Attachment G - SWQMP Intake Form Copy.pdf

County of San Diego Stormwater Quality Management Plan (SWQMP) Attachment 1: Storm Water Intake Form for All Permit Applications

Template Date: January 30, 2019 Intake Form

This form establishes Stormwater Quality Management Plan (SWQMP) requirements for Development Projects per Sections 67.809 and 67.811 of the County of San Diego Watershed Protection Ordinance (WPO).

See Storm Water Intake Form Instructions for additional guidance and explanation of terms.

Part 1. Project Information Project Name:

Record ID (Permit) No(s):

Assessor’s Parcel No(s):

Street Address (or Intersection):

City, State, Zip:

Part 2. Applicant / Project Proponent Information Name:

Company:

Street Address:

City, State, Zip:

Phone Number

Email:

Part 3. Required Information for All Development Projects

1. Existing

(pre-development) impervious surfaces (ft2)

2. Created or replaced impervious surfaces (ft2)

3. Total disturbed area (acres or ft2)

☐ Check here and provide a WDID# if this project is subject to the California Construction General Permit (Order No.

2009-0009-DWQ)1

WDID # (if issued)

For County Use Only Reviewed By: Review Date:

☐ Standard SWQMP ☐ PDP SWQMP ☐ Green Streets PDP Exemption SWQMP

1 Available at: https://www.waterboards.ca.gov/water_issues/programs/stormwater/construction.html

P a g e | 2

Part 4. Priority Classification & SWQMP Form Selection

If your project is the following … (select one) You must complete …

☐ Standard Project

☐ a. Project is East of the Pacific/Salton Sea Divide

☐ b. None of the PDP criteria below applies

Standard SWQMP Form

☐ Priority Development Project (PDP) ☐ 1. Project is part of an existing PDP, OR ☐ 2. Project does any of the following:

☐ a. Creates or replaces a total of 10,000 ft2 or more of impervious surface

☐ b. Creates or replaces a combined total of 5,000 ft2 or more of impervious surface within one or more of the following uses: (1) parking lots; (2) streets, roads, highways, freeways, and/or driveways; (3) restaurants;

and (4) hillsides

☐ c. Creates or replaces a combined total of 5,000 ft2 or more of impervious surface within one or more of the following uses: (1) automotive repair shops; and (2) retail gasoline outlets

☐ d. Discharges directly to an Environmentally Sensitive Area (ESA) AND creates or replaces 2,500 ft2 or more of impervious surface

☐ e. Disturbs one or more acres of land (43,560 ft2) and is expected to generate pollutants post-construction

☐ f. Is a redevelopment project that creates or replaces 5,000 ft2 or more of impervious surface on a site already having at least 10,000 ft2 of impervious surface

PDP SWQMP Form

☐ Green Streets PDP Exemption2 Green Streets PDP Exemption SWQMP Form

Part 5. Applicant Signature

I have reviewed the information in this form, and it is true and correct to the best of my knowledge.

Applicant / Project Proponent Signature: Date:

Upon completion submit this form to the County.

If requested, attach supporting documentation to justify selections made or exemptions claimed.

If this is a PDP that is part of a larger existing PDP, you will be required to attach a copy of the existing SWQMP to the newer SWQMP submittal.

2 Green Streets PDP Exemption Projects are those claiming exemption from PDP classification per WPO Section 67.811(b)(2) because they consist exclusively of either 1) development of new sidewalks, bike lanes, and/or trails; or 2) improvements to existing roads, sidewalks, bike lanes, and/or trails.