the construction project (e.g., where a pipeline crosses a public road). The operator shall maintain the posted information until termination of general permit coverage as specified in Part I F. D. SWPPP availability. 1. Operators with day-to-day operational control over SWPPP implementation shall have a copy of the SWPPP available at a central location on-site for use by those identified as having responsibilities under the SWPPP whenever they are on the construction site. 2. The operator shall make the SWPPP and all amendments, modifications, and updates available upon request to the department, the VSMP authority, the EPA, the VESCP authority, local government officials, or the operator of a municipal separate storm sewer system receiving discharges from the construction activity. If an on-site location is unavailable to store the SWPPP when no personnel are present, notice of the SWPPP's location must be posted near the main entrance of the construction site. 3. The operator shall make the SWPPP available for public review in an electronic format or in hard copy. Information for public access to the SWPPP shall be posted and maintained in accordance with Part II C. If not provided electronically, public access to the SWPPP may be arranged upon request at a time and at a publicly accessible location convenient to the operator or his designee but shall be no less than once per month and shall be during normal business hours. Information not required to be Skase contained within the SWPPP by this general permit is not required to be released. E. SWPPP implementation. The operator shall implement the SWPPP and subsequent amendments, modifications, and updates from commencement of land disturbance until termination of general permit coverage as specified in Part I F. 1. All control measures must be properly maintained in effective operating condition in accordance with good engineering practices and, where applicable, manufacturer specifications. If a site inspection required by Part II F identifies a control measure that is not operating effectively, corrective action(s) shall be completed as soon as practicable, but no later than seven days after discovery or a longer period as established by the VSMP authority, to maintain the continued effectiveness of the control measures. 2. If site inspections required by Part II F identify an existing control measure that needs to be modified or if an additional control measure is necessary for any reason, implementation shall be completed prior to the next anticipated measurable storm event. If implementation prior to the next anticipated measurable storm event is impracticable, then alternative control measures shall be implemented as soon as practicable, but no later than seven days after discovery or a longer period as established by the VSMP authority. F. SWPPP Inspections. 1. Personnel responsible for on-site and off-site inspections. Inspections required by this general permit shall be conducted by the qualified personnel identified by the operator in the SWPPP. The operator is responsible for insuring that the qualified personnel conduct the inspection. 2. Inspection schedule. a. Inspections shall be conducted at a frequency of: General Permit No.: VAR10 Page 11 of 21 (1) At least once every five business days; or (2) At least once every 10 business days and no later than 48 hours following a measurable storm event. In the event that a measurable storm event occurs when there are more than 48 hours between business days, the inspection shall be conducted no later than the next business day. b. Where areas have been temporarily stabilized or land-disturbing activities will be suspended due to continuous frozen ground conditions and stormwater discharges are unlikely, the inspection frequency may be reduced to once per month. If weather conditions (such as above freezing temperatures or rain or snow events) make discharges likely, the operator shall immediately resume the regular inspection frequency. c. Representative inspections may be utilized for utility line installation, pipeline construction, or other similar linear construction activities provided that: (1) Temporary or permanent soil stabilization has been installed and vehicle access may compromise the temporary or permanent soil stabilization and potentially cause additional land disturbance increasing the potential for erosion; (2) Inspections occur on the same frequency as other construction activities; (3) Control measures are inspected along the construction site 0.25 miles above and below each access point (i.e., where a roadway, undisturbed right-of-way, or other similar feature intersects the construction activity and access does not compromise temporary or permanent soil stabilization); and (4) Inspection locations are provided in the report required by Part II F. 3. Inspection requirements. a. As part of the inspection, the qualified personnel shall: (1) Record the date and time of the inspection and when applicable the date and rainfall amount of the last measurable storm event; (2) Record the information and a description of any discharges occurring at the time of the inspection; (3) Record any land-disturbing activities that have occurred outside of the approved erosion and sediment control plan; (4) Inspect the following for installation in accordance with the approved erosion and sediment control plan, identification of any maintenance needs, and evaluation of effectiveness in minimizing sediment discharge, including whether the control has been inappropriately or incorrectly used: (a) All perimeter erosion and sediment controls, such as silt fence; (b) Soil stockpiles, when applicable, and borrow areas for stabilization or sediment trapping measures; (c) Completed earthen structures, such as dams, dikes, ditches, and diversions for stabilization; General Permit No.: VAR10 Page 12 of 21 (d) Cut and fill slopes; (e) Sediment basins and traps, sediment barriers, and other measures installed to control sediment discharge from stormwater; (f) Temporary or permanent channel, flume, or other slope drain structures installed to convey concentrated runoff down cut and fill slopes; (g) Storm inlets that have been made operational to ensure that sediment laden stormwater does not enter without first being filtered