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Home My WebLink AboutWPO200600050 Correspondence 2019-05-21N DRAFT VIRGINIA DEPARTMENT OF ENVIRONMENTAL QUALITY GENERAL VPDES PERMIT FOR DISCHARGES OF STORMWATER FROM CONSTRUCTION ACTIVITIES REGISTRATION STATEMENT NEW ISSUANCE O MODIFICATION WITH ACREAGE INCREASE ❑ Existing Permit Coverage Number (if applicable Section I. Operator/Permittee Information, RE -ISSUANCE FOR OFFICE USE ONLY ID Number: Technical Criteria: 118 O IIC ❑ MODIFICATION WITHOUT ACREAGE INCREASE ❑ 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 Operator Name: I WITM I ANn Contact person: Address: City, State Zip code: Phone number: Primary email: CC Email: B. Billing Information (leave blank if same as the Operator identified in Section 1. A. above). This entity will receive Annual Permit Maintenance and Permit Modification Fee invoices (If applicable). Name: M, 11 - . _ . _ . _ _ Contact person: Address: City, State Zip code: Phone number: Primary email: CC Email: 180 C. May we transmit correspondence electronically? You must choose credit card and to receive your permit coverage approval letter via email: YES 0 NO ❑ email in order to pay by DEQ 199-DRAFT PAGE 1 1 8 CONSTRUCTION GENERAL PERMIT (VAR10) REWSTRATION STATEMENT 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: Address: City and/or County and Zip code: Latitude and Longitude (6-digit decimal degrees): C. Construction Activity Entrance Location (description, street address and/or latitude/longitude in decimal degrees): NORTHTOWN CENTER GANDER DR CHARLOTTESVILLE, VA 22901 38.09195 AND-78.467773 GANDER DRIVE 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 will need to obtain coverage under a separate VPDES permit. A. Offsite Activity Name: Address: City and/or County and Zip code: Latitude and Longitude (6-digit decimal degrees): B. Offsite Activity Entrance Location (description, street address and/or latitude/longitude in decimal degrees): Section IV. Site Information. 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): DEQ 199-DRAFT 4Completion mated Project Dates (MM/DD/YYYY) te: 10/1/2011 date: 1 //30/2018 FEDERAL ❑ STATE ❑ PUBLIC ❑ PRIVATE COMMERCIAL PAGE 2 18 CONSTRUCTION GENERAL PERMIT (VAR30) REGISTRATION STATEMENT F. This construction activity is part of a common plan of development or sale: G. 6" Order Hydrologic Unit Code HUC 020802040203 and associated Receiving Water RECEIVING SOUTH FORK RIVANNA RIVER additional HUCs and 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 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 approved for the disturbance in Sect* V. A.? YES ® NO ❑ If yes, provide the date of Erosion and Sediment Control Plan approval: 2013 C. Land disturbance has commenced: YES ® NO ❑ W2-12-09 t D. Stormwater management maintenance agreement included (If applicable): YES ❑ Not Applicable ❑ E. 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 11. A.): SEE THE FOLLOWING PAGE FOR SIGNATURE ARID CERTIFICATION REQUIREMENTS AND INFORMATION DEQ 199-DRAFT PAGE 3, 8 CONSTRUCTION GENERAL PERMIT (VAR10) REGISTRATION STATEMENT Section VI. Certification. This Certification must be signed by a person representing the operator identified in Section II. A. and meeting the requirements of 9VAC25-880-70. Part III, K. 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: (/) the person has direct operational control over construction plans and specifications, including the ability to make mod/fications to those plans and specifications or (11) 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 state 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 storm water discharges from Municipal Separate Storm Sewer Systems (MS4s), operator means the operator of the regulated M54 system. 9VAC25-880-70. Part III. K Signatory Requirements: 1. 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: N 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; or (11) the manager of one or more manufacturing, production, or operating facilities provided the manager is authorized to make 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 ensure that the necessary systems 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 omarfienh/p or sole proprietorship: by a general partner or the 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 officer of a public agency includes N the chief executive officer of the agency or (11) a senior executive officer having responsibilityfor the 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: AU,—L"- / 1 1 1,,,.- I i "o r , . / 1) / Signature (signed in Ink): Date: Submit this form to the VSMP Authority, If DEQ is the VSMP Authority, please send to: Department of Environmental Quality Office of Starmwater Management Suite 1400 PO Box 1105 Richmond VA 23218 DEQ 199-DRAFT PAGE 4 18