HomeMy WebLinkAboutWPO201800068 Registration Statement 2018-10-23 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.)
Name: Albemarle County Service Authority
Contact:Alexander J. Morrison
Mailing Address: 168 Spotnap Road
City: Charlottesville State:VA Zip:22911 Phone: (434)-977-4511 •
Email address(if available): amorrison@serviceauthority.org
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: ACSA Operations Expansion: Parking Lot Expansion
Address(if available): 168.Spotnap Road
City: Charlottesville State: VA Zip: 22911
County(if not located within a City)Albemarle County
Latitude(decimal degrees): 38.0325 Longitude(decimal degrees):-78.4525
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 IN
5. Nature of the Construction Activity(e.g.,commercial,industrial,residential,agricultural,oil and gas,etc.):
Commercial / Business
6. Name of the Receiving Water(s)and Hydrologic Unit Code(HUC):
Name:Rivanna Rive - Meadow Creek Name:
HUC: JR14 HUC:
7. If the discharge is through a Municipal Separate Storm Sewer System(MS4),the name of the MS4 operator:
County of Albemarle
8. Estimated Project Start and Completion Date:
Start Date(mm/ddlyyyy): 04/01/2019 Completion Date(mmlddlyyyy): 09/01/2019
9. Total Land Area of Development(to the nearest one-hundredth acre): 0.57 acres
Estimated Area to be Disturbed(to the nearest one-hundredth acre):' 0.57 acres
10. Is the area to be disturbed part of a larger common plan of development or sale? Yes❑ No IN
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: "1 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: t6 n � t t lort'1mOr Title: Sesser trti Ene}near
Signature' Date: "0/23//S
(Please sign in I . his Certification must be signed by the appropriate person associated with the operator identified in
- Item#1.)
07/2014 Page 1 of 1