HomeMy WebLinkAboutWPO201700031 Permit 2019-11-12VIRGINIA DEPARTMENT OF ENVIRONMENTAL QUALITY
GENERAL VPDES PERMIT FOR DISCHARGES OF STORMWATER FROM CONSTRUCTION ACTIVITIES (VAR10)
NOTICE OF TERMINATION 2019
Permit Coverage Number (VAR10####):Vr"-% r ° V O 1 23q
Section I. Operator/Permittee Information. The person or entity that has active permit coverage approval and 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 VII (per Part III. K. of the VAR10 Permit).
Construction Activity
Operator Name: % -- x � Pm l�
Contact Person:
Address: I-�1r.gfl�JexarTt�
City, State, Zip Code:
Phone Number: ��CP `�� 4Q
Primary Email: [ �hki�iU
CC Email:
Section H. Construction Activity Location Information. Project site information.
Construction Activity Name: ���� I N DC%'*' & P am. 'rdaCAL4—N
Address: ' 1��j i �—xY� 7
City and/or County and Zip Code: VA 22!b!?
Latitude and Longitude
(6-digit, decimal degrees format):�7�
Section III. Reason for Terminating Coverage under the General Permit. The operator shall submit a Notice of Termination within
30 days after meeting one or more of the following conditions (select one or more):
XA. Necessary permanent control measures included in the SWPPP for the site are in place and functioning effectively and final
stabilization has been achieved on all portions of the site for which the operator is responsible. When applicable, long-term
responsibility and maintenance requirements for permanent control measures shall be recorded in the local land records
prior to the submission of a Notice of Termination;
❑ B. Another operator has assumed control over all areas of the site that have not been finally stabilized and obtained coverage for
the ongoing discharge;
❑ C. Coverage under an alternative VPDES or state permit has been obtained; or
❑ D. For residential construction only, temporary soil stabilization has been completed, the operator has provided written
notification to the homeowner about the importance of final stabilization and incorporating a copy of the notification and
signed certification statement into the SWPPP and the residence has been transferred to the homeowner.
Rev 04/2019
PAGE 1 1 6
CONSTRUCTION GENERAL PERMIT (VAR10) NOTICE OF TERMINATION 2019
Section IV. Participation in a Regional Stormwater Management Plan. If your site discharges to a regional stormwater
management facility, provide information related to the regional stormwater management plan. Attach a separate list if discharging
to multiple regional facilities.
Regional Stormwater Management
Facility Type:
Address:
City and/or County and Zip Code:
Latitude and Longitude
(6-digit, decimal degrees format):
Total Acres Treated by Regional Facility
(report to one -hundredth of an acre):
Impervious Acres Treated by Regional Facility
(report to one -hundredth of an acre):
Section V. Perpetual Nutrient Credits. If your site is utilizing nutrient credits, provide information related to the perpetual nutrient
credits that were acquired in accordance with § 62.1-44.15:35 of the Code of Virginia. Attach a separate list if needed.
Nonpoint Nutrient Credit Generating Entity
(Bank Name):
Perpetual Nutrient Credits Acquired
(pounds/acres/year):
Include the affidavit of sale for all nutrient credits acquired. Is the affidavit of sale of nutrient credits attached? DYES ONO
Section VI. Permanent Control Measures. If applicable, list the post -development stormwater management facilities or best
management practices (BMPs) that were constructed and installed as part of this activity to comply with the stormwater
management technical criteria (structural and nonstructural, on -site and off -site). Attach a separate list if needed.
If you have permanent control measures, the following items are required to be included with this form in order to complete your
Notice of Termination submittal:
H g. Engineer's Certification Statement
B. As -built plans (construction record drawings) — digital _
As -built plans (construction record drawings) —full-sized, paper f
❑ D. Stormwater Management Plans — digital -� . nx�� - ( QU OP
BMP Maintenance a ent —notarize original, for public and private projects under DEQ's VSMP AutFfority ' r�'
Stormwater Management Facility Types (please choose from the following bmp types):
Bioretention 1
Bioretention 2
Bioretention basin
Bioretention filter
Constructed Wetland 1
Constructed Wetland 2
Constructed wetlands
Dry Swale 1
Dry Swale 2
Extended detention (2 x WQ Vol)
Extended Detention Pond 1
Extended Detention Pond 2
Extended detention -enhanced
Filtering Practice 1
Filtering Practice 2
Grass Channel
Grassed swale
Infiltration (1 x WQ Vol)
Infiltration (2 x WQ Vol)
Infiltration 1
Infiltration 2
Other 118 (manufactured
treatment device, etc.)
Other IIC (manufactured
treatment device, etc.)
