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WPO201900033 Permit 2020-01-06
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 ❑ IIC ❑ REGISTRATION STATEMENT 2019 NEW ISSUANCE 10 MODIFICATION WITH ACREAGE INCREASE ❑ RE -ISSUANCE C MODIFICATION WI_ THOUT ACREAGE INCREASE ❑ Existing Permit Coverage Number (if applicable, VAR10####): Section I. Operator/iPermittee information. A. Construction Activity Operator (Permittee). The person or entity that is applying for permft 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: OCT Stoneneld Property Owner LLC Contact person: Bill O'Conner Address: 535 Madison Ave, Sth Floor City, State, Zip Code: (212 318-7700 Phone Number: (212 318-7700 Primary Email: sbinsted@ralee-bolt— 1"eQ.cez44X4kN L'erl, CC Email: boronnorQoconnorcp.com S. 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 9 NO ❑ Rev 04/2019 PAGE 1 1 7 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 storrnwater discharges from the site. B. Construction Activity Name: The Shops at Stonefield Address: City and/or County and Zip Code: Charlottesville, VA 22901 Latitude and Longitude (64git, decimal degrees format): 38.06722, 78.48861 C. Construction Activity Entrance Location (description, street address and/or latitude/longitude in decimal degrees): 38.06722,-78.48861 Section 111. Oftske Support Activity Location Information. List all offsite support activities to be Included under this permit registration. Enteradditional areas on a separate page. Offsite areas not included on this registration may need to obtain coverage under a separate VPDES permit. A. Offske Activity Name: N/A 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 permit coverage. Report to the nearest one -hundredth of an acre. Total land area of development (including the entire area to be disturbed as approved In the Stormwater 66.80 Management Plan): Primary estimated area to be disturbed (portions with Erosion and Sediment Control Plan approval only) -.— 0.46 Off -site .estimated area to be disturbed (if applicable): 0 C. Property Owner Status: D. Nature of the Construction Activity Description (i.e. commercial, industrial, residential, agricultural, environmental): E. Municipal Separate Storm Sewer System (MS4) name (if discharging to a MS4): B. Estimated Project Dates (MM/DD/YYYY) Start date: 1/6/2020 Completion date: 8/1/2020 FEDERAL ❑ STATE ❑ PUBLIC © PRIVATE ❑ Commercial Albemarle .County Rev 04/2019 PAGE 2 17 CONSTRUCTION GENERAL. PERMIT (VAR10) REGISTRATION STATEMENT 2019 F. Is this construction activity part of a common plan of development or sale? YES ® NO El G. 61 Order Hydrologic Unit Code (HUC) and Receiving Water Name(s). Attach a separate list if needed. Section V. Other information. A. 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 Odor 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 ® NO ❑ Erosion and Sediment Control Plan Approval Date (for estimated area to be disturbed).:9Pl/19 C. Has land disturbance has commenced? YES ❑ NO D. If this 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.): SEE THE FOLLOWING PAGE FOR SIGNATURE AND CERTIFICATION REQUIREMENTS AND INFORMATION Rev 04/2019 PAGE 3 17 CDNSTRUCfION GENERAL PERMIT (VAR10) REGISTRATION STATEMENT 2019 Section Vl. Certification. A person representing the operator as identified in Section 1. A. and meeting the requirements of 9VAC25-BOD-70. Part Ili. K must physically sign this certification. A typed signature is not acceptable. Please note that operator is defined in 9VAC2S-87D•10 as follows: "Operatail means the owner or operator of any facliity or activity subject to the Act and this chapter. In the context of starmwater associated with a large or small construction activity, opemtor means any person associated with a construction project that meets either of the f Allowing two cdteda. (1) the person has direct operational control overconstruction plans and speclAcation4 including the abdity to make modiflcatlons to those playas and spec(ftaa dons or (11) the person has day-to-day operational control of those activities at a praiect that are necessary to ensure compliance with a stormwater pollution praevention picas for the site or otherstate permit or VSMP authority permit conditions (i.e., they are authorised to direct workers at.a site to cony out activides required by the stormwater pollutlon prevention pion or comply with other permit condHow). In the context ofstormwater discharges from Munkipol Separate Storm Sewer Systems {MS4s), operator means the Wn for of the regulated MS4 system. 9VAC25-88t1-70. Part Ill. K. Signatory Requirements. Registration Statement All Registration Statements shell be signed os follows: a. Fora corporation. by a responsibk corporate ofj%er. For the purpose of this chapter, a responsible corporate o flker means. (1J a president; secretary, treasurer, or vice-president of the corporation In charge of a principal business function, or any other person who perjbrms slmilarpoficy-raking or drdslon-making f wdom f or the co► wrotlon; or (H) the manager of one or more monufacturing, producfibk aroperatin9fadftle4 provided the manager is authorised to make management d mWans that govem the operation of the raagukdW fadiity including lurving the magp► dt or implkit duty of making major capital Investment recommendations, and haltloting and dk-ecting othercomprehendw measures to assure long-term compliance with envlmnmental laws and regulations; the manager con ensure that Lire necessary systems are eg abffdW or actions taken to gather conplete and accurate information forstate permit applicationrequirements; and where audwifty to sign documents has been assigned or delegated to the manager In accordance with corporate procrdures; b. Fora parMership orsole proprido bip: by a general partneror the prvpril w, respecumly; or c. For a municipality, state, j ederd6 or other publk agency. by either a prindpal executive after or ranking elected official. For purposes of this chapter, a principal executive of cer of a publk agency includes: (Ij the chief executive offer of the agency or 00 a senior executive officer having responsffifHty for the overall aperadons of a principal gergmphk 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 Use information including the possibility of One and imprisonment for knowing violations." Printed Name: Signature (slimed In ink): Date: ~•-. 1 r 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. Department of Environmental Quality Office of Stwrnwater Management Suite 1400 PO Box lies Richmond VA 23213 sortructionea@dea.yirelnia.eav If the locality is the.VSMP Authoritx, please send to. Albemarle County 401 McIntire Road Charlottesville, VA 22902 Rev 04/2019 PAGE 4 17