DIVISION of WATER QUALITY NDPDES PROGRAM

THIS PAGE IS NOT PART OF ANY SWPPP

CONSTRUCTION

Storm Water Pollution Prevention Plan

(SWPPP) Template

(2020-05)

A SWPPP must be prepared and implemented for all construction activities covered under NDR10-0000 and NDR11-0000.

Purpose: This document is to be used only as a template in order to develop a SWPPP to provide a description of pollution prevention measures that will be implemented and monitored throughout the life of a construction project. The SWPPP is a “living document” for use at the site, and it will be reviewed in the event of an NDPDES inspection at the construction site. You may add pages, notes, and updates as needed throughout the project. Handwritten notes are acceptable, just be sure to date and initial any changes made or added to the SWPPP.

* Disclaimer: This SWPPP template is intended to be used as an outline/starting point. Permittees are to provide information under each section which pertains specifically to the project which is permitted. The use of this template does not necessarily ensure compliance with the construction stormwater general permit. More information may be required. Review of the NDR11-0000 general construction stormwater permit is recommended to ensure all necessary information has been supplied.

THIS PAGE IS NOT PART OF ANY SWPPP

Contents

Instructions	3

Resources	3

CONTACT INFORMATION/CHAIN OF RESPONSIBILITY	4

PROJECT DESCRIPTION	4

SITE MAP DEVELOPMENT	6

OPERATIONAL CONTROLS	7

SIGNIFICANT MATERIALS	9

EROSION AND SEDIMENT CONTROLS	12

INSPECTIONS	13

FINAL STABILIZATION	17

SIGNATORY CERTIFICATION	17

REVISION RECORD	18

ADDITIONAL OWNERS/OPERATORS	19

Instructions:

Complete each section of this template to create a SWPPP for your site. Keep the following items in mind as you compile information:

A SWPPP for the project must be prepared before the permit application is submitted. The SWPPP must be available for review by the department upon any site inspections. The SWPPP is not submitted to the department unless requested.

The SWPPP is a “living document” for use at the site. You may add pages, notes, and updates as needed. Handwritten notes and changes are acceptable, just be sure to date and initial any additions or changes made to the SWPPP or site map.

You may use this SWPPP draft/template or another that has been created for the site. To create a site plan that is compliant with permit requirements the SWPPP template, site inspection template, and the permit are good resources.

Additional information, maps, and protocols should be added to create a comprehensive document customized to meet the individual conditions at the construction site and to meet all the requirements of the NDR11-0000 permit.

Not all SWPPP requirements may apply to your site. If a portion does not pertain or is not applicable (NA) to the site, fill in with “NA” and write in the reason why it does not apply.

Full explanations for each plan requirement are in the permit (found on the NDPDES website at https://deq.nd.gov/WQ/2_NDPDES_Permits/7_Stormwater/StW.aspx). If you are not certain what to enter into a field, reference the permit and/or the statement of basis for a more detailed explanation.

Please contact the NDPDES Permit Department at (701)328-5210 or stormwater@nd.gov with any questions or advice.

Resources:

North Dakota Pollutant Discharge Elimination System Permit No: NDR10-0000

https://deq.nd.gov/publications/wq/2_NDPDES/Stormwater/Construction/NDR11per20200401F.pdf

Stormwater Discharges from Construction Activities

http://www.epa.gov/npdes/stormwater-discharges-construction-activities#overview

Sediment and Erosion Control Guidelines for Sites Disturbing Less than One Acre

https://deq.nd.gov/publications/WQ/2_NDPDES/Stormwater/Construction/NDPDES_Homebuilder_FactSheetFinal.pdf

Basic Operation and Maintenance Requirements of the Construction Storm Water General Permit

https://deq.nd.gov/publications/WQ/2_NDPDES/Stormwater/Construction/NDPDES_ConstructionO-M_FactSheetFinal.pdf

