HomeMy WebLinkAboutWPO201800073 VSMP - SWPPP 2019-03-27
Registration Statement
General VPDES Permit for Discharges of Stormwater from Construction Activities (VAR10)
(Please Type or Print All Information)
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.)
University of Virginia Foundation
Name:
Todd Marshall
Contact:
P.O. Box 400218
Mailing Address:
22904
Charlottesville434-924-2569
VA
City: State: Zip: Phone:
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:
Lewis and Clark Drive Road Extension
Name:
4211 Lewis and Clark Drive
Address (if available):
Charlottesville
Virginia
22911
City: State: Zip:
Albemarle
County (if not located within a City):
-78.438957
38.146487
Latitude (decimal degrees): Longitude (decimal degrees):
Name and Location of all Off-site Support Activities to be covered under the general permit:
Name:
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):
Rivanna
Name: Name:
02080204
HUC: HUC:
7. If the discharge is through a Municipal Separate Storm Sewer System (MS4), the name of the MS4 operator:
8. Estimated Project Start and Completion Date:
03/01/2020
03/01/2019
Start Date (mm/dd/yyyy): Completion Date (mm/dd/yyyy):
455.85
9. Total Land Area of Development (to the nearest one-hundredth acre):
12.50
Estimated Area to be Disturbed (to the nearest one-hundredth acre):
10. Is the area to be disturbed part of a larger common plan of development or sale? Yes No
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 for knowing violations."
Printed Name: Title:
Signature: Date:
(Please sign in INK. This Certification must be signed by the appropriate person associated with the operator identified in
Item #1.)
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