or similarly treated; and (h) Construction vehicle access routes that intersect or access paved roads for minimizing sediment tracking; (5) Inspect areas that have reached final grade or that will remain dormant for more than 14 days for initiation of stabilization activities; (6) Inspect areas that have reached final grade or that will remain dormant for more than 14 days for completion of stabilization activities within seven days of reaching grade or stopping work; (7) Inspect for evidence that the approved erosion and sediment control plan, "agreement in lieu of a plan," or erosion and sediment control plan prepared in accordance with department- approved annual standards and specifications has not been properly implemented. This includes but is not limited to: (a) Concentrated flows of stormwater in conveyances such as rills, rivulets or channels that have not been filtered, settled, or similarly treated prior to discharge, or evidence thereof; Sloe (b) Sediment laden or turbid flows of stormwater that have not been filtered or settled to remove sediments prior to discharge; (c) Sediment deposition in areas that drain to unprotected stormwater inlets or catch basins that discharge to surface waters. Inlets and catch basins with failing sediments controls due to improper installation, lack of maintenance, or inadequate design are considered unprotected; (d) Sediment deposition on any property (including public and private streets) outside of the construction activity covered by this general permit; (e) Required stabilization has not been initiated or completed on portions of the site; (f) Sediment basins without adequate wet or dry storage volume or sediment basins that allow the discharge of stormwater from below the surface of the wet storage portion of the basin; (g) Sediment traps without adequate wet or dry storage or sediment traps that allow the discharge of stormwater from below the surface of the wet storage portion of the trap; and (h) Land disturbance outside of the approved area to be disturbed; (8) Inspect pollutant generating activities identified in the pollution prevention plan for the proper implementation, maintenance and effectiveness of the procedures and practices; �,,,,. (9) Identify any pollutant generating activities not identified in the pollution prevention plan; and General Permit No.: VAR10 Page 13 of 21 (10) Identify and document the presence of any evidence of the discharge of pollutants prohibited by this general permit. 4. Inspection report. Each inspection report shall include the following items: a. The date and time of the inspection and when applicable, the date and rainfall amount of the last measurable storm event; b. Summarized findings of the inspection; c. The location(s)of prohibited discharges; d. The location(s)of control measures that require maintenance; e. The location(s) of control measures that failed to operate as designed or proved inadequate or inappropriate for a particular location; f. The location(s)where any evidence identified under Part II F 3 a (7)exists; g. The location(s) where any additional control measure is needed that did not exist at the time of inspection; h. A list of corrective actions required (including any changes to the SWPPP that are necessary) as a result of the inspection or to maintain permit compliance; i. Documentation of any corrective actions required from a previous inspection that have not been implemented; and j. The date and signature of the qualified personnel and the operator or its duly authorized representative. The inspection report and any actions taken in accordance with Part II must be retained by the operator as part of the SWPPP for at least three years from the date that general permit coverage expires or is terminated. The inspection report shall identify any incidents of noncompliance. Where an inspection report does not identify any incidents of noncompliance, the report shall contain a certification that the construction activity is in compliance with the SWPPP and this general permit. The report shall be signed in accordance with Part III K of this general permit. G. Corrective actions. 1. The operator shall implement the corrective action(s) identified as a result of an inspection as soon as practicable but no later than seven days after discovery or a longer period as approved by the VSMP authority. If approval of a corrective action by a regulatory authority (e.g., VSMP authority, VESCP authority, or the department) is necessary, additional control measures shall be implemented to minimize pollutants in stormwater discharges until such approvals can be obtained. 2. The operator may be required to remove accumulated sediment deposits located outside of the construction activity covered by this general permit as soon as practicable in order to minimize environmental impacts. The operator shall notify the VSMP authority and the department as well as obtain all applicable federal, state, and local authorizations, approvals, and permits prior to the removal of sediments accumulated in surface waters including wetlands. General Permit No.: VAR10 Page 14 of 21 PART III CONDITIONS APPLICABLE TO ALL VPDES PERMITS NOTE: Discharge monitoring is not required for this general permit. If the operator chooses to monitor stormwater discharges or control measures, the operator must comply with the requirements of subsections A, B, and C, as appropriate. A. Monitoring. 1. Samples and measurements taken for the purpose of monitoring shall be representative of the monitoring activity. 2. Monitoring shall be conducted according to procedures approved under 40 CFR Part 136 or alternative methods approved by the U.S. Environmental Protection Agency, unless other procedures have been specified in this general permit. Analyses performed according to test procedures approved under 40 CFR Part 136 shall be performed by an environmental laboratory certified under regulations adopted by the Department of General Services (1 VAC30-45 or 1 VAC30-46). 3. The operator shall periodically calibrate and perform maintenance procedures on all monitoring and analytical instrumentation at intervals that will ensure accuracy of measurements. B. Records. 