40 CFR PART 122 Subpart C —EPA Administered Permit Program: The National Pollutant Discharge Elimination System

https://www.gpo.gov/fdsys/pkg/CFR-2015-title40-vol22/pdf/CFR-2015-title40-vol22-part122.pdf

CONTACT INFORMATION/CHAIN OF RESPONSIBILITY

Main Contact Name: Title:	Phone:

Secondary Contact Name: Title:	Phone:

Chain of Responsibility:

Operator/Owner Name	Contact Information	Responsibility

PROJECT DESCRIPTION

Project Name: Permit ID#:

Project Type:

Project Location:

911 Address

Decimal Degrees

Latitude	Longitude

Total acres of the project: Total acres to be disturbed:

Describe of construction activity:

Proposed timetable for construction phases or activities or add a page for Gantt Chart:

Describe existing soils, fill material, and erodibility (http://websoilsurvey.sc.egov.usda.gov/App/HomePage.htm):

Name of receiving waters or Municipal Separate Storm Sewer System (MS4):

Is the waterbody listed in the TMDL List?

https://deq.nd.gov/publications/WQ/3_WM/TMDL/1_IntegratedReports/2018_Final_ND_Integrated_Report_20190426.pdf

If so describe the BMPs used near the TMDL listed body of water:

Is the waterbody listed in the 303(d) List?

https://deq.nd.gov/publications/WQ/3_WM/TMDL/1_IntegratedReports/2018_Final_ND_Integrated_Report_20190426.pdf

If so describe the BMPs used near the 303(d) listed body of water:

SITE MAP DEVELOPMENT

MAP FEATURE CHECKLIST

The site map should be suitably scaled and drawn to show the following required information.

Site maps must show items listed in this section.

OPERATIONAL CONTROLS

Employee training:

Describe the installation, maintenance, and removal of BMPs for each phase of construction; list if BMP is permanent or temporary:

Describe rationale for selection or infeasibility of BMPs and include any calculations:

List all good housekeeping practices:

List chemical, litter, debris, and parts management:

Describe trackout controls:

Describe dust control:

List preventative maintenance on site:

Describe how concrete grindings and slurry are managed on site:

List how waste water from washouts, cleanouts from paint, stucco, and other building materials are managed:

Describe any dewatering or basin draining operations and sediment control within those operations:

Spill prevention and response procedures (https://deq.nd.gov/WQ/4_Spill_Investigations/):

Spill Reporting

Report any spill that may seriously endanger health or the environment as soon as possible, but no later than 24 hours from the time you became aware of the spill.

Immediate response by trained emergency personnel may be coordinated through the Department of Health, Department of Emergency Services and any other state or local emergency response agencies that may be needed. If there is any question as to proper response, call the 24 hour North Dakota hazardous materials emergency assistance and spill reporting number (800.472.2121) and provide all relevant information about the incident.

North Dakota Department of Health:

Division of Water Quality	701.328.5210

Division of Waste Management	701.328.5166

Division of Air Quality	701.328.5188

Division of Municipal Facilities	701.328.5211

Report Spills to: https://deq.nd.gov/WQ/4_spill_Investigations/IncidentReporting.aspx

SIGNIFICANT MATERIALS

INSTRUCTIONS: Based on your site’s material inventory, provide the following information. For the definition of “significant materials,” see Part V of the permit. The location of the significant materials should be indicated on the site map. Use the drop down menus to select a chemical or type in if “other”.

Chemical or type in if other

Quantity

Description and Location Spill/Disposal Management

Handling and Pollution Prevention Measures

Chemical or type in if other

Quantity

Description and Location Spill/Disposal Management

Handling and Pollution Prevention Measures

Chemical or type in if other

Quantity

Description and Location Spill/Disposal Management

Handling and Pollution Prevention Measures

Chemical or type in if other

Quantity

Description and Location Spill/Disposal Management

Handling and Pollution Prevention Measures

(Attach additional pages if needed)

BMP	Year	Months
J	F	M	A	M	J	J	A	S	O	N	D	J	F	M	A	M	J	J	A	S	O	N	D

Drop Down Fill-In Time Line for BMPs

Fill in the blank spaces if BMP is not listed

*Be sure that all BMPs are marked on the site map during their appropriate phase.

