"Stormwater Pollution Prevention Plan (Swppp) Application" - Town of LaGrange, New York

Stormwater Pollution Prevention Plan (Swppp) Application is a legal document that was released by the Department of Public Works - City of LaGrange, New York - a government authority operating within New York. The form may be used strictly within Town of LaGrange.

Form Details:

  • The latest edition currently provided by the Department of Public Works - City of LaGrange, New York;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Department of Public Works - City of Lagrange, New York.

ADVERTISEMENT
ADVERTISEMENT

Download "Stormwater Pollution Prevention Plan (Swppp) Application" - Town of LaGrange, New York

Download PDF

Fill PDF online

Rate (4.3 / 5) 13 votes
Page background image
TOWN OF LAGRANGE
PUBLIC WORKS DEPARTMENT
120 STRINGHAM ROAD
LAGRANGEVILLE, N.Y. 12540
845-452-8562
STORMWATER POLLUTION PREVENTION PLAN (SWPPP)
APPLICATION
No landowner or land user may commence a land disturbance or land development activity subject to §197
of the Code of the Town of LaGrange, “Stormwater Management and Erosion & Sediment Control” without
receiving prior approval of a Stormwater Pollution Prevention Plan (SWPPP) and/or an Erosion and
Sediment Control Plan for the site from the local approval authority.
ALL NECESSARY INFORMATION MUST BE PROVIDED ON THIS APPLICATION FORM
Name of Project: _______________________________________________________
Owner/Operator Information:
Name: ___________________________
Contact Person: _____________________
Mailing Address: ________________________________________________________
City, State, Zip Code: ____________________________________________________
Telephone Number, Fax, E-Mail: ___________________________________________
Site Information:
Grid No. of Property: _____________________________________________________
Location of Property (If different from above): __________________________________
Project Start Date: ____________________ Project End Date: ____________________
Total Area of Site: _________ (acres) Total Estimated Disturbed Area: ________ (acres)
Site Impervious Area: Pre- Development ___________ %
Site Impervious Area: Post-Development ___________ %
Type of Construction: (i.e. residential, commercial, etc.) __________________________
Will the construction site’s stormwater discharge to: (check all that apply)
_______ Storm drainage system – infiltrates to groundwater
_______ Storm drainage system – discharge to surface water
_______ Directly or indirectly to waterbody ______________________________(Name)
_______ Infiltration to groundwater on-site
1
TOWN OF LAGRANGE
PUBLIC WORKS DEPARTMENT
120 STRINGHAM ROAD
LAGRANGEVILLE, N.Y. 12540
845-452-8562
STORMWATER POLLUTION PREVENTION PLAN (SWPPP)
APPLICATION
No landowner or land user may commence a land disturbance or land development activity subject to §197
of the Code of the Town of LaGrange, “Stormwater Management and Erosion & Sediment Control” without
receiving prior approval of a Stormwater Pollution Prevention Plan (SWPPP) and/or an Erosion and
Sediment Control Plan for the site from the local approval authority.
ALL NECESSARY INFORMATION MUST BE PROVIDED ON THIS APPLICATION FORM
Name of Project: _______________________________________________________
Owner/Operator Information:
Name: ___________________________
Contact Person: _____________________
Mailing Address: ________________________________________________________
City, State, Zip Code: ____________________________________________________
Telephone Number, Fax, E-Mail: ___________________________________________
Site Information:
Grid No. of Property: _____________________________________________________
Location of Property (If different from above): __________________________________
Project Start Date: ____________________ Project End Date: ____________________
Total Area of Site: _________ (acres) Total Estimated Disturbed Area: ________ (acres)
Site Impervious Area: Pre- Development ___________ %
Site Impervious Area: Post-Development ___________ %
Type of Construction: (i.e. residential, commercial, etc.) __________________________
Will the construction site’s stormwater discharge to: (check all that apply)
_______ Storm drainage system – infiltrates to groundwater
_______ Storm drainage system – discharge to surface water
_______ Directly or indirectly to waterbody ______________________________(Name)
_______ Infiltration to groundwater on-site
1
SWPPP Submission Requirements:
(Check if provided in submission)
____
Background information about the scope of the project, including location, type and size of project.
____
A site map/construction drawing(s) for the project, including a general location map. At a minimum,
the site map should show the total site area; all improvements; areas of disturbance; areas that will
not be disturbed; existing vegetation; on-site and adjacent off-site surface water(s); wetlands and
drainage patterns that could be affected by the construction activity; existing and final slopes;
locations of off-site material, waste, borrow or equipment storage areas; and location(s) of the
stormwater discharges(s).
_____ A description of the soil(s) present at the site.
_____ A construction phasing plan describing the intended sequence of construction activities, including
tree removal, stumping, clearing and grubbing, excavation and grading, utility and infrastructure
installation and any other activity at the site that results in soil disturbance. Consistent with the New
York State Department of Environmental Conservation (NYSDEC) SPDES General Permit GP-02-
01, no more than five acres of land shall be disturbed at any one time without written approval from
the NYSDEC.
_____ A description of the pollution prevention measures that will be used to control litter, construction
chemicals and construction debris from becoming a pollutant source in stormwater runoff.
_____ A description of construction and waste materials expected to be stored on site with updates as
appropriate, and a description of controls to reduce pollutants from these materials including
storage practices to minimize exposure of the materials to stormwater, and spill-prevention and
response.
