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2. Application

   Please fill out the following fields and answer the questions to the best of your ability. If you have any question, concerns or need assistant please contact Powhatan County's Environmental Coordinator at (804) 598-5623. Thanks!

4. Project Information:
6. Tax Map Number / Parcel Id*
7. Site Address (If Assigned)

   Example: 3834 Old Buckingham Road, Powhatan, VA 23139

9. Permit Number (If Assigned)

   Example: 240-2024

10. Description of Existing Property*

    Example: Vacant unimproved land off of Old Buckingham Road. Gradual slope from proposed home site leading to an Intermittent stream and lake on the back of the property.

12. Area of Disturbance (Sq Ft)*

    Include the building site, driveways, septic systems, and any other areas cleared, regraded or disturbed.

13. Description of Work*

    Example: 2000 Sq Ft single family dwelling with well and septic field; 500 Sq Ft detached garage with 100 ft driveway.

15. Project Timeline*
    Project Timeline Start Date

    —

    Project Timeline End Date

    Start Date:

    Completion Date: (Estimate)

17. Contact Information:
19. Property Owner
21. First Name*
22. Last Name*
23. Email Address*
24. Phone Number*

    Example: 804-598-5623

26. Mailing Address*

    Example: 3834 Old Buckingham Road, Powhatan, VA 23139

28. Responible Land Disturber

    All permits not issued directly to the property owner must have a designated Responsible Land Disturber (RLD) with a current and valid certification through the Virginia Department of Environmental Quality (DEQ)

    DEQ Certification Lookup

    
    

29. Certification Number

    Example: RLD29417

30. Expiration Date
    Expiration Date
32. First Name
33. Last Name
34. Email Address
35. Phone Number

    Example: 804-598-5623

37. Mailing Address

    Example: 3834 Old Buckingham Road, Powhatan, VA 23139

39. Eligibility Questionnaire
41. Question 1: Is the Area of Disturbance Equal to or Greater than an Acre*
    -- Select One --YESNO

    If an acre or more of land is planned to be disturbed, the project is ineligible to submit an Agreement in Lieu of an ESC Plan. Instead, an Erosion and Sediment Control Plan must be submitted to Powhatan County and a Construction General Permit (CGP) must be obtained from DEQ. Documented approval from DEQ must be submitted prior to approval of an ESC Plan by Powhatan County. Failure to obtain this permit could result in strict enforcement actions taken by DEQ to gain compliance. 

    For more information, visit DEQ's Website or contact DEQ at (804) 698-4000. 

43. Question 2: Are Any Creeks, Streams, Rivers, Lakes or Wetlands Located on or Adjacent to the Property?*
    -- Select One --YESNO

    If yes, submittal of a Joint Permit Application (JPA) to the U.S. Army Corps of Engineers (USACE) may be required. The JPA is used to apply for corresponding permits from the Virginia Marine Resources Commission (VMRC), DEQ, and/or Local Wetland Boards. If protected bodies of water and/or wetlands will be disturbed, the applicant is required to submit verification of permit approval from the USACE, VMRC and DEQ, or verification stating that no permit is required. All bodies of water and/or wetlands must be flagged prior to construction and confirmed by a certified professional wetland delineator and/or the USACE.

    For more information, visit the USACE's Website.

45. Question 3: Are Any Secondary Culverts Being Installed on the Property*
    -- Select One --YESNO

    If yes, culvert inlet and outlet protection shall be provided around all inlets and outlets. A letter from a certified professional engineer, surveyor or landscape architect will be required prior to approval. This letter must state the specifications of the secondary culverts and certify that they are properly sized for the drainage area and at least a 10-year flood event.

47. Question 4: Will Cut/Fill Material be Brought to or Removed from the Property?*
    -- Select One --YESNO

    If yes, identify where fill material is coming from and/or where cut soil will be disposed of offsite. The applicant may be required to provide the estimated quantity of fill material required for the project and/or the amount leaving the site.

49. Question 5: Are Any Steep Slopes Located on the Property?*
    -- Select One --YESNO

    If yes, a site visit with the applicant and/or RLD may be required prior to approval. 

51. Eligibility

    If you answered YES to any of the questions listed above, you may not be eligible for an Agreement in Lieu of an ESC Plan and may need to prepare an Erosion and Sediment Control Plan. Contact Powhatan County’s Environmental Coordinator at (804) 598-5623 to verify whether the project is eligible to be implemented in accordance with an Agreement in Lieu of an ESC Plan rather than a full Erosion and Sediment Control Plan. 

    If you answered NO to each of the questions listed above, the project is eligible to utilize an Agreement in Lieu of an ESC Plan. Complete the remaining items on this application.

53. Minimum Standards

    Review the following minimum standards. These are the standards that each and every project is held to and must comply with during the construction process.