EROSION AND SEDIMENT CONTROLS

Is there a sediment basin Calculated sediment storage in cubic feet

Description and Location of all sediment basins:

*Be sure to identify any sediment basins on site map.

Description of winter stabilization practices that will be utilized:

List permanent controls for pollutants and erosion after construction has been completed:

*Sediment basins must be provided, where practical, when 10 or more acres of disturbed area drain to a common location.

Requirements for sediment basins may be found in Appendix 1 of the permit.

**Outlet drawdown devices must be provided for all temporary or permanent basins. Devices that will be installed permanently must meet local design standards. Requirements for temporary devices may be found in Appendix 1 of the permit.

†Stage of installation may include the planned date or the specific construction stage when the item may be installed such as initial site clearing, grading, finish grading, seeding, stabilization, etc… Dates may change depending on delays.

INSPECTIONS

Observations and Actions Taken: Document incidents such as erosion, sediment accumulation, spills, SWPPP related maintenance, remediation, etc.

*Document that the SWPPP has been amended when changes are made

Reason for Inspection	Time & Date	Name of Inspector	Findings, recommendations, schedule for corrective actions, corrective actions taken (including dates, times, and party completing maintenance activities)
1) All Perimeter Controls (silt fence, wattles, filter strips, etc) have been inspected and are properly functioning. Reminder they must also be maintained.
2) All Inlets are protected and void of sediment. Reminder all storm drain inlets in the vicinity must have protection.
3) Streets, curbs and sidewalks located along the construction site are free of tracked sediment. Reminder all sediment must be removed immediately.
4) Are egresses being maintained and not allowing off site accumulation?
5) Concrete Wash is collected in leak-proof containers or leak-proof pits. Reminder this includes mortar and other masonry products.
6) All BMPs (berms, blankets, mulch and rock checks, etc) are inspected and found to be properly functioning. Reminder ditches and swales must be protected as well.

Reason for Inspection Reminder that any discharge into a storm sewer is prohibited.	Time & Date	Name of Inspector	Findings, recommendations, schedule for corrective actions, corrective actions taken (including dates, times, and party completing maintenance activities)
7) Water pumped off site has all sediment removed from it. Not applicable if no dewatering has taken place.	Volume of Water discharged:___
8) Are all Hazardous Materials (paints, solvents, dyes, gasoline, oils and glues) protected from entering the storm sewer?
9) Are Vehicle Maintenance and Fueling Areas maintained?
10) Site and all slopes have been stabilized.
11) Vegetated Buffers have proper flow distribution and are clear from sediment and debris.
12) All other observations that need to be addressed.
13)
14)
15)
16)

Record each Precipitation event in inches.

SWPPP Precipitation Records (January - June)	Year:
JAN	Precip Total	FEB	Precip Total	MAR	Precip Total	APR	Precip Total	MAY	Precip Total	JUN	Precip Total
1	1	1	1	1	1
2	2	2	2	2	2
3	3	3	3	3	3
4	4	4	4	4	4
5	5	5	5	5	5
6	6	6	6	6	6
7	7	7	7	7	7
8	8	8	8	8	8
9	9	9	9	9	9
10	10	10	10	10	10
11	11	11	11	11	11
12	12	12	12	12	12
13	13	13	13	13	13
14	14	14	14	14	14
15	15	15	15	15	15
16	16	16	16	16	16
17	17	17	17	17	17
18	18	18	18	18	18
19	19	19	19	19	19
20	20	20	20	20	20
21	21	21	21	21	21
22	22	22	22	22	22
23	23	23	23	23	23
24	24	24	24	24	24
25	25	25	25	25	25
26	26	26	26	26	26
27	27	27	27	27	27
28	28	28	28	28	28
29	29	29	29	29
30	30	30	30	30
31	31	31