1. Monitoring records and reports shall include: a. The date, exact place, and time of sampling or measurements; %to"`` b. The individual(s)who performed the sampling or measurements; c. The date(s)and time(s)analyses were performed; d. The individual(s)who performed the analyses; e. The analytical techniques or methods used; and f. The results of such analyses. 2. The operator shall retain records of all monitoring information, including all calibration and maintenance records and all original strip chart recordings for continuous monitoring instrumentation, copies of all reports required by this general permit, and records of all data used to complete the registration statement for this general permit, for a period of at least three years from the date of the sample, measurement, report or request for coverage. This period of retention shall be extended automatically during the course of any unresolved litigation regarding the regulated activity or regarding control standards applicable to the operator, or as requested by the board. C. Reporting monitoring results. 1. The operator shall update the SWPPP to include the results of the monitoring as may be performed in accordance with this general permit, unless another reporting schedule is specified elsewhere in this general permit. 2. Monitoring results shall be reported on a discharge monitoring report (DMR); on forms provided, approved or specified by the department; or in any format provided that the date, location, parameter, Nrwe method, and result of the monitoring activity are included. General Permit No.: VAR10 Page 15 of 21 3. If the operator monitors any pollutant specifically addressed by this general permit more frequently than required by this general permit using test procedures approved under 40 CFR Part 136 or using other test procedures approved by the U.S. Environmental Protection Agency or using procedures specified in this general permit, the results of this monitoring shall be included in the calculation and reporting of the data submitted in the DMR or reporting form specified by the department. 4. Calculations for all limitations which require averaging of measurements shall utilize an arithmetic mean unless otherwise specified in this general permit. D. Duty to provide information. The operator shall furnish, within a reasonable time, any information which the board may request to determine whether cause exists for modifying, revoking and reissuing, or terminating this general permit or to determine compliance with this general permit. The board, department, EPA, or VSMP authority may require the operator to furnish, upon request, such plans, specifications, and other pertinent information as may be necessary to determine the effect of the wastes from his discharge on the quality of surface waters, or such other information as may be necessary to accomplish the purposes of the CWA and the Virginia Stormwater Management Act. The operator shall also furnish to the board, department, EPA, or VSMP authority, upon request, copies of records required to be kept by this general permit. E. Compliance schedule reports. Reports of compliance or noncompliance with, or any progress reports on, interim and final requirements contained in any compliance schedule of this general permit shall be submitted no later than 14 days following each schedule date. F. Unauthorized stormwater discharges. Pursuant to § 62.1-44.5 of the Code of Virginia, except in compliance with a state permit issued by the department, it shall be unlawful to cause a stormwater discharge from a construction activity. G. Reports of unauthorized discharges. Any operator who discharges or causes or allows a discharge of sewage, industrial waste, other wastes or any noxious or deleterious substance or a hazardous substance or oil in an amount equal to or in excess of a reportable quantity established under either 40 CFR Part 110, 40 CFR Part 117, 40 CFR Part 302, or§ 62.1-44.34:19 of the Code of Virginia that occurs during a 24-hour period into or upon surface waters or who discharges or causes or allows a discharge that may reasonably be expected to enter surface waters, shall notify the Department of Environmental Quality of the discharge immediately upon discovery of the discharge, but in no case later than within 24 hours after said discovery. A written report of the unauthorized discharge shall be submitted to the department and the VSMP authority within five days of discovery of the discharge. The written report shall contain: 1. A description of the nature and location of the discharge; 2. The cause of the discharge; 3. The date on which the discharge occurred; 4. The length of time that the discharge continued; 5. The volume of the discharge; 6. If the discharge is continuing, how long it is expected to continue; 7. If the discharge is continuing, what the expected total volume of the discharge will be; and 8. Any steps planned or taken to reduce, eliminate and prevent a recurrence of the present discharge or any future discharges not authorized by this general permit. General Permit No.: VAR10 Page 16 of 21 Discharges reportable to the department and the VSMP authority under the immediate reporting requirements of other regulations are exempted from this requirement. H. Reports of unusual or extraordinary discharges. If any unusual or extraordinary discharge including a "bypass" or "upset," as defined herein, should occur from a facility and the discharge enters or could be expected to enter surface waters, the operator shall promptly notify, in no case later than within 24 hours, the department and the VSMP authority by telephone after the discovery of the discharge. This notification shall provide all available details of the incident, including any adverse effects on aquatic life and the known number of fish killed. The operator shall reduce the report to writing and shall submit it to the department and the VSMP authority within five days of discovery of the discharge in accordance with Part III 12. Unusual and extraordinary discharges include but are not limited to any discharge resulting from: 1. Unusual spillage of materials resulting directly or indirectly from processing operations; 2. Breakdown of processing or accessory equipment; 3. Failure or taking out of service of some or all of the facilities; and 4. Flooding or other acts of nature. I. Reports of noncompliance. The operator shall report any noncompliance which may adversely affect surface waters or may endanger public health. 