    MS-1: Stabilization

    Permanent or temporary soil stabilization will be applied to denuded (bare soil) areas within 7 days after final grade is reached on any portion of the site. Temporary soil stabilization will be applied within 7 days to denuded areas that may not be at final grade but will remain dormant for longer than 14 days. Permanent stabilization will be applied to areas that are to be left dormant for more than 1 year.

    MS-2: Stockpiles, Waste, and Borrow Areas

    During construction of the project, soil stockpiles and borrow areas will be stabilized or protected with sediment trapping measures. The applicant is responsible for the temporary protection and permanent stabilization of all soil stockpiles onsite as well as borrow areas and soil intentionally transported from the project site.

    MS-3: Permanent Vegetation

    A permanent vegetative cover will be established on denuded areas that are not otherwise permanently stabilized. Permanent vegetation will not be considered established until a ground cover is achieved that is uniform, mature enough to survive, and will inhibit erosion.

    MS-4: First-Step Measures

    Sediment basins and traps, perimeter dikes, sediment barriers, and other measures intended to trap sediment will be constructed as a first step in any Land-Disturbing Activity (LDA) and will be made functional before upslope land disturbance takes place.

    MS-5: Earthen Structure Stabilization

    Stabilization measures will be applied to earthen structures, such as dams, dikes, channels, and diversions, immediately after installation.

    MS-6: Traps and Basins

    Sediment traps and sediment basins will be designed and constructed based on the total drainage area to be served by the trap or basin. Sediment traps should be not used for more than 18 months unless they are designed as a permanent impoundment.

    MS-7: Cut and Fill Slopes

    Cut and fill slopes will be designed and constructed in a manner that will minimize erosion. Slopes that are found to be eroding excessively within 1 year of permanent stabilization will be provided with additional slope stabilizing measures until the problem is corrected.

    MS-8: Concentrated Runoff

    Concentrated runoff will not flow down cut or fill slopes unless contained within an adequate temporary or permanent channel, flume, or slope drain structure.

    MS-9: Water Seeps

    When water seeps from a slope face, adequate drainage or other protection will be provided.

    MS-10: Inlet Protection

    All storm sewer inlets that are made operable during construction will be protected so that sediment-laden water cannot enter the conveyance system without first being filtered or otherwise treated to remove sediment.

    MS-11: Outlet Protection

    Before newly constructed stormwater conveyance channels or pipes are made operational, adequate outlet protection and any required temporary or permanent channel lining will be installed in both the conveyance channel and receiving channel.

    MS-12: Watercourse Construction

    When work in a live watercourse is performed, precautions will be taken to minimize encroachment, control sediment transport, and stabilize the work area to the greatest extent possible during construction. Non-erodible material will be used for the construction of causeways and cofferdams. Earthen fill may be used for these structures if they are armored by non-erodible cover materials.

    MS-13: Temporary Vehicular Stream Crossing

    When a live watercourse must be crossed by construction vehicles more than twice in any 6-month period, a temporary vehicular stream crossing constructed of non-erodible material will be provided.

    MS-14: Other Watercourse Regulations

    All applicable federal, state, and local requirements pertaining to working in or crossing live watercourses will be met.

    MS-15: Bed and Bank Stabilization

    The bed and banks of a watercourse will be stabilized immediately after work in the watercourse is completed.

    MS-16: Utility Construction

    Underground utility lines will be installed in accordance with the following standards in addition to other applicable criteria:

    1. No more than 500 linear feet of trench may be opened at one time.
    2. Excavated material will be placed on the uphill sides of trenches.
    3. Effluent from dewatering operations will be filtered or passed through an approved sediment trapping device (or both) before being discharged in a manner that does not adversely affect flowing streams or offsite property.
    4. Material used for backfilling trenches will be properly compacted in order to minimize erosion and promote stabilization.
    5. Re-stabilization will be accomplished in accordance with Part V of the Regulation, 9VAC25-875-470 et seq.
    6. Applicable safety requirements will be met.

    MS-17: Vehicular Tracking and Construction Entrances

    Where construction vehicle access routes intersect paved or public roads, provisions will be made to minimize the transport of sediment by vehicular tracking onto the paved surface. Where sediment is transported onto a paved or public road surface, the road surface will be cleaned thoroughly at the end of each day. Sediment will be removed from the roads by shoveling or sweeping and transported to a sediment control disposal area. Street washing will be allowed only after sediment is removed in this manner. This provision will apply to individual development lots as well as to larger LDAs.

    MS-18: Temporary Control Removal

    All temporary erosion and sediment control measures will be removed within 30 days after final site stabilization or after the temporary measures are no longer needed, unless otherwise authorized by the VESMP or VESCP authority. Trapped sediment and the disturbed soil areas resulting from the disposition of temporary measures will be permanently stabilized to prevent further erosion and sedimentation.

    MS-19: Adequate Stormwater Conveyance to Adequate Stormwater Outfall

    Properties and waterways downstream from development sites will be protected from sediment deposition, erosion, and damage due to increases in volume, velocity, and peak flowrate of stormwater runoff for the stated frequency storm of 24-hour duration.

