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HomeMy WebLinkAboutWPO201800036 Construction General Permit (VAR 10) Registration Statement 2019-06-04�A4t� VIRGINIA DEPARTMENT O ENVIRONMENTAL QUALITY ATER FOR OFFICE USE ONLY GENERAL VPDES PERMIT FOR DISCHARGES OF STURMWATLsR FROM CONSTRUCTION ACTIVITIES (VAR10) FID Number; REGISTRATION STATEMENT 2019 hnical Criteria. NB © IiC CI NEW ISSUANCE CJ RE -ISSUANCE f MODIFICATION jffH ACREAGE INCREASE C MODII:ICATbN Wit rr ACREAGE INCREASE Existing Permit Coverage Number (if applicable, VARlW###)_ VAR IDL241 tA I7 20fF_ . Section L Operator/Permlttee Information, A. Construction Activity Operator (Perminee). 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 Ili. K, of the VAR10 Permit). Construction Activity Operator Name, Contact person - Address: City. State, Zip Code: Phone Number: Primary Email: CC Email: Stony Point Design Build LLC Josh Batman 200 Garrett st. Suite 0 Charlottesville. VA 22902 434 941 5257 ibatman@stDnypointdb.com chenryci Di stonypointelb.com unting@stonypointdb,com B, Billing Information (leave blank if some 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 lid NO n Rev 04/2019 PAGE117 V CONSTRUCTION GENERAL Pf RMIT (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. 0. Construction Activity Name: Dunlora Park Lots 12, 13, 14, 22, 23 and 24 Townhornes Address: Varick St and Merin Ct City and/or County and Zip Code; Charlottesville, VA 22901 Latitude and Longitude (6-digit, dedmai degrees format): L4% ' 3 Q_D(c f 404,. - -7 9, L%OpF2q C. Construction Activity Entrance Location (description, street address and/or latitude/longitude In decimal degrees): Section lil. 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: jtI Address: City and/or County and Zip Code: Latitude and Longitude (6-digit, decimal degrees format): S. Offslte Activity Entrance Location (description, street address and/or latitude/longitude in decimal degrees): Section IN. 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 f Nlanawamant Alanl- Primary estimated area to be disturbed (portlons`with / Erosion and Sediment control. Plan approval onl Offsite estimated area to be disturbed (if applicable): C. Property owner Status: 0. Estimated Project Dates (MM/DD/YYYY) Start -date: c�s�a�f2�u Completion date: *16-12011 FEDERAL 0 STATE © PUBLIC J PRIVATE is D. future of the Construction Activity Description (Le. commercial, industrial, residential, agricultural, environmental): Residential E. Municipal Separate Storm Sewer System (MSS#) name (if discharging to a M54): Rev 04/2019 PAGE 2 17 CONSTRtlC'irTON GENERAL PERMIT (VAR10) IiFG15TRATtm sTATEMENT 2019 F. Is this construction activity part of a common plan of development or sale? YEtVNO I] G. Sd'Order Hydrologic Unit Code (HU[C) and Receiving Water Name(s). Attach a separate list if needed. FiUC r _ RECEIVING WATEiRBODY(S) Section V. tither 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 12rior 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 VNO.0 Erasion and Sediment Control Plan Approval _Date (for estimated area to be disturbed).: —"A ; +P:. A01 i C. Has land disturbance has commenced? YES-1NO J 8040 44qu~ D. If this project is using approved Annual Standards and Specifications (AS&S), attach the completed AS&S Entity Dorm, AS&S Entity Name (if different from the Operator identifies) in Section II. A.): /A SEE THE FOLLOWING PAGE FOR SIGNATURE AND CERTIFICATION REQUIREMENTS AND INFORMATION Rev 04/2019 PAGE 3 17 CONSTRUCTION GENERAL ptia mi r (VARio) REGISTRATION STATEMENT 2019 Section VI. Certification. A person representing the operator as identified in Section 1. A. and meeting the requirements of 9VAC25-99040. Part Ill, K must physically sign this certification, A typed signature is not acceptable. Please note that operator is defined in 9VAC25-870-10 as follows: '01WMtor" means the owner or apemtar of any foci#ty. or pctivfty subject to Me Act and this chapter. in the context of stormwater associated with o forge orsmafl canstruc an activity, operator means any person associated with a construction protect that meets ether of the foflawing two criteria: (i) the person has direct operational control over construction plans and specifications, including the ability to make modifications to those plans and spetaiflcodons or (H) the person has day -today operational con trot of those activities at a project that art necessary to ensure compliance with a stannwater pollution prevention plan for the site or other state Permit or v5MP authority permit conditions (i.e., they qre authorized to direct workers at a site to carry out activities required bythe sWirnwater pollution prevention plan or comply with other permit conditions). In the context of stormwater discharges from MunidpolSeparateStorm SewerSystems(M54s),operdformeanso operatoroftfheregulatedMS4system. 9VAC25-880.70. Part Ill. K. Signatory Requirements, ReOlstradon Statement All Registration Statement$ shall be signed as follows: a. For a corporatlon: by a responsible corporate Officer, for the purpose of this chapter, a responsible corporate offker means: (1) a presiden4 secretary, treasurer, atVlce-president of the corporation in change of a principal business function, or any Other person Who performs similar polfcy-tr►aking ar decls'lan-makkg forictlans for the corporation; or (11) the manager of one or more maru factuiing, production, or operating futilities, provided the manager is authorised to make management decisions that govern the operation of the regulated fadlity including having the explide or Implicit duty of making major capital Investment recommendations, and inldoting and directing other comprehensive measures to assure long-term compliance with environmentallaws and r>egulcitions; the monager can ensure that the necessary systems are estobfished or actions taken .to Bother complete and accurate information for state permit application requirements; and where authority to sign d0almetits has been assigned or delegated to the manager in accordance with corporate procedures; b. For a partnership or sole proprietorship: by a general partnerar the proprfetar, respectively; or c. For a municipality, state, federal, or other p�bfic agency., by either a principal executive officer or ranking elected official For purposes of this chapter, a principal execuOve officer of a public agency Includes: A) the chief executive afficer of the agency or (fi) a senior executive officer having;responsibilityfor the overall operations of a principal geographic un)tof the agency. Certification: "I certify under penalty of law that lihave 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 'ubmitted. Based on my inquiry of the person or persons who manage We 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: Signature (signed In ink); Date: Section VII. Submittal Instructions. 4ubmit this form to the Virginia Stormwater Management Program (VSMP) Authority. If the locality is the V5MP Authority, phase send your Registration Statement submittal directly to the locality; do NOT send this form to DEQ. A list of local V5MP Authorities is available here: j SMPA9thorities. EQLs thr, YMVI&Whority. please send to; If the locality is the VSMP Authorit please send to. Department -of Environmental Quality Office of Storrs water Management Suite 1400 PO lid 1105 iticllmond VA Z5Z18 n..yl_,d1Sg 1.€+.,Rli Local Rev 04/2019 PAGE 4 17