1. An oral report to the department and the VSMP authority shall be provided within 24 hours from the time the operator becomes aware of the circumstances. The following shall be included as information that shall be reported within 24 hours under this subdivision: %ir' a. Any unanticipated bypass; and b. Any upset that causes a discharge to surface waters. 2. A written report shall be submitted within five days and shall contain: a. A description of the noncompliance and its cause; b. The period of noncompliance, including exact dates and times, and if the noncompliance has not been corrected, the anticipated time it is expected to continue; and c. Steps taken or planned to reduce, eliminate, and prevent reoccurrence of the noncompliance. The department may waive the written report on a case-by-case basis for reports of noncompliance under Part III I if the oral report has been received within 24 hours and no adverse impact on surface waters has been reported. 3. The operator shall report all instances of noncompliance not reported under Part III 11 or 2 in writing as part of the SWPPP. The reports shall contain the information listed in Part III 12. NOTE: The reports required in Part III G, H and I shall be made to the department and the VSMP authority. Reports may be made by telephone, email, or by fax. For reports outside normal working hours, leaving a recorded message shall fulfill the immediate reporting requirement. For emergencies, the Virginia Department of Emergency Management maintains a 24-hour telephone service at 1-800-468- 8892. General Permit No.: VAR10 Page 17 of 21 4. Where the operator becomes aware of a failure to submit any relevant facts, or submittal of incorrect information in any report, including a registration statement, to the department or the VSMP authority, the operator shall promptly submit such facts or correct information. J. Notice of planned changes. 1. The operator shall give notice to the department and the VSMP authority as soon as possible of any planned physical alterations or additions to the permitted facility or activity. Notice is required only when: a. The operator plans an alteration or addition to any building, structure, facility, or installation that may meet one of the criteria for determining whether a facility is a new source in 9VAC25-870- 420; b. The operator plans an alteration or addition that would significantly change the nature or increase the quantity of pollutants discharged. This notification applies to pollutants that are not subject to effluent limitations in this general permit; or 2. The operator shall give advance notice to the department and VSMP authority of any planned changes in the permitted facility or activity, which may result in noncompliance with state permit requirements. K. Signatory requirements. 1. Registration statement. All registration statements shall be signed as follows: a. For a corporation: by a responsible corporate officer. For the purpose of this chapter, 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 state permit application requirements; and where authority to sign documents has been assigned or delegated to the manager in accordance with corporate procedures; b. For a partnership or sole proprietorship: by a general partner or the proprietor, respectively; or c. For a municipality, state, federal, or other public agency: by either a principal executive officer or ranking elected official. For purposes of this chapter, a principal executive officer of a public agency includes: (i) the chief executive officer of the agency or (ii) a senior executive officer having responsibility for the overall operations of a principal geographic unit of the agency. 2. Reports, etc. All reports required by this general permit, including SWPPPs, and other information requested by the board or the department shall be signed by a person described in Part Ill K 1 or by a duly authorized representative of that person. A person is a duly authorized representative only if: a. The authorization is made in writing by a person described in Part Ill K 1; b. The authorization specifies either an individual or a position having responsibility for the overall operation of the regulated facility or activity such as the position of plant manager, operator of a well or a well field, superintendent, position of equivalent responsibility, or an individual or position having overall responsibility for environmental matters for the operator. (A duly authorized General Permit No.: VAR10 Page 18 of 21 representative may thus be either a named individual or any individual occupying a named position); and c. The signed and dated written authorization is included in the SWPPP. A copy must be provided to the department and VSMP authority, if requested. 3. Changes to authorization. If an authorization under Part III K 2 is no longer accurate because a different individual or position has responsibility for the overall operation of the construction activity, a new authorization satisfying the requirements of Part III K 2 shall be submitted to the VSMP authority as the administering entity for the board prior to or together with any reports or information to be signed by an authorized representative. 4. Certification. Any person signing a document under Part III K 1 or 2 shall make the following certification: "I certify under penalty of law that I have read and understand this document and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." L. Duty to comply. The operator shall comply with all conditions of this general permit. Any state permit noncompliance constitutes a violation of the Virginia Stormwater Management Act and the Clean Water Act, except that noncompliance with certain provisions of this general permit may constitute a violation of the Virginia Stormwater Management Act but not the Clean Water Act. Permit noncompliance is grounds for enforcement action; for state permit termination, revocation and reissuance, or modification; or denial of a state permit renewal application. The operator shall comply with effluent standards or prohibitions established under§ 307(a) of the Clean Water Act for toxic pollutants within the time provided in