55. Erosion and Sediment Control Practices*

    Check off all control practices that will be used.

    1. Safety Fence (SAF)
    2. Construction Entrance (CE)
    3. Construction Road Stabilization (CRS)
    4. Straw Bale Barrier (STB)
    5. Silt Fence (SF)
    6. Brush Barrier (BB)
    7. Storm Drain Inlet Protection (IP)
    8. Culvert Inlet Protection (CIP)
    9. Diversion Dike (DD)
    10. Fill Diversion (FD)
    11. Right-of-Way Diversion (RWD)
    12. Diversion (DV)
    13. Sediment Trap (ST)

    1. Sediment Basin (SB)
    2. Temporary Slope Drain (TSD)
    3. Paved Flume (PF)
    4. Stormwater Conveyance Channel (SCC)
    5. Outlet Protection (OP)
    6. Riprap (RR)
    7. Check Dams (CD)
    8. Level Spreader (LS)
    9. Vegetative Streambank Stabilization (VSS)
    10. Structural Streambank Stabilization (SSS)
    11. Stream Crossing (SC)
    12. Utility Stream Crossing (USC)
    13. Dewatering Structure (DS)

    1. Turbidity Curtain (TC)
    2. Subsurface Drain (SD)
    3. Surface Roughening (SR)
    4. Topsoiling (TO)
    5. Temporary Seeding (TS)
    6. Permanent Seeding (PS)
    7. Sodding (SO)
    8. Mulching (MU)
    9. Soil Stabilization Blankets (B)
    10. Soil Stabilization Matting (M)
    11. Planted Landscaping / Vegetation (VEG)
    12. Tree Preservation / Protection (TP)
    13. Dust Control (DC)
57. Other

    Example: Super Silt Fence (SSF), Silt Fence Outlet (SFO)

59. Sketched Plans*

    *For Multiple Files Hold Control (ctrl) and Select Each File

    On an official survey or recorded plat of the property please provide a sketch of the following:

    • Limits of Disturbance (Any areas cleared, regraded or impacted by the project)
    • Property Entrances, Driveways and Location of Plans Box
    • New Wells and Septic Systems/Fields (If Applicable)
    • Steep or Critical Slopes (If Applicable)
    • Bodies of Water and/or Wetlands Delineated (If Applicable)
    • Culverts and/or Internal Crossings through Bodies of Water or Wetlands (If Applicable)
    • Erosion and Sediment Control Practices
61. Property Photos

    *For Multiple Files Hold Control (ctrl) and Select Each File

    Provide photos of the installed stone construction entrance, entrenched perimeter controls, and plans box.

63. Authorization and Acknowledgements

    In lieu of submission of an Erosion and Sediment Control Plan for the construction of this single family dwelling, I agree to comply with all applicable requirements of the Powhatan County Erosion and Sediment Control Ordinances and minimum standards for erosion and sediment control established by the Commonwealth of Virginia. 

    Prior to the start of construction:

    • Natural vegetative buffers along streams and wetlands shall be flagged.
    • A stone construction entrance shall be installed on the property.
    • Address numbers posted at roadside.
    • Plans available on property within a designated inspections box.
    • Entrenched silt fence or other acceptable perimeter controls shall be established downslope of the disturbed area to prevent sediment from leaving the property or limits of disturbance (LOD).

    In addition, all denuded areas on the property that will be left dormant longer than 14 days must be temporarily stabilized within 7 days. Any and all earthen structures must be immediately stabilized. Once final grade is achieved permanent stabilization must be provided within 7 days. Permanent vegetation or protective ground cover applied must be suitable for the time of year.

    I hereby authorize representatives from Powhatan County Community Development to enter my property for the purpose of conducting erosion and sediment control inspections. I understand that the erosion and sediment control inspection is the first inspection required and that this inspection must be scheduled prior to the scheduling of any building inspections for the project. 

    In addition, I waive my right to future building inspections in the event that inspection of the property reveals that it is not in compliance with minimum standards established by the Commonwealth of Virginia for erosion and sediment control. I understand that any erosion and sediment control deficiencies identified by Powhatan County must be fully addressed before building inspections of the property may resume. Further, I understand, covenant, and agree that if the property has not been stabilized, Powhatan County may require that a bond be posted until final construction stabilization can be achieved and that a final occupancy permit shall not be issued. Additional state and federal permits may also be required. If an Erosion and Sediment Control Plan is required, it must be posted on the site at all times with the building permit. If it is not posted at the time of the first inspection, the inspection will fail. Failure to provide appropriate site conditions will result in a Stop Work Order being placed on the project.

65. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
67. Electronic Signature*
Leave This Blank:


69. 1. Receive an email copy of this form.
70. Email address

    This field is not part of the form submission.

71. Submit

* indicates a required field