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Home My WebLink AboutWPO201600035 Correspondence 2019-09-03DRAFT VIRGINIA DEPARTMENT OF ENVIRONMENTAL QUALITY GENERAL VPDES PERMIT FOR DISCHARGES OF STORMWATER FROM D OFFICE USE ONLY N I CONSTRUCTION ACTIVITIES D Number: (VAR1U) REGISTRATION STATEMENT Technical Criteria: IIB ❑ IIC El NEW ISSUANCE ❑ RE -ISSUANCE MODIFICATION WITH ACREAGE INCREASE ❑ Existing Permit Coverage Number (if applicable): \AAK1j2C,3CX0 Section I. Operator/Permittee Information. MODIFICATION WITHOUT ACREAGE INCREASE ❑ 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 Ill. K. of the VAR10 Permit). Construction Activity Operator Name: Nr)r-k:E0_; —k)! Contact person: �� J Address: City, State Zip code: p )I- Ile ZZ` IDS"As Phone number: 3ti I 5(v% - $�� ' `-�3`� Z� -��'� f > 0 Primary email:St)►,4, rn CC Email: 1 6'16err'P Aewe artJ �+e(� o� �S• Ltc B. Billing Information (leave blank if same as the Operator identified in Section 1. 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 NO ❑ DEQ 199-DRAFT PAGE 1 1 8 CONSTRUCTION GENERAL PERMIT (VAR10) REGISTRATION STATEMENT Section II. Construction Activity Location information. Project site information. A. include a site map showing the location of the existing or proposed land -disturbing activities, the limits of land disturbance, construction entrances and all water bodies receiving stormwater discharges from the site. B. Construction Activity Name:yt PCi A+ _ ,1P Address: 4u"+4 4 �'�C � f PraOA City and/or County and Zip code: [ L4je+cS�i Ire- ( Se �J z-2-`l l Latitude and Longitude (6-digit decimal degrees): C. Construction Activity Entrance Location (description, street address and/or latitude/longitude in decimal degrees): Section III. Offsite Support Activity Location information. List all offsite support activities to be included under this permit registration. Enter additional areas on a separate page. Offsite areas not included on this registration will need to obtain coverage under a separate VPDES permit. A. Offsite Activity Name: Address: City and/or County and Zip code: Latitude and Longitude (6-digit decimal degrees): B. Offsite Activity Entrance Location (description, street address and/or latitude/longitude in decimal degrees): Section IV. Site Information. A. Acreage totals for all land -disturbing activities to be included under this permit coverage. (to the nearest one -hundredth of an acre) Total land area of development (include the entire area to be disturbed under the approved Stormwater Management Plan): �(°g' CC) Estimated area to be disturbed (portions with Erosion and Sediment Control Plan approval only): Offsite estimated area to be disturbed (if applicable): C. Property owner status: D. Nature of the construction activity description (i.e. commercial, industrial, residential, agricultural, environmental): E. Municipal Separate Storm Sewer System (M54) name (if discharging to a MS4): B. Estimated Project Dates (M M/DD/YYYY) Start date: el 102-jzorl Completion date: Ot'1615)2 ;- FEDERAL ❑ STATE ❑ PUBLIC ❑ PRIVATE M+�"ecy [,[sue T PAGE 2 18 DEQ 199-DRAFT CONSTRUCTION GENERAL PERMIT (VAR10) REGISTRATION STATEMENT F. This construction activity is part of a common plan of development or sale: YES ❑ NOX Section V. Other Information. A. A stormwater pollution prevention plan (SWPPP) must be prepared in accordance with the requirements of the General VP DES Permit for Discharges of stormwater from Construction Activities rid or to submitting the registration statement. By signing the registration statement, the operator is certifying that the SWPPP has been prepared. B. Has an Erosion and Sediment Control Plan been approved for the disturbs ce in Section IV. A.? YES % NO ❑ If yes, provide the date of Erosion and Sediment Control Plan approval: -{IU TO 15 C. Land disturbance has commenced: YES X NO ❑ D. Storm water management maintenance agreement included (if applicable): YES ❑ Not Applicable7 E. If this project is using approved Annual Standards and Specifications jAS&Sj, attach the completed AS&S Entity Form. AS&S Entity Name (if different from the Operator identified in Section II. A.): SEE THE FOLLOWING PAGE FOR SIGNATURE AND CERTIFICATION REQUIREMENTS AND INFORMATION DEQ 199-DRAFT PAGE 3 18 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 activitysubject to the Act and this chapter. In the context of stormwater associated with a large orsmaIt construction activity, operator means any person associated with a construction project that meets either of the fallowing two criteria: (i) the person has direct operational control aver construction plans and specifications, including the ability to make m a difica tia ns to those pions and specifications a (ii) the persan has day- to- doy operational contraI of those activities at a project that are necessary to ensure compliance with a stormwater paflu tion prevention plan for the site or ather state permit a VSMP authority permit conditions (l.e., they are authorized to direct workers at a site to carry a u t activities required by the sform water pollution prevention plan a 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: o. For a corporation: by a responsible corporate officer. For the purpose of this chapter, a responsible corporate officer means: (i) a president secretary, treasurer, a vice-president of the carp aration in charge of a principal business function, ar 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 con ensure that the necessary systems are estoblished a actions taken to gather complete and accurate information forstote permit application re q uire rn e n ts; and where authority to sign documents has been assigned or delegated to the manager in accordance with corporate procedures; b. For a partnership a sale proprietorship: by a general partner a the proprietor, respectively; or c. For a municipality, state, federal, or ather 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 (U) 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: �ous w r � 1.to 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 P❑ Box 1105 Richmond VA 23218 constructiongp deci.virginia_.g-oy DEQ 199-DRAFT PAGE 4 18