the regulations that establish these standards or prohibitions or standards for sewage sludge use or disposal, even if this general permit has not yet been modified to incorporate the requirement. M. Duty to reapply. If the operator wishes to continue an activity regulated by this general permit after the expiration date of this general permit, the operator shall submit a new registration statement at least 90 days before the expiration date of the existing general permit, unless permission for a later date has been granted by the board. The board shall not grant permission for registration statements to be submitted later than the expiration date of the existing general permit. N. Effect of a state permit. This general permit does not convey any property rights in either real or personal property or any exclusive privileges, nor does it authorize any injury to private property or invasion of personal rights, or any infringement of federal, state or local law or regulations. O. State law. Nothing in this general permit shall be construed to preclude the institution of any legal action under, or relieve the operator from any responsibilities, liabilities, or penalties established pursuant to any other state law or regulation or under authority preserved by§ 510 of the Clean Water Act. Except as provided in general permit conditions on "bypassing" (Part III U) and "upset" (Part III V), nothing in this general permit shall be construed to relieve the operator from civil and criminal penalties for noncompliance. P. Oil and hazardous substance liability. Nothing in this general permit shall be construed to preclude the institution of any legal action or relieve the operator from any responsibilities, liabilities, or penalties to which the operator is or may be subject under§§ 62.1-44.34:14 through 62.1-44.34:23 of the State Water Control Law or§ 311 of the Clean Water Act. General Permit No.:VAR10 Page 19 of 21 Q. Proper operation and maintenance. The operator shall at all times properly operate and maintain all facilities and systems of treatment and control (and related appurtenances), which are installed or used by the operator to achieve compliance with the conditions of this general permit. Proper operation and maintenance also includes effective plant performance, adequate funding, adequate staffing, and adequate laboratory and process controls, including appropriate quality assurance procedures. This provision requires the operation of back-up or auxiliary facilities or similar systems, which are installed by the operator only when the operation is necessary to achieve compliance with the conditions of this general permit. R. Disposal of solids or sludges. Solids, sludges or other pollutants removed in the course of treatment or management of pollutants shall be disposed of in a manner so as to prevent any pollutant from such materials from entering surface waters and in compliance with all applicable state and federal laws and regulations. S. Duty to mitigate. The operator shall take all steps to minimize or prevent any discharge in violation of this general permit that has a reasonable likelihood of adversely affecting human health or the environment. T. Need to halt or reduce activity not a defense. It shall not be a defense for an operator in an enforcement action that it would have been necessary to halt or reduce the permitted activity in order to maintain compliance with the conditions of this general permit. U. Bypass. 1. "Bypass," as defined in 9VAC25-870-10, means the intentional diversion of waste streams from any portion of a treatment facility. The operator may allow any bypass to occur that does not cause effluent limitations to be exceeded, but only if it also is for essential maintenance to ensure efficient operation. These bypasses are not subject to the provisions of Part Ill U 2 and 3. loot 2. Notice. a. Anticipated bypass. If the operator knows in advance of the need for a bypass, the operator shall submit prior notice to the department, if possible at least 10 days before the date of the bypass. b. Unanticipated bypass. The operator shall submit notice of an unanticipated bypass as required in Part III I. 3. Prohibition of bypass. a. Except as provided in Part III U 1, bypass is prohibited, and the board or department may take enforcement action against an operator for bypass unless: (1) Bypass was unavoidable to prevent loss of life, personal injury, or severe property damage. Severe property damage means substantial physical damage to property, damage to the treatment facilities that causes them to become inoperable, or substantial and permanent loss of natural resources that can reasonably be expected to occur in the absence of a bypass. Severe property damage does not mean economic loss caused by delays in production; (2) There were no feasible alternatives to the bypass, such as the use of auxiliary treatment facilities, retention of untreated wastes, or maintenance during normal periods of equipment downtime. This condition is not satisfied if adequate back-up equipment should have been installed in the exercise of reasonable engineering judgment to prevent a bypass that occurred during normal periods of equipment downtime or preventive maintenance; and (3) The operator submitted notices as required under Part III U 2. General Permit No.: VAR10 Page 20 of 21 b. The department may approve an anticipated bypass, after considering its adverse effects, if the department determines that it will meet the three conditions listed in Part III U 3 a. V. Upset. 1. An "upset," as defined in 9VAC25-870-10, means an exceptional incident in which there is unintentional and temporary noncompliance with technology-based state permit effluent limitations because of factors beyond the reasonable control of the operator. An upset does not include noncompliance to the extent caused by operational error, improperly designed treatment facilities, inadequate treatment facilities, lack of preventive maintenance, or careless or improper operation. 2. An upset constitutes an affirmative defense to an action brought for noncompliance with technology- based state permit effluent limitations if the requirements of Part III V 4 are met. A determination made during administrative review of claims that noncompliance was caused by upset, and before an action for noncompliance, is not a final administrative action subject to judicial review. 