_____ Temporary and permanent structural and vegetative measures to be used for soil stabilization,
runoff control and erosion and sediment control for each stage of the project, from initial land
clearing and grubbing to project closeout.
_____ A site map/construction drawing(s) specifying the location(s), size(s) and length(s) of each erosion
and sediment control practice.
_____ Dimensions, material specifications and installation details for all temporary and permanent erosion
and sediment control practices, including the site, sizing and supporting calculations of any
temporary sediment basins;
_____ Temporary practices that will be converted to permanent control measures.
_____ An implementation schedule for staging temporary erosion and sediment control practices, including
the timing of initial placement and duration that each practice should remain in place.
_____ An inspection and maintenance schedule to ensure continuous and effective operation of the
erosion and sediment control measures.
_____ The name(s) of the receiving water(s);
_____ The delineation of SWPPP implementation responsibilities for each portion of the site.
_____ A description of structural practices designed to divert flows from exposed soils, store flows, or
otherwise limit runoff and the discharge of pollutants from exposed areas of the site to the degree
attainable.
_____ Any existing data that describes the stormwater runoff at the site.
2
Water quality and quantity controls for land development activities:
Land development activities as defined in §197-4 and meeting at least one of the three conditions below,
(i.e., Condition A, B or C) shall also include water quantity and water quality controls (post-construction
stormwater runoff controls) as set forth below as applicable:
Conditions
1. Condition A: stormwater runoff from land development activities discharging a pollutant of concern to
either an impaired water identified on the Department's 303(d) list of impaired water bodies or a total
maximum daily load (TMDL) designated watershed for which pollutants in stormwater have been
identified as a source of the impairment; or
2. Condition B: stormwater runoff from land development activity disturbing between one and five acres
of land during the course of the project, exclusive of the construction of single-family residences and
construction activities at agricultural properties; or
3. Condition C: stormwater runoff from land development activities disturbing five or more acres.
SWPPP requirements for land development activities that meet Condition A, B or C, above:
(Check if provided in submission)
_____ All information as noted on Page 2 under SWPPP Submission Requirements.
_____ A description of each post-construction stormwater management practice.
_____ A Site map/construction drawing(s) showing the specific location(s) and size(s) of each post-
construction stormwater management practice.
_____ A hydrologic and hydraulic analysis for all structural components of the stormwater management
system for the applicable design storms.
_____ A comparison of the post-development stormwater runoff conditions with pre-development
conditions. The comparison shall include peak flows for the one (1), ten (10), and one-hundred
(100) year storm events.
_____ The dimensions, material specifications and installation details for each post-construction
stormwater management practice.
_____ An inspection and maintenance schedule to ensure continuous and effective operation of each
post-construction stormwater management practice.
_____ Drainage easements to ensure access to all stormwater management practices at the site for the
purpose of inspection, maintenance and repair.
_____ The SWPPP has been prepared by a licensed professional engineer, registered landscape
architect, or certified professional, and is signed by the professional preparing the plan, and is
certified that the design of all stormwater management practices meet the minimum requirements
of §197 of the Code of the Town of LaGrange and NYSDEC SPDES General Permit GP-02-01.
3
Has the SWPPP been prepared in accordance with NYSDEC SPDES General Construction
Permit GP-02-01? ______ Yes ______ No
Does the SWPPP meet the technical standards of the “New York State Stormwater Design
Manual” and the “New York State Standards and Specifications for Erosion and Sediment
Control”? ______ Yes ______ No
Certification:
“I certify that this document and all attachments and enclosures submitted herewith were prepared at my
direction or under my supervision, and I have exercised best efforts to assure that qualified personnel
properly gather and evaluate the information submitted. The information submitted is, to the best of my
knowledge and belief, true, accurate, and complete. In addition, I certify that the provisions of the approval,
including the development and implementation of the SWPPP and Erosion and Sediment Control Plan will
be complied with. I acknowledge that I have received and reviewed a copy of §197 of the Code of the Town
of LaGrange, “Stormwater Management and Erosion & Sediment Control”. I hereby give permission to the
Town local approval authority and all designated representatives to enter the property as specified in §197-
18.C. I am aware of the enforcement provisions in §197-20, and where notice of non-compliance has been
given and not corrected within a time frame as determined by the Stormwater Management Officer (SMO), I
authorize the Town to take corrective action as described in §197-20.
Owner/Operator Printed Name
Title
Owner/Operator Signature
Date
Telephone, Fax, E-mail
Complete this portion if this SWPPP application was prepared by a consultant or someone other
than an employee of the site Owner/Operator.
Preparer Printed Name
Firm
Mailing Address
Title
City, State, Zip Code
Telephone Number, Fax, E-mail
Signature of Preparer
Date
(If Applicant is not the landowner, attach a notarized statement authorizing Applicant to act as agent)
4
PUBLIC WORKS DEPARTMENT USE ONLY
SWPPP Application received by (initials) __________ on (date) _________________________
SWPPP Application Fee in the amount of $ __________ paid on (date) ___________________
SWPPP Approved by Stormwater Management Officer (SMO)
Signature __________________________________________ Date ____________________
5
Page of 5