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Home My WebLink AboutWPO201800020 Permit 2019-04-10Registration 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.) Name: W.M. Jordan Company, LLC Contact: Eddie Hildalgo Mailing Address: 11010 Jefferson Avenue City: Newport News State: VA zip: 23601 Phone: 804-233-6921 Email address (if available): ehidalgo(a7WMJordain com 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: Keswick Hall Additions and Site Improvements Address (if available): 701 Club Drive city: Keswick State: Virginia zip: 22947 County (if not located within a City): Albemarle Latitude (decimal degrees): 38.017164 Longitude (decimal degrees):-78.366629 Name and Location of all Off -site Support Activities to be covered under the general permit: Address (if County (if not located within a Latitude (decimal degrees):_ Longitude (decimal 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: Rlvanna HUC: 02080204 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: Start Date (mm/dd/yyyy):11 /01/2018 Completion Date (mm/dd/yyyy): 5/01 /2020 9. Total Land Area of Development (to the nearest one -hundredth acre): 168.58 AC Estimated Area to be Disturbed (to the nearest one -hundredth acre): 9.95 AC 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: Eddie Hildal o Title: Project Superintendent Signature: Date: c)4, lam. 00V5 (Please sign in INK. This ific n must be signed by the appropriate person associated with the operator identified in Item #1.) 07i2014 Page 1 of 1 DRAFT VIRGINIA DEPARTMENT OF ENVIRONMENTAL QUALITY GENERAL VPDES PERMIT FOR DISCHARGES OF STORMWATER FROM FOR OFFICE USE ONLY CONSTRUCTION ACTIVITIES ID Number: (VAR10) REGISTRATION STATEMENT Technical Criteria: 11B ❑ IIC ❑ NEW ISSUANCE ❑ RE -ISSUANCE X MODIFICATION WITH ACREAGE INCREASE ❑ MODIFICATION WITHOUT ACREAGE INCREASE ❑ Existing Permit Coverage Number (if applicable): VAz_10 ►iZcaP vqt-lo- ooiS —d00&-2) Section I. Operator/Permittee Information. A. Construction Activity Operator (Permittee). The person or entity that is applying for permit coverage and will have operational control over construction activities to ensure compliance with the general permit. A person with signatory authority for this operator must sign the certification in Section VI. (per Part III. K. of the VAR10 Permit). Construction Activity Operator Name: W.M Jordan Company, L.C. Contact person: Eddie Hidalgo - Project Superintendent Address: 11010 Jefferson City, State Zip code: Newport News, VA 23601 Phone number: 804-233-6921 Primary email: ehidalgo@wmjordan.com CC Email: azwarycz@WMJordan.com; jmccormick@mbpce.com B. Billing Information (leave blank if same as the Operator identified in Section I. A. above). This entity will receive Annual Permit Maintenance and Permit Modification Fee invoices (if applicable). Name: Contact person: Address: City, State Zip code: Phone number: Primary email: CC Email: C. May we transmit correspondence electronically? You must choose YES and include a valid email in order to pay by credit card and to receive your permit coverage approval letter via email: YES M NO ❑ DEQ 199-DRAFT PAGE 1 1 8 CONSTRUCTION GENERAL PERMIT (VAR10) REGISTRATION STATEMENT Section VI. Certification. This Certification must be signed by a person representing the operator identified in Section II. A. and meeting the requirements of 9VAC25-880-70. Part III. K. Please note that operator is defined in 9VAC25-870-10 as follows: "Operator" means the owner or operator of any facility or activity subject to the Act and this chapter. In the context of stormwater associated with a large or small construction activity, operator means any person associated with a construction project that meets either of the following two criteria: (i) the person has direct operational control over construction plans and specifications, including the ability to make modifications to those plans and specifications or (ii) the person has day-to-day operational control of those activities at a project that are necessary to ensure compliance with a storm water pollution prevention plan for the site or other state permit or VSMP authority permit conditions (i.e., they are authorized to direct workers at a site to carry out activities required by the stormwater pollution prevention plan or comply with other permit conditions). In the context of stormwater discharges from Municipal Separate Storm Sewer Systems (MS4s), operator means the operator of the regulated MS4 system. 9VAC25-880-70. Part III. K Signatory Requirements: 1. Registration statement. All registration statements shall be signed as follows: a. For a corporation: by a responsible corporate officer. For the purpose of this chapter, a responsible corporate officer means: (i) a president, secretary, treasurer, or vice-president of the corporation in charge of a principal business function, or any other person who performs similar policy -making or decision -making functions for the corporation; or (ii) the manager of one or more manufacturing, production, or operating facilities, provided the manager is authorized to make management decisions that govern the operation of the regulated facility including having the explicit or implicit duty of making major capital investment recommendations, and initiating and directing other comprehensive measures to assure long-term compliance with environmental laws and regulations; the manager can ensure that the necessary systems are established or actions taken to gather complete and accurate information for state permit application requirements; and where authority to sign documents has been assigned or delegated to the manager in accordance with corporate procedures; b. For a partnership or sole proprietorship: by a general partner or the proprietor, respectively; or c. For a municipality, state, federal, or other public agency: by either a principal executive officer or ranking elected official. For purposes of this chapter, a principal executive officer of a public agency includes: (i) the chief executive officer of the agency or (ii) a senior executive officer having responsibility for the overall operations of a principal geographic unit of the agency. 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: Signature (signed in ink): Date: Submit this form to the VSMP Authority. If DEQ is the VSMP Authority, please send to: Department of Environmental Quality Office of Stormwater Management Suite 1400 PO Box 1105 Richmond VA 23218 constructs on¢p@d eg.yi rein ia.eov DEQ 199-DRAFT PAGE 4 18