Storm Water Pollution Permit #___________

Prevention Plan Construction Date:______________

Activity Template > 1 ACRE

Project Name: _____________________________________________________________________________

Project Address: ___________________________________________________________________________

Owner’s Name & Address: _________________________________________________________________

E-mail Address: _____________________________________ Phone: __________________________

Contractor’s Name & Address: _____________________________________________________________

E-mail Address: _____________________________________ Phone: __________________________

SWPPP Contact Name & Address: __________________________________________________________

E-mail Address: _____________________________________ Phone: __________________________

Total Area in Acres and area to be

_________________________________________________________
disturbed in Acres:

Please provide the following

SWPPP (For land disturbance activities that disturb an area greater than 1 acre or are part of a
common plan of development) use the required State of Utah SWPPP template.
http://www.deq.utah.gov/Permits/water/updes/stormwater.htm

NOI (Notice of Intent) (For land disturbance activities that disturb an area greater than 1 acre) filed
with the Department of Environmental Quality. You must first create an “Utah.gov” account and
then “login” to the database once the template is completed then file for the Notice of Intent (NOI).
http://www.deq.utah.gov/Permits/water/updes/stormwatercon.htm#app

Utah Division of Environmental Quality General Permit No. UTR000000.

http://www.deq.utah.gov/Permits/water/updes/stormwatercon.htm#app

SWPPP drawing with BMP locations and BMP detail sheet.

Spill Prevention control and countermeasure plan. (SPCC)

 Copies of any Federal or State permits required for the project.
(e.g. wetlands, stream alteration, dewatering, etc.)

Construction Site Dewatering

State law prohibits point source discharges to a water body(ies) of the State without a Utah Pollution
Discharge Elimination System (UPDES) permit. The operator of construction dewatering or hydrostatic
testing activity that has such a discharge must submit a NOI to obtain coverage under the UPDES
General Permit for Construction Dewatering/Hydrostatic Testing. If you have questions about whether
you need a permit under the UPDES program contact the Division of Water Quality at (INSERT CONTACT
NUMBER)

Is the project going to generate any non-storm water discharge? YES NO

If yes, please submit the required documents with this form.
Stream Alteration
Utah Code requires any person, government agency, or other organization wishing to alter the bed or
banks of a natural stream to obtain written authorization from the State Engineer prior to beginning
work. For more information visit www.nrwt1.nr.state.ut.us.

Is the project going to alter any stream or water body(ies)? YES NO

If yes, please submit the required documents with this form.

Wetlands
The Clean Water Act (CWA) establishes a program that regulates the discharge of dredged or fill material
into waters of the United States, including wetlands. Please visit US Army Corp of Engineers webpage for
more information. www.nwo.usace.army.mil/html/od-tl/tri-lakes.html

Are wetlands going to be disturbed during the project? YES NO

If yes, please submit the required documents with this form.

Common Plan of Development (CPoD)

A common plan of development or “sale” is a site where multiple separate and distinct construction
activities may be taking place at different times on different schedules; however, each lot that will be sold
is required to have its own SWPPP.

For sites that are part of a common plan of development or smaller than 1 acre, use the CPoD
Template found at www.provo.org. or call (801) 709-9717.

SWPPP Sign Requirements

Projects over 1 acre: The permittee must post a sign within 7 days of the issue date on this permit.
The following must be posted near the main entrance to the project site, the SWPPP map, and the
current NOI.

Sign Information:

Exterior grade ¾” Plywood cut 4’x4’, with red letters, white background, and must
include the following text.

SWPPP
A Storm Water Pollution Prevention Plan covers this construction site.
If any non-storm water discharge or severe vehicle tracking occurs please call
(801) 709-9717 or (801) 367-1265.
Example of the Main Entrance sign

SWPPP sign requirements for all secondary entrances. The sign must be 18”x24” and must include
 the following text (letters must be 2” tall and red in color).

Sign Information:
SWPPP
A Storm Water Pollution Prevention Plan covers this construction site.
If any non-storm water discharge or severe vehicle tracking occurs please call
(801) 709-9717 or (801) 367-1265.