Permeable Pavement 1
Permeable Pavement 2
Rainwater Harvesting
Retention basin 1 (3 x WQ Vol)
Retention basin II (4 x WQ Vol)
Retention basin III (4 x WQ Vol
with aquatic bench)
Sand filter
Sheetflow to Vegetated Filter or
Conserved Open Space 2
Soil Amendments
Urban Bioretention
Vegetated filter strip
Vegetated Roof 1
Vegetated Roof 2
Wet Pond 1
Wet Pond 2
Wet Swale 1
Wet Swale 2
Rev 04/2019
PAGE 216
CONSTRUCTION GENERAL PERMIT (VAR10) NOTICE OF TERMINATION 2019
Stormwater Management Facility #1
BMP Type:�b
Date BMP Became Functional:
12 /ao
`iV515 (OLD', L
Address (if available):
� • (OC:jOLF
City and/or County and Zip Code:
Latitude and Longitude
(6-digit, decimal degrees format):
Receiving Water(s)
(outfall discharge):
1 r\C'blZ�j
Total Acres Treated
(report to one -hundredth of an acre):
2 t (p
Impervious Acres Treated
i
(report to one -hundredth of an acre):
Stormwater Management Facility #2
BMP Type:
It
10
Date BMP Became Functional:
Address (if available):
� .�j�
City and/or County and Zip Code:
Latitude and Longitude
(6-digit, decimal degrees format):
SIC�7 . ( �-� 4 •-' l 0 , '53q-7
Receiving Water(s)
(outfall discharge):
KV
Total Acres Treated
(report to one -hundredth of an acre):
2
Impervious Acres Treated
(report to one -hundredth of an acre):
Stormwater Management Facility #3
BM P Type:
Date BMP Became Functional:
Address (if available):
City and/or County and Zip Code:
Latitude and Longitude
(6-digit, decimal degrees format):
Receiving Water(s)
(outfall discharge):
Total Acres Treated
(report to one -hundredth of an acre):
Impervious Acres Treated
(report to one -hundredth of an acre):
Rev 04/2019 PAGE 3 16
CONSTRUCTION GENERAL PERMIT (VAR10) NOTICE OF TERMINATION 2019
Section VII. Certification. This Certification must be signed by a person representing the operator identified in Section I. and
meeting the requirements of 9VAC25-880-70 Part III K.
Certification: "I certify under penalty of law that I have read and understand this Notice of Termination 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
Printed Name:
Signature (signed in ink):
Date:
1 / `4
Section Vill. Submittal Instructions. Please submit this form to the Virginia Stormwater Management Program (VSMP) Authority
that has jurisdiction for your construction activity. If the locality is the VSMP Authority, please submit your form 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 Stormwater Management Suite 1400
PO Box 1105
Richmond VA 23218
constructiongp@deg.virginia.gov_
If the locality is the VSMP Authority, please send to:
The Local VSMP Authority (insert address below)
Permit terminations may be delayed if there are
outstanding annual permit maintenance fee balances due.
Rev 04/2019
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CONSTRUCTION GENERAL PERMIT (VAR10) NOTICE OF TERMINATION 2019 INSTRUCTIONS
PLEASE DO NOT PRINT OR SUBMIT
A complete and accurate Notice of Termination is required for terminating coverage under the General VPDES Permit for Discharges
of Stormwater from Construction Activities. Termination shall become effective upon notification from the department that the
provisions of termination have been met or 60 days after submittal of a complete and accurate Notice of Termination, whichever
occurs first.
Authorization to discharge terminates at midnight on the date that the Notice of Termination is submitted unless otherwise notified
by the VSMP authority or the department.
Permit Coverage Number. Include your existing, active permit coverage number. Example: VAR10####.
Section I. Operator/Permittee Information. The construction activity operator (permittee). The permittee with active permit
coverage and that has operational control over the construction activities to ensure compliance with the general permit. For
companies, use the complete, active, legal entity name as registered with a state corporation commission. Entities that are
considered operators commonly consist of the property owner, developer of a project (the party with control of project plans and
specifications), or general contractor (the party with day-to-day operational control of the activities at the project site that are
necessary to ensure compliance with the general permit). If an individual person is named as the operator, that person (or a
representative of) must sign the certification in Section VII.
Section II. Construction Activity Location Information. Project site information. Complete this section with the same information
as listed on the current registration statement. A list of active permits and corresponding location information is available on our
website.
Section Ill. Reason for Terminating Coverage under the General Permit. The operator shall submit the Notice of Termination no
later than 30 days after one or more of the termination conditions being met. Authorization to discharge terminates at midnight on
the date that the Notice of Termination is submitted to the VSMP Authority, unless otherwise notified by the VSMP authority or the
Department. Termination of authorizations to discharge for the conditions shall be effective upon notification from the Department
that the provisions of termination have been met or 60 days after submittal of the Notice of Terminations, whichever occurs first.
The operator of the construction activity shall submit a Notice of Termination within 30 days after meeting one or more of the
following conditions (you may select one or more of these conditions):
• [A] Necessary permanent control measures included in the SWPPP for the site are in place and functioning effectively and final
stabilization has been achieved on all portions of the site for which the operator is responsible has operational control. When
applicable, long-term responsibility and maintenance requirements for permanent control measures shall be recorded in the
local land records prior to the submission of a complete and accurate Notice of Termination;
• [B] Another operator has assumed control over all areas of the site that have not been finally stabilized and obtained coverage
for the ongoing discharge;
• [C] Coverage under an alternative VPDES or state permit has been obtained; or
• [D] For individual lots in residential construction only, temporary soil final stabilization as defined in 9VAC25-880-1, has been
completed and the residence has been transferred to the homeowner.
Section IV. Participation in a Regional Stormwater Management Plan. Where applicable, include information for each regional
stormwater management facility to which this site contributes. If your site is contributing to more than one regional facility, please
include the information for each facility in a separate list.
The following information shall be included for each regional stormwater management facility installed:
• the type stormwater management facility (see the list of facility types on page 2 of the Notice of Termination);
• the physical location of the facility, including city or county, and latitude and longitude in decimal degrees;
• the receiving water to which the regional facility is discharging; and
• the number of total and impervious acres treated by the regional stormwater management plan to the nearest one -hundredth
of an acre. The total of the impervious acreage may equal but not exceed the total acreage.
Section V. Perpetual Nutrient Credits. If your site is utilizing nutrient credits, provide information related to all perpetual nutrient
credits acquired in accordance with § 62.1-44.15:35 of the Code of Virginia. Attach a separate list if needed. Attach the affidavit(s)
of sale for the purchase of all nutrient credits acquired for this activity.
Rev 04/2019 PAGE 5 16
CONSTRUCTION GENERAL PERMIT (VAR10) NOTICE OF TERMINATION 2019 INSTRUCTIONS
PLEASE DO NOT PRINT OR SUBMIT
Section VI. Permanent Control Measures. If applicable, list all post -development stormwater management facilities or best
management practices (BMPs) that were constructed and installed as part of this activity to comply with the stormwater
management technical criteria (structural and nonstructural, on -site and off -site). Choose the type from the list provided in the
Notice of Termination form Section VI. If you have multiple BMPs, attach a separate list if needed.
The following information shall be included for each permanent control measure installed:
• the type of permanent control measure receiving the discharge (choose from list provided);
• the date that it became functional as a permanent control measure (MM/DD/YYYY);
• the location of the BMP, including city or county, and latitude and longitude in decimal degrees;
• the receiving water(s) to which the permanent control measure discharges; and
• the number of total and impervious acres treated by the permanent control measures to the nearest one -hundredth of an acre.
The total of the impervious acreage may equal but not exceed the total acreage.
The following items are required to be submitted with the Notice of Termination if you have permanent control measures:
• Engineer's Certification Statement. Signed by a professional registered in the Commonwealth of Virginia, certifying that the
stormwater management facilities were constructed in accordance with the approved plan.
• Construction record drawing(s) (as -built plan) in a format as specified by the VSMP authority for permanent stormwater
management facilities in accordance with 9VAC25-870-55 D appropriately sealed and signed. One digital and one full-sized
paper copy.
• Stormwater management plans (digital)
• BMP Maintenance Agreement. Submit an original, signed and notarized BMP Maintenance Agreement for all public and private
permits where DEQ is the VSMP Authority. Termination is not final until you submit the local court record of receipt to DEQ
showing that the signed Stormwater Management Maintenance Agreement was recorded with the land deed.
Section VII. Certification. This Certification must be signed by a person representing the operator identified in Section I. and
meeting the requirements of 9VAC25-880-70. Part III. K.
Section Vill. Submittal Instructions. Submit this form to the VSMP Authority that has jurisdiction for your construction activity. The
VSMP Authority maybe either DEQ or your locality depending on the location and type of project. If your project is under the
jurisdiction of a Local VSMP Authority, please contact the locality for additional submittal instructions. A blank area is provided for
the Local VSMP Authority to include their mailing address.
Who is the VSMP Authority for my project? DEQ or the locality?
• DE(: DEQ is the VSMP Authority and administers permit coverage for land -disturbing activities that are:
➢ within a locality that is not a VSMP Authority;
➢ owned by the State or Federal government; or
➢ utilizing approved Annual Standards and Specifications.
• The Locality: The local government (locality) is the VSMP Authority and administers permit coverage for all other projects not
covered by DEQ as listed above. For these projects, please submit permit forms directly to the Local VSMP Authority. A list of
Local VSMP Authorities is available on DEQ's website here: Local VSMP Authority List.
DEQ'S CONSTRUCTION GENERAL PERMIT WEBSITE
htt /`www.dea.virginia-Roy/Programs/WateriStormwaterManagemenyVSMPPermits/ConstructionGeneralPermit aspx
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Rev 04/2019 03/U303d
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