3. An upset does not include noncompliance to the extent caused by operational error, improperly designed treatment facilities, inadequate treatment facilities, lack of preventative maintenance, or careless or improper operation. 4. An operator who wishes to establish the affirmative defense of upset shall demonstrate, through properly signed, contemporaneous operating logs or other relevant evidence that: a. An upset occurred and that the operator can identify the cause(s)of the upset; b. The permitted facility was at the time being properly operated; c. The operator submitted notice of the upset as required in Part III I; and d. The operator complied with any remedial measures required under Part III S. 5. In any enforcement proceeding, the operator seeking to establish the occurrence of an upset has the burden of proof. W. Inspection and entry. The operator shall allow the department as the board's designee, the VSMP authority, EPA, or an authorized representative of either entity (including an authorized contractor), upon presentation of credentials and other documents as may be required by law to: 1. Enter upon the operator's premises where a regulated facility or activity is located or conducted, or where records must be kept under the conditions of this general permit; 2. Have access to and copy, at reasonable times, any records that must be kept under the conditions of this general permit; 3. Inspect and photograph at reasonable times any facilities, equipment (including monitoring and control equipment), practices, or operations regulated or required under this general permit; and 4. Sample or monitor at reasonable times, for the purposes of ensuring state permit compliance or as otherwise authorized by the Clean Water Act or the Virginia Stormwater Management Act, any substances or parameters at any location. For purposes of this section, the time for inspection shall be deemed reasonable during regular business hours, and whenever the facility is discharging. Nothing contained herein shall make an inspection unreasonable during an emergency. ice,. General Permit No.: VAR10 Page 21 of 21 X. State permit actions. State permits may be modified, revoked and reissued, or terminated for cause. 4410 The filing of a request by the operator for a state permit modification, revocation and reissuance, or termination, or a notification of planned changes or anticipated noncompliance does not stay any state permit condition. Y. Transfer of state permits. 1. State permits are not transferable to any person except after notice to the department. Except as provided in Part Ill Y 2, a state permit may be transferred by the operator to a new operator only if the state permit has been modified or revoked and reissued, or a minor modification made, to identify the new operator and incorporate such other requirements as may be necessary under the Virginia Stormwater Management Act and the Clean Water Act. 2. As an alternative to transfers under Part Ill Y 1, this state permit may be automatically transferred to a new operator if: a. The current operator notifies the department at least 30 days in advance of the proposed transfer of the title to the facility or property; b. The notice includes a written agreement between the existing and new operators containing a specific date for transfer of state permit responsibility, coverage, and liability between them; and c. The department does not notify the existing operator and the proposed new operator of its intent to modify or revoke and reissue the state permit. If this notice is not received, the transfer is effective on the date specified in the agreement mentioned in Part III Y 2 b. 3. For ongoing construction activity involving a change of operator, the new operator shall accept and maintain the existing SWPPP, or prepare and implement a new SWPPP prior to taking over operations at the site. Z. Severability. The provisions of this general permit are severable, and if any provision of this general permit or the application of any provision of this state permit to any circumstance, is held invalid, the application of such provision to other circumstances and the remainder of this general permit shall not be affected thereby. STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad 17 . NOTICE OF TERMINATION FOR GENERAL VSMP VALLEY I ENGINEERING 4411101 IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg,Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital%tg•• In accordance with Part I F of the General VPDES Permit for Discharges of Stormwater from Construction Activities: The operator of the construction activity shall submit a notice of termination in accordance with 9VAC25-880-60 to the VSMP authority after one or more of the following conditions have been met: a. Necessary permanent control measures included in the SWPPP for the site are in place and functioning effectively and final stabilization has been achieved on all portions of the site for which the operator is responsible. When applicable, long term responsibility and maintenance requirements shall be recorded in the local land records prior to the submission of a notice of termination; b. Another operator has assumed control over all areas of the site that have not been finally stabilized and obtained coverage for the ongoing discharge; c. Coverage under an alternative VPDES or state permit has been obtained; or d. For residential construction only, temporary soil stabilization has been completed and the residence has been transferred to the homeowner. Noiar The notice of termination should be submitted no later than 30 days after one of the above conditions in subdivision 1 of this subsection are met. Authorization to discharge terminates at midnight on the date that the notice of termination is submitted for the conditions set forth in subdivisions 1 b through 1 d of this subsection. Termination of authorizations to discharge for the conditions set forth in subdivision 1 of this subsection shall be effective upon notification from the department that the provisions of subdivision 1 a of this subsection have been met or 60 days after submittal of the notice of termination, whichever occurs first. The