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Home My WebLink AboutWPO201800043 Other 2019-07-29 VIRGINIA DEPARTMENT OF ENVIRONMENTAL QUALITY FOR OFFICE USE ONLY GENERAL VPDES PERMIT FOR DISCHARGES OF STORMWATER FROM ' ID Number: _ CONSTRUCTION ACTIVITIES (VAR10) Technical Criteria: IIB ElIIC ❑ REG ISTRATIO N STATEM E NT 2019 - NEW ISSUANCE C RE-ISSUANCE 0 MODIFICATION WITH ACREAGE INCREASE El MODIFICATION WITHOUT ACREAGE INCREASE ❑ Existing Permit Coverage Number (if applicable,VAR10####): V.A'R M"C Se/ 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 Environmental Quality Resources, LLC Operator Name: Contact person: Chris Wharton Address: 6802 Paragon Place Suite 410 Richmond, VA 23230 City, State, Zip Code: (443) 833-5257 Phone Number: cwharton@egrllc.com Primary Email: annemarie@ecosystemservices.us/kburton@egrllc.com CC Email: 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: Liberty Hall Farm Holdings, LLC Contact Person: Grey McLean, Landowner Address: 2798 Liberty Hall Lane City,State Zip Code: Charlottesville, VA 22902 Phone Number: (434) 977-0112 Primary Email: grey@adiuvans.org CC Email: annemarie@ecosystemservices.us 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 In NO EZZ, �� Rev 04/2019 PAGE 1 17 fett5beleir e0( 9 CONSTRUCTION GENERAL PERMIT(VAR10) REGISTRATION STATEMENT 2019 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: Liberty Hall Stream Restoration Address: 2798 Liberty Hall Lane City and/or County and Zip Code: Charlottesville,VA 22902 Latitude and Longitude 38.113119 -78.566719 (6-digit,decimal degrees format): C. Construction Activity Entrance Location (description,street address and/or 38.113119, -78.566719 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 may need to obtain coverage under a separate VPDES permit. A. Offsite Activity Name: wp` • Address: City and/or County and Zip Code: Latitude and Longitude (6-digit, decimal degrees format): 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 B. Estimated Project Dates permit coverage. Report to the nearest one-hundredth of an acre. (MM/DD/YYYY) Total land area of development(including the entire area to be disturbed as approved in the Stormwater 4.99 Start date: 07/15/19 Management Plan): Primary estimated area to be disturbed (portions with 1 '16( Erosion and Sediment Control Plan approval only): ' Completion date: 10/30/19 Offsite estimated area to be disturbed (if applicable): N/A C. Property Owner Status: FEDERAL ❑ STATE ❑ PUBLIC El PRIVATE C D. Nature of the Construction Activity Description (i.e. commercial,industrial, residential,agricultural, environmental): Environmental on Agricultural Property E. Municipal Sepa,rate,Sform;.SdeWter System(MS4) County of Albemarle name (if discliargingto a MS4) Rev 04/2019 PAGE 2 17 • -a . CONSTRUCTION GENERAL PERMIT(VAR10) REGISTRATION STATEMENT 2019 F. Is this construction activity pa rt of a common plan of development or sale? YES ❑ NO G. 6th Order Hydrologic Unit Code (HUC) and Receiving Water Name(s). Attach a separate list if needed. HUC RECEIVING WATERBODY(S) 020802040102 Mechums River Section V. Other Information. A. Astormwater 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 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 submitted to the VESCP Authority for review? YES C NO El Erosion and Sediment Control Plan Approval Date (for estimated area to be disturbed).: C. Has land disturbance has commenced? YES aC NO ❑ D. Ifthis project is using approved Annual Standards and Specifications(AS&S), attach the completed AS&S Entity Form. AS&S Entity Name (if different from the Operator identified in Section II.A.): N/A SEE THE FOLLOWING PAGE FOR SIGNATURE . AND CERTIFICATION REQUIREMENTS AND INFORMATION Rev 04/2019 PAGE 3 17 CONSTRUCTION GENERAL PERMIT(VAR10) REGISTRATION STATEMENT 2019 w— • ti Section VI. Certification. A person representing the operator as identified in Section I.A.and meeting the requirements of 9VAC25-880-70.Part III. K must physically sign this certification. A typed signature is not acceptable. 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 storm water 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 stormwater pollution prevention plan for the site or other permit or VSMP authority permit conditions(i.e., they are authorized to direct workers at a site to carry out activities required by the storm water 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.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; (ii)the manager Of one ormore manufacturing,production';or operating facilities;provided the inanagerrs'authbrized to Mae 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 ennsure that"the necessary systerns 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 orthe 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 officerof a public agency'includes:(i)the chief executive officer of the agency or(ii)a senior executive officer having responsibility forthe.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: Chris Wharton: • Y,Yywd q Chrb K,ufm F °" h.ban®eprkrm,LN6Ma Signature (signed in ink): Chris Whartor ,..7.,,,,,,,,,,,4_ Date: 7/29/2019 Section VII. Submittal Instructions. Submit this form to the Virginia Stormwater Management Program(VSMP) Authority. If the locality is the VSMP Authority, please send your Registration Statement submittal directly to the locality; do NOT send this form to DEQ. A list of local VSMP Authorities is available here: VSMP Authorities. If DEQ is the VSMP Authority,please send to: If the locality is the VSMP Authority,please send to: Department of Environmental Quality The Local VSMP Authority (insert address below) Office of Stormwater Management Suite 1400' PO Box 1105 Richmond VA 23218 • • constructiongp@deq.virginia.gov Rev 04/2019 PAGE 4 17 •