Control Measures
The proposed control measures shall be designed to prevent or minimize, to the maximum extent
practicable, the discharge of sediment, debris and other construction-related pollutants from the
construction site by storm water runoff into the storm drainage system.

Check each item that you will use. Many items are mandatory; initial those to verify that you have read
them and will comply.

Include additional sheets if necessary

Initials

_______ No dirt or debris placed on the roadways, sidewalk and curb (Mandatory).
If using chemical toilets, it must be place minimum of 6’ away from impervious surfaces (e.g.
_______ roadways, sidewalk, and curb) and staked down to prevent tipping (Mandatory).
_______ Concrete washout/collection containment area is installed (Mandatory).

All other potential access points will be eliminated or controlled by:

(Please check all that apply)

Sign Silt Fence Barrier Temporary Fencing

Other (Describe) __________________________________________________________________________

Potential soil erosion and storm water runoff will be controlled by:
(Please check all that apply)

Erosion control blankets Limiting area of disturbance

Re-vegetation of un-stabilized area Gravel wattle check dam

Silt fences Bonded fiber matrix

Retention Areas Other _________________________________________________

Job access area street tracking to be eliminated by:

(Please check all that apply)

Mechanical or manual sweeping provided for

Stabilized construction entrance
immediate cleanup (mandatory)

Wash down pad Other ________________________________________________

Use Site Maps to Track Progress

Keep up-to date site maps showing BMP’s that change frequently in location as the work on a
construction site progresses. Your permit requires that you keep your SWPPP up to-date, so make up the
side map with the location of the BMPs.

SWPPP Team
Each owner/operator must assemble a storm water team. The team will be responsible for overseeing the
development of the SWPPP. The team is responsible for compliance and requirements of the SWPPP.

Please list the name and number for the following:

Emergency Contact ______________________________________

SWPPP Team Members

_____________________________________________ _____________________________________________
_____________________________________________ _____________________________________________
_____________________________________________ _____________________________________________
_____________________________________________ _____________________________________________

Construction Site

Attach a list of pollutant generating activities for the construction site.

Treatment chemicals will be used on site? If so you must provide an approval letter from
the DWQ.

Site is within 50’ of surface water? If so the proper Buffer Documentation will be required

_____ Staff training will be done according to the General Construction Permit.

_____ The SWPPP will stay onsite/online and be available within 30 minutes.
 Notice of Violation
Whenever the City finds that a person has violated a prohibition or failed to comply with a requirement of
the permit, the City will order compliance by written notice of violation to the responsible person. Such
notice may be required without limitations of verbal warning with corrections and/or monetary citation.
Violations and Enforcement
〉 The violation of any of the provisions to this Article shall be a Class C misdemeanor. Each day
that a violation occurs shall constitute a separate offense. Each violation/infraction is considered
a separate offence each day.
〉 Authorized code enforcement personnel working under the direction of the Public Works
Department Director and/or Development of Services Department Director are hereby declared to
be Public Officials within the meaning of Section 77-7-18 Utah Code as amended, and these
Public Officials are hereby authorized to issue misdemeanor citations and/or stop work order for
violations of this Chapter.
〉 Violators of the Article are also subject to any penalties that may be imposed by the State of Utah,
under the authority of the Utah Water Quality Act, Title 19, and Chapter 5 of the Utah Code.
〉 In addition to any criminal fines and/or penalties which may be assessed for a violation of this
Article, the City shall have the right to install and/or maintain appropriate erosion and sediment
control measures on any site which is required to have such measures. In the event that
construction activity is commenced or continued without such measures having been installed as
required by this Article, the City shall have the right to have such measures installed or
maintained by City personnel or to hire a private contractor to perform such work. The contractor
and/or the property owner shall be liable for any and all expenses related to performing such
work plus a 25% penalty charge. The City may assess said charges against the bond posted by
the contractor and/or property owner and/or developer.
〉 Violators of this Article may also be subject to prosecution, fines and penalties from the State of
Utah and the United States EPA.
Terminating Coverage (NOT)
Operators wishing to terminate coverage under this permit must submit a Notice of Termination (NOT)
found in the addendum section in the Utah State Storm Water General Permit for Construction
Activities. www.deq.utah.gov/Permits/water/updes/stormwatercon.htm#not

Storm Water Pollution Prevention Plan Construction Activity Template will not be considered terminated
until the Permittee submits a Notice of Termination to the Division of Water Quality and the Notice is
accepted by the City. The City shall accept the Notice if the Permittee has met the requirements of the
Permit. The Permittee shall keep and maintain all Permit-required improvements on the site until the City
accepts the NOT.