SWPPP Precipitation Records (July - December)	Year:
JUL	Precip Total	AUG	Precip Total	SEP	Precip Total	OCT	Precip Total	NOV	Precip Total	DEC	Precip Total
1	1	1	1	1	1
2	2	2	2	2	2
3	3	3	3	3	3
4	4	4	4	4	4
5	5	5	5	5	5
6	6	6	6	6	6
7	7	7	7	7	7
8	8	8	8	8	8
9	9	9	9	9	9
10	10	10	10	10	10
11	11	11	11	11	11
12	12	12	12	12	12
13	13	13	13	13	13
14	14	14	14	14	14
15	15	15	15	15	15
16	16	16	16	16	16
17	17	17	17	17	17
18	18	18	18	18	18
19	19	19	19	19	19
20	20	20	20	20	20
21	21	21	21	21	21
22	22	22	22	22	22
23	23	23	23	23	23
24	24	24	24	24	24
25	25	25	25	25	25
26	26	26	26	26	26
27	27	27	27	27	27
28	28	28	28	28	28
29	29	29	29	29	29
30	30	30	30	30	30
31	31	31	31

FINAL STABILIZATION

SIGNATORY CERTIFICATION

INSTRUCTIONS: The following statement shall be signed by a responsible corporate officer, general partner, principle executive officer or ranking elected official. The statement may be signed by a duly authorized representative of the person above in accordance with Part IV-E of the permit.

CERTIFICATION “I , certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.
Printed Name of Applicant	Title
Signature of Applicant	Date

REVISION RECORD

The SWPPP should be revised and updated to address changes in site conditions, updated government regulations, and additional on-site storm water controls.

All revisions to the SWPPP must be documented on the SWPPP Revision Record, which should include the information shown below. The authorized permittee representative, either the owner, a representative of the owner, or the operator, who approves the SWPPP should be an individual who has the ability to modify project plans and specifications related to the SWPPP. The name of this representative will attest that the SWPPP revision information is true and accurate.

SWPPP Modification Log
Name of Construction Site	Location of Construction Site
Type of Modification	Description of Modification	Location of Modification
Major	Minor
Start Date:
Completion Date:
Reason for Modifications:	Approved/Implemented By:
Type of Modification	Description of Modification	Location of Modification
Major	Minor
Start Date:
Completion Date:
Reason for Modifications:	Approved/Implemented By:
Type of Modification	Description of Modification	Location of Modification
Major	Minor
Start Date:
Completion Date:
Reason for Modifications:	Approved/Implemented By:
Type of Modification	Description of Modification	Location of Modification
Major	Minor
Start Date:
Completion Date:
Reason for Modifications:	Approved/Implemented By:
ADDITIONAL OWNERS/OPERATORS

INSTRUCTIONS: This section is provided to include additional owners and operators that may be designated by the permit holder to perform activities on a project (i.e., subcontractor). The additional owners/operators must adhere to this Storm Water Pollution Prevention Plan.

Signatory “I certify under penalty of law that I have personally read, understood, and accepted all terms and conditions of this Storm Water Pollution Prevention Plan, and that I shall implement the Plan accordingly. I am also familiar with the NDPDES General Permit for Storm Water Discharges Associated with Construction Activity (NDR10-0000).

SWPPP Owner - Contractor - Sub-Contractor Log
Name of Construction Site	Location of Construction Site
Company	Printed Individual Name and Title	Signature
1)
Start Date:
Completion Date:
2)
Start Date:
Completion Date:
3)
Start Date:
Completion Date:
4)
Start Date:
Completion Date:
5)
Start Date:
Completion Date:
6)
Start Date:
Completion Date:
7)
Start Date:
Completion Date:
8)
Start Date:
Completion Date: