C 50-20-177, Virginia Soil and Water Conservation Board 1. Name of Impounding Structure: Inventory Number: Other Name (if any): Stream Name: Latitude: City/County: Longitude: 2. Name of Owner: Address: Telephone: (Residential) Other means of communication: (Note: 24-hour telephone contact required) (Business) 3. Name of Impounding Structure Operator: Address: Telephone: (Residential) Other means of communication: (Note: 24-hour telephone contact required) (Business) Name of Alternate Oper.
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How to fill out the VA DCR199-103 online
The VA DCR199-103 form is essential for documenting emergency preparedness plans for low hazard Virginia regulated impounding structures. This guide provides a step-by-step approach to filling out the form online, ensuring clarity and ease for all users.
Follow the steps to complete the VA DCR199-103 online.
- Press the ‘Get Form’ button to obtain the form and open it in the appropriate editor.
- Begin by entering the name of the impounding structure in the designated field, along with the inventory number, any alternate names, stream name, latitude, and longitude.
- Fill in the details of the owner, including their name, address, residential and business telephone numbers, and other means of communication.
- Provide information about the impounding structure operator, including their name, address, and contact details, ensuring both residential and business contact numbers are included.
- Complete the section for the rainfall and staff gage observer, including their name, address, and communication methods.
- Identify the 24-hour dispatch center closest to the impounding structure, along with their address and contact number.
- Detail the procedure for notifying potentially impacted downstream properties, including the responsible parties for these notifications.
- Discuss the procedures for timely detection, evaluation, and classification of emergency situations relevant to the impounding structure.
- Attach a simple dam break inundation map that illustrates expected inundation areas if the impounding structure fails.
- If applicable, identify downstream public roads by highway number and distance from the dam.
- Document the amount of rainfall that will trigger different emergency conditions.
- Indicate whether a staff gage exists, its location, and its observation frequency during specified conditions.
- Outline the evacuation procedures, including notification methods and responsibilities of the dam owner/operator and local emergency services.
- Finalize the form with the owner's certification, including the signature and date of completion.
- Once completed, save your changes, download, print, or share the form as needed.
Complete your VA DCR199-103 form online today to ensure your emergency preparedness plan is filed accurately.
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