All Permittees must submit a NOT within thirty (30) days after completion of their construction activities
and final stabilization of their portion of the site, or another operator taking over all of their
responsibilities at the site. A Permittee cannot submit an NOT without final stabilization unless another
party has agreed to and filled a Notice of Intent (NOI) to assume responsibility for final stabilization of the
site. Appropriate enforcement actions may be taken for permit violations where a Permittee submits a
NOT but the Permittee has not transferred operational control to another Permittee or the site has not
undergone final stabilization. If Permittee is developing the property and it planning to sell
individual lots then it will be the responsibility of the Permittee to legally transfer the SWPPP
portion of that lot to the new owner. The new owner will then have to obtain a new permit and
implement his/her own SWPPP for that lot before the NOT will be accepted.
 SWPPP Inspection Required
Before any construction work can being, the SWPPP must be implemented. Once the BMP’s have
been installed, a site inspection will be required. When submitting an NOT, a final site inspection
will be required. No SWPPP will be released until the area of disturbance has been stabilized.

Storm Water Pollution Prevention Plan Construction Activity

Template

I understand that this SWPPP template is required and will remain in effect until the entire project is
stabilized, including re-vegetation and the NOT has been filled and accepted. All control measures will be
inspected at least weekly and immediately after or during every storm even of .5 inches or more. Tracking
onto roads will be cleaned up immediately. Written records of all inspections, changes to this plan, and
failures of control devices will be kept. The contractor is required to train all subcontractors, vendors,
delivery personnel, and others who will be working on the site. The contractor is responsible for
compliance of the SWPPP for the entire site and duration of the project. I am aware that there are
significant penalties for submitting false information, including the possibility of fines and imprisonment
for known violations. I understand that a pre-SWPPP inspection will be needed before any work can
commence and a NOT will be submitted when the project is finished.

Print Name _______________________________________________________________________________

Signature _______________________________________________________________________________

Date ________________________________

OFFICIAL USE ONLY

Approved ______________________________________ Date: ____________________________________

Special Conditions: ______________________________________________________________________________

_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
 OFFICIAL USE ONLY
PRECONSTRUCTION INSPECTION

Approved: _____________________________________ Date: ____________________________________

Special Conditions: _____________________________________________________________________________

____________________________________________________________________________________________
____________________________________________________________________________________________

Site Plan Storm Water Pollution Prevention Plan Checklist

YES NO N/A

Does the SWPPP show the location of the SWPPP Board BMP?

Does the SWPPP show the location of the construction entrance/exit?

Does the SWPPP show a designated material storage area?

Does the SWPPP show the equipment wash out area?

Does the SWPPP include the location of the concrete wash out area?

Does the SWPPP include the location of the portable toilet?

Does the SWPPP include the installation of storm drain inlet

protection
BMPs?

Does the SWPPP include the location of the perimeter storm runoff
control BMPs?

Does the SWPPP include the location of trash containers or trash

receptacles?

Does the SWPPP show the spacing and number of trash containers
provided?

Does the SWPPP include existing wetlands?

Does the SWPPP specify the percentage of area to be disturbed or

cleared?

Does the SWPPP show exiting waters of the state located within 200
feet?

Does the SWPPPP include a proposed phasing plan if the project will
be divided into several phases?
Does the SWPPP include the frequency of the street/ parking lot
sweeping?

Does the SWPPP include the frequency of the litter collection?

Does the SWPPP include the number of inlet protection BMPs to be

installed during construction?

Does the SWPPP include the frequency of the maintenance

inspections of the storm drain inlet protection BMPs?