notice of termination shall be signed in accordance with Part III K of the general permit. VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad 1111110 *11/ VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com General Permit for Discharges of Stormwater from Construction Activities (VAR10) Notice of Termination (Please Type or Print All Information) 1. Construction Activity Operator: Name: Sksol Mailing Address: City: State: Zip: Phone: Email address(if available): 2. Location of Construction Activity(As listed on registration statement): Name: Address: City: State: Zip: County: If street address unavailable: Latitude Longitude 3. Stormwater General Permit Number: 4. The Reason for Terminating Coverage Under the General Permit (The construction activity operator may only submit a Notice of Termination after one or more of the conditions below have been met): A. Necessary post-construction control measures included in the SWPPP for the site are in place and functioning effectively and final stabilization has been achieved on all portions of the site for which the operator is responsible; 0 B. Another operator has assumed control over all areas of the site that have not been finally stabilized and obtained coverage for the ongoing discharge; 0 C. Coverage under an alternative VPDES or State permit has been obtained;or D. For residential construction only,temporary stabilization has been completed and the residence has been transferred to the homeowner. The Notice of Termination must be submitted within 30 days of one of the above conditions being met.Authorization to discharge terminates at midnight on the date that the Notice of Termination is submitted for conditions B through D above. Authorization to discharge terminates upon notification from the Department or 60 days after the submittal of the Now' Notice of Termination(whichever occurs first)for condition A above. 5. Permanent Control Measures Installed: Attach a list of permanent control measures (both structural and non-structural) that were installed at the construction site. For each control measure, include the following information: (a) Type of control measure installed and the date that it became functional as a permanent control measure; (b) Geographic location (county or city and Hydrologic Unit Code) (latitude and longitude may additionally be included if available); (c) Waterbody the control measure discharges into;and, (d)Number of acres that will be treated (to the nearest one-tenth of an acre). If no permanent control measures were installed please check this box ❑. 6. Participation in a Regional Stormwater Management Plan: Where applicable, attach the following information related to participation in a regional stormwater management plan: (a)Type of regional facility to which the site discharges; (b) Geographic location of any regional facility to which the site discharges (county or city and Hydrologic Unit Code); (c) Geographic location of the site(county or city and Hydrologic Unit Code)(latitude and longitude may additionally be included if available);and(d)Number of acres treated by a regional facility. 7. Nutrient Offsets: Where applicable, attach the following information related to nutrient offsets that were acquired in accordance with §62.1-44.15:35 of the Code of Virginia: (a) Name of the broker from which offsets were acquired; (b) Geographic location (county or city and Hydrologic Unit Code)of the broker's offset generating facility; (c) Number of nutrient offsets acquired (lbs. per acre per year);and (d)Nutrient reductions achieved on site(lbs. per acre per year). 8. Certification: "I certify under penalty of law that I have read and understand this notice of termination and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system or those persons directly responsible for gathering the information, the information submitted is to the best of my knowledge and belief true, accurate, and complete. I am aware that there are significant penalties for submitting false information including the possibility of fine and imprisonment for knowing violations." Print Name: Title: Signature: Date: (Please sign in INK.The person signing this form must be associated with the operator identified in Item#1 above.) Mail to: Department of Environmental Quality,Office of Stormwater Management, 10`h Floor, P.O. Box 1105, Richmond,VA 23218 (DEQ 199-147) (08/13) i INSTRUCTIONS for FORM DEQ 199-147 General Permit Notice of Termination - Construction Activity Stormwater Discharges General (c) Waterbody the control measure discharges into;and, A Notice of Termination must be submitted when an (d) Number of acres that will be treated (to the nearest operator no longer wishes to be covered under the General one-tenth of an acre). Permit for Stormwater Discharges from Construction If no permanent control measures were installed, please Activities. check the box at the end of this section. Mail to: Department of Environmental Quality Office of Stormwater Management, 10th Floor Section 6 Participation in a Regional Stormwater P.O. Box 1105 Management Plan Richmond,VA 23218 Where applicable, attach the following information related to participation in a regional stormwater management plan: (a) 1 Activity Operator Information Type of regional facility to which the site discharges; (b) Section Give the legal name of the person,firm, public organization, Geographic location of any regional facility to which the site discharges (county or city and Hydrologic Unit Code); (c) or any other entity that was issued the general permit for Geographic location of the site (county or city and the site described in this Notice of Termination. Do not use Hydrologic Unit Code) (latitude and longitude may a colloquial name. Enter the complete address and phone additionally be included if available); and, (d) Number of number of the operator. acres treated by a regional facility. Section 2 Activity Location Information Section 7 Nutrient Offsets Enter the activity's official name and complete street Where applicable, attach the following information related to address, including city (or town), county (if not located nutrient offsets that were acquired in accordance with within a City), state and ZIP code. If the site lacks a street §62.1-44.15:35 of the Code of Virginia: (a) Name of the address, enter the city (or town), county (if not located broker from which offsets were acquired; (b) Geographic within a City) and the latitude and longitude in degrees, minutes,seconds(DMS). location (countyor city and Hydrologic Unit Code) of the broker's offset generating facility; (c) Number of nutrient Section 3 Permit Information offsets acquired (lbs. per acre per year); and (d) Nutrient Enter the existing Stormwater General Permit Number reductions achieved on site(lbs. per acre per year). assigned to the activity or site identified in Section 1 that the operator wishes to be terminated. Section 8 Certification State statutes provide for severe penalties for submitting 101609 Section 4 Reason for Termination false information on this Notice of Termination. State Check the appropriate statement indicating the reason for regulations require this Notice of Termination to be signed submitting this Notice of Termination. The Notice of as follows: Termination may only be submitted after one or more of the For a corporation: by a responsible corporate following conditions have been met: officer. For the purpose of this section, a responsible A. Necessary post-construction control measures corporate officer means: (1) A president, secretary, included in the SWPPP for the site are in place and treasurer, or vice-president of the corporation in charge of a functioning and final stabilization has been achieved principal business function, or any other person who on all portions of the site for which the operator is performs similar policy-or decision-making functions for the responsible; corporation, or (2) the manager of one or more B. Another operator has assumed control over all areas manufacturing, production, or operating facilities provided of the site that have not been finally stabilized; the manager is authorized to make management decisions C. Coverage under an alternative VPDES or State which govern the operation of the regulated facility including permit has been obtained;or having the explicit or implicit duty of making major capital D. For residential construction only, temporary investment recommendations, and initiating and directing stabilization has been completed and the residence other comprehensive measures to assure long term has been transferred to the homeowner. environmental compliance with environmental laws and The Notice of Termination must be submitted within 30 regulations; the manager can ensure that the necessary days of one of the above conditions being met. systems are established or actions taken to gather complete and accurate information for permit application Section 5 Permanent Control Measures Installed requirements; and where authority to sign documents has Attach a list of the permanent control measures (both been assigned or delegated to the manager in accordance structural and non-structural) that were installed at the with corporate procedures. construction site. For each control measure, include the For a partnership or sole proprietorship: by a following information: general partner or the proprietor. (a) Type of control measure installed; For a municipality, state, federal, or other public (b) Geographic location (county or city and Hydrologic agency: by either a principal executive officer or a ranking Unit Code); elected official. The Department of Environmental Quality reserves the right to request additional information not directly addressed by the registration statement if,in its discretion,a facility or operation poses a potential impact on water quality. (DEQ 199-147) (08/13) J J J STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad 18 . PERMIT TRANSFER AGREEMENT FORM VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg,Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com General Permit for Discharges of Stormwater from Construction Activities (VAR10) Transfer Agreement (Please Type or Print All Information) Instructions: The General Permit for Discharges of Stormwater from Construction Activities (VAR10) may be automatically transferred to a new operator if the current operator notifies the permit-issuing authority at least 30 days in advance of the proposed transfer of the title to the facility or property, the notice includes a written agreement between the existing and new operator containing a specific date for transfer of permit responsibility, coverage, and liability between them. Please mail the original copy of this agreement to: Department of Environmental Quality Office of Stormwater Management, 10th Floor P.O. Box 1105 Richmond, VA 23218 Stormwater General Permit Number: Date of Transfer: Construction Activity Name: CURRENT OPERATOR (Permit coverage was authorized for this operator): Construction Activity Operator: Mailing Address: 'It✓ City: State: Zip: Phone: "I hereby agree to the transfer of the above referenced Construction Stormwater General Permit coverage." Print Name: Title: Signature: Date: NEW OPERATOR(Permit coverage will be transferred to this operator): Construction Activity Operator: Mailing Address: City: State: Zip: Phone: "I hereby agree to the transfer of the above referenced Construction Stormwater General Permit coverage, and agree to accept all permit responsibility, coverage, and liability of the permit." Print Name: Title: low Signature: Date: (Please sign in INK and submit the original to DEQ at the above referenced address and retain copies for your files.) (DEQ 199-191)(08/13) STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad 19 . DRAINAGE REPORT VALLEY ENGINEERING Sirrl IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad 20 . SUBCONTRACTOR CERTIFICATION VALLEY I ENGINEERING Skase IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg,Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com Subcontractor Certification/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 Skis conditions of the SWPPP for the above designated project and agree to follow the BMPs and 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: z Title: Date: { STORMWATER POLLUTION PREVENTION PLAN Sentara Martha Jefferson Hospital Helipad RECEIVED JAN 252016 COMMUNITY DEVELOPMENT VALLEY ENGINEERING IDEAS MADE REAL 3231 Peoples Drive Harrisonburg, Virginia 22801 Phone (540) 434-6365 Fax (540) 432-0685 www.valleyesp.com