HomeMy WebLinkAboutWPO201700014 Permit WPO VSMP 2017-01-11 Registration Statement
General VPDES Permit for Discharges of Stormwater from Construction Activities{VAR10)
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1. Construction Activity Operator: (General permit coverage will be issued to this operator, The Certification in item#12 must be
signed by the appropriate person associated with this operator.)
Name:University of Virginia Foundation
Contact:Nat Perkins
Mailing Address:One Boar's Head Pointe
City:Charlottesville State:VA Zip:22903 Phone:(434) 982-5304
Email address(if available):
indicate if DEQ may transmit general permit correspondence electronically: Yes❑No
2. Existing General Permit Registration Number(for renewals only):
3. Name and Location of the Construction Activity:
Name:Town Center Four
Address(if available):Research Park Blvd.
City:Charlottesville State:Virginia Zip:22911
County(if not located within a City):County of Albemarle
Latitude(decimal degrees):38.149218 Longitude(decimal degrees):-78.435476
Name and Location of all Off-site Support Activities to be covered under the general permit:
Name:n/a
Address(if available):
City: State: Zip:
County(if not located within a City):
Latitude(decimal degrees): Longitude(decimal degrees):
4. Status of the Construction Activity(check only one): Federal State❑ Public❑Private❑�
5. Nature of the Construction Activity(e.g.,commercial,industrial,residential,agricultural,oil and gas,etc.):
Commercial
6. Name of the Receiving Water(s)and Hydrologic Unit Code(HUC):
Name:North Fork Rivanna River Name:
HUC:02080204 HUC:
7. if the discharge is through a Municipal Separate Storm Sewer System(MS4),the name of the MS4 operator:
n/a
8. Estimated Project Start and Completion Date:
Start Date(mm/dd/yyyy):04/01/2017 Completion Date(mm/dd/yyyy): 10/31/2018
9. Total Land Area of Development(to the nearest one-hundredth acre):6.52 ac (proposed lease area)
Estimated Area to be Disturbed(to the nearest one-hundredth acre): 12.50 ac
10. Is the area to be disturbed part of a larger common plan of development or sale? Yes No Ej
11. A stormwater pollution prevention plan (SWPPP) must be prepared In accordance with the requirements of the General
VPDES Permit for Discharges of Stormwater from Construction Activities prior to submitting this Registration Statement.
By signing this Registration Statement the operator is certifying that the SWPPP has been prepared.
12. Certification:"I certify under penalty of law that I have read and understand this Registration Statement and that this document
and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and
evaluated 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/or knowing violations." ..
Printed Name: Firda- C(C A A. Ht.'s.,e I Title:17wrc1t or 4 Deur oA". t J
Signature: Date: / '/11 7
(Please signn INK. ertification must be signed by the appropriate person associated with the operator Identified in
item#1.)
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