HomeMy WebLinkAboutWPO201800055 Permit 2018-07-03 General Permit for Discharges of Stormwater from Construction Activities(VAR10)
Registration Statement
(Please Type or Print All Information)
1. Construction Activity Operator(The permit will be issued to this operator, and the Certification in Item#13 must be signed by the
appropriate person associated with this operator[see the instructions]):
Name: OLD TRAIL HEIGHTS LLC
Mailing Address: 400 LOCUST AVE#3
City:CHARLOTTESVILLE State:VA Zip: 22902 Phone: (434)977-6400
Email address(if available): Robby@tbmcom.com
Indicate if DEQ may transmit the permit electronically: Yes No
2. (Must be included for renewals of coverage only)Existing Permit Coverage#:
3. Location of Construction Activity:
Name:OLD TRAIL HEIGHTS
Address:NORTHEAST QUADRANT OF INTERSECTION OF OLD TRAIL DRIVE AND ASHLAR AVENUE
City: CROZET State: VA Zip: 22932
County: ALBEMARLE
DMS to the nearest 15 seconds:Latitude 38°3'34"N Longitude 78°42'40"W -
Location of all Offsite Support Activities to be Covered Under the Permit:
Name:
Address:
City: State: Zip:
County:
If street address unavailable: Latitude Longitude
4. Status of Activity:Federal ❑ State❑ Public❑ Private (Check one only)
5. The Nature of the Construction Activity(e.g.,commercial,Industrial, residential,agricultural,oil and gas,etc.):
RESIDENTIAL BUILDING W/COMMERCIAL FIRST FLOOR
6. Name of the Receiving Water(s): LICKINGHOLE CREEK
Hydrologic Unit Code(HUC): JR02
(Receiving waters identified as impaired on the 2008 305(b)/303(d)Water Quality Assessment Integrated Report or for which a
TMDL WLA has been established for stormwater discharges from a construction site shall be noted in an attached list.)
7. If the discharge is through a Municipal Separate Storm Sewer System(MS4),the name of the municipal operator of the
storm sewer:
8. Estimated Project Start Date(mmiddlyyyy): JULY 23, 2018
Estimated Project Completion Date(mmldd/yyyy):JUNE 1, 2019
9. Total Land Area of Development(to the nearest one-tenth acre): 0.3
Estimated Area to be Disturbed(to the nearest one-tenth acre): 0.3
10. Is the area to be disturbed by the construction activity part of a larger common plan of development or sale?Ye I.NoL
11. Are nutrient offsets intended to be acquired for this activity?Yes❑ No Under considerations
12. A stormwater pollution prevention plan (SWPPP) must be prepared in accordance with the requirements of the General
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.
13. 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."
Print Name: £:.' ( • eA Voy"''"A Title: MA 4/ t e r
Signature: ( Date: 3 i
(Please sign in I K.The person signing his for must be ciated with the operator identified in Item#1 above.)
Mail to: Department of Environmental Quality,Office of Stormwater Management. 10th Floor, P.O. Box 1105, Richmond,VA 23218
(DEQ 199-146)(08/13)