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OWNER / SITE / AND RESPONSIBLE LAND DISTURBER (RLD) INFORMATION
Owner Name:  Owner Address:
Tax Map / Parcel No.:   Site Address:
Total Acreage to be Disturbed:  Contact No. (s):
Building Permit No.:    Email:
RLD Name:   RLD Certificate No.:
RLD Address:  RLD Contact No. (s):
RUSSELL COUNTY BUILDING DEPARTMENT
137 HIGHLAND DR. Ste D.
LEBANON, VA  24266
AGREEMENT IN LIEU OF PLAN
FOR CONSTRUCTION OF A SINGLE-FAMILY RESIDENCE
In lieu of submission of an erosion and sediment control plan for the construction or location of a single-family dwelling
and/or appurtenant structure in the location referenced above, I the undersigned party(s) agree to comply with all
requirements of the Russell County Erosion and Sediment Control Ordinance. I further agree to comply with additional
erosion and sediment control requirements determined necessary by the County Erosion and Sediment Control Program
Administrator or his/her authorized agents to protect down gradient properties and waterways from sedimentation from the
said land disturbance. Such requirements shall be based on the conservation standards contained in the Russell County
Erosion and Sediment Control Ordinance and shall represent the minimum practices necessary to provide adequate control
of erosion and sedimentation on or resulting from this project.
As a minimum I agree to install the following erosion and sediment control measures prior to beginning any land
disturbing activity:

Silt fence or other sediment trapping measures shall be installed on all down slope perimeters of disturbed
areas and maintained in good operating condition during course of construction;
A temporary stone construction entrance (or stable driveway) shall be provided wherever traffic will be entering
onto a paved surface or public road from the construction site sufficient to prevent tracking; and
All denuded areas on the site shall be stabilized within (7) days of final grading with permanent vegetation or a
protective ground cover suitable for the time of year. Temporary soil stabilization shall be applied within (7) days
to denuded areas that may not be at final grade but which will remain dormant (undisturbed) for longer than (14)
days.

I understand that failure to comply with the conditions of this Agreement in lieu of Plan or any corrective action(s) noted as
a result of a site inspection by County Inspectors or his/her authorized agents, within 3 days following notice of required
corrective action(s), could result in citation for violation of the Russell County Erosion and Sediment Control Ordinance.
By signature below, the applicant certifies, agrees and accepts liability for the requirements of this agreement.
Signature of Property Owner or Contractor:  Date:
This Agreement in Lieu of Plan issued and effective:

For Russell County Building Department
Bridgett McGlothlin, ESC Program Administrator Josh Stinson, Russell County Building Official,
ESC Inspector
RUSSELL COUNTY BUILDING DEPARTMENT
137 HIGHLAND DR. Ste D.
LEBANON, VA 24266
AGREEMENT IN LIEU OF PLAN
FOR CONSTRUCTION OF A SINGLE-FAMILY RESIDENCE
OWNER/SITE/ AND RESPONSIBLE LAND DISTURBER (RLD) INFORMATION
Owner Name: Owner Address:
‘Tax Map / Parcel No, Site Address:
Total Acreage to be Disturbed: Contact No. (8):
Building Permit No.: Email:
RLD Name: RLD Certificate No.:
RLD Address: RLD Contact No. (s):
In lieu of submission of an erosion and sediment control plan for the construetion or location of a single-family dwelling
and/or appurtenant structure in the location referenced above, | the undersigned party(s) agree to comply with all
requirements of the Russell County Erosion and Sediment Control Ordinance. I further agree to comply with additional
erosion and sediment control requirements determined necessary by the County Erosion and Sediment Control Program
Administrator or his/her authorized agents to protect down gradient properties and waterways from sedimentation from the
said land disturbance. Such requirements shall be based on the conservation standards contained in the Russell County
Erosion and Sediment Control Ordinance and shall represent the minimum practices necessary to provide adequate control
of erosion and sedimentation on or resulting from this project.
Asa minimum I agree to install the following erosion and sediment control measures prior to beginning any land
disturbing activity:

Silt fence or other sediment trapping measures shall be installed on all down slope perimeters of disturbed

areas and maintained in good operating condition during course of construction;


A temporary stone construction entrance (or stable driveway) shall be provided wherever traffic will be entering
onto a paved surface or public road from the construction site sufficient to prevent tracking; and


All denuded areas on the site shall be stabilized within (7) days of final grading with permanent vegetation or a
protective ground cover suitable for the time of year. Temporary soil stabilization shall be applied within (7) days
to denuded areas that may not be at final grade but which will remain dormant (undisturbed) for longer than (14)
days.


T understand that failure to comply with the conditions of this Agreement in lieu of Plan or any corrective action(s) noted as
a result of a site inspection by County Inspectors or his/her authorized agents, within 3 days following notice of required
corrective action(s), could result in citation for violation of the Russell County Erosion and Sediment Control Ordinance.
By signature below, the applicant certifies, agrees and accepts liability for the requirements of this agreement.
Signature of Property Owner or Contractor:, Date:
This Agreement in Lieu of Plan issued and effective:
For Russell County Bulldh
Bridgett MeGlothlin, ESC Program Administrator Josh Stinson, Russell County Building Off
ESC Inspector
FOR CONSTRUCTION OF A SINGLE-FAMILY RESIDENCE
1. Silt fence or other sediment trapping measures shall be installed on all down slope perimeters of disturbed areas and maintained in good operating condition during course of construction;
Signature of Property Owner or Contractor:   Date:

Owner Name: 
Owner Address: 
Tax Map  Parcel No: 
Site Address: 
Total Acreage to be Disturbed: 
Contact No s: 
Building Permit No: 
Email: 
RLD Name: 
RLD Certificate No: 
RLD Address: 
RLD Contact No s: 
Date: 
This Agreement in Lieu of Plan issued and effective: 
Bridgett McGlothlin ESC Program Administrator: 
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