The URL can be used to link to this page

Home My WebLink AboutWPO201700038 Correspondence 2019-06-27V/ VIRGINIA DEPARTMENT OF ENVIRONMENTAL QUALITY FOR OFFICE USE ONLY GENERAL VPDES PERMIT FOR DISCHARGES OF STORMWATER FROM ID Number: CONSTRUCTION ACTIVITIES (VAR10) REGISTRATION STATEMENT 2019 Technical Criteria: IIB IIC ❑ NEW ISSUANCE ❑ RE -ISSUANCE 2 MODIFICATION WITH ACREAGE INCREASE ❑ MODIFICATION WITHOUT ACREAGE INCREASE ❑ Existing Permit Coverage Number (if applicable, VAR30####): VAR10K327 /,0 AWd/7 74600F Section 1. Operator/Permittee Information. 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 VARSO Permit). Construction Activity Operator Name: University of Virginia Foundation Contact person: Not Perkins Address: P.O. Box 400218 City, State, Zip Code: C444 e- jJ� Phone Number: 434.982.6304 Primary Email: nperkins@uvafoundation.com CC Email: B. 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 m NO ❑ Rev 04/2019 11f3'2ik-� PAGE 117 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 stormwater discharges from the site. B. Construction Activity Name: Address: City and/or County and Zip Code Latitude and Longitude (6-digit, decimal degrees format): C. Construction Activity Entrance Location (description, street address and/or latitude/longitude in decimal degrees): University of Virginia Squash Facility 200 Wellington Dr Charlottesville VA 22903 38.0459,-78,5390 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 may 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 format): S. 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 �p Management Plan): / I Primary estimated area to be disturbed (portions with Erosion and Sediment Control Plan approval only): •� Offsite estimated area to be disturbed (if applicable): N 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: -Wlf 20(I I- g-oll Completion date: Ju 0ia FEDERAL ❑ STATE ❑ PUBLIC ❑ PRIVATE Rev 04/2019 PAGE 2 ) 7 CONSTRUCTION GENERAL PERMIT (VAR10) REGISTRATION STATEMENT 2019 F. Is this construction activity part of a common plan of development or sale? YES ❑ NO m G. 6`^ Order Hydrologic Unit Code (HUC) and Receiving Water Name(s). Attach a separate list if needed. HUC I RECEIVING WATERBODY(S) JR15 Section V. Other Information. Moore's Creek 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 submitted to the VESCP Authority for review? YES WI NO ❑ Erosion and Sediment Control Plan Approval Date (for estimated area to be disturbed).: C. Has land disturbance has commenced? YES m 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 D4/2019 PAGE 3 (7 CONSTRUCTION GENERAL PERMIT (VAR30) REGISTRATION STATEMENT 2019 Section VI. Certification. A person representing the operator as identified in Section I. A. and meeting the requirements of 9VAC25-880-70. Part III. K must physically sign this certification. A typed signature is not acceptable. Please note that operator is defined in 9VAC25-870-10 as follows: "Operator"means the owner or operator of any facility ar activity subject to the Act and this chapter. In the context of stormwater associated with a large or small construction activity, operator means any person associated with a construction project that meets either of the following two crlterla: (i)the person has direct operational control over construction plans and specocatlons, including the ability to make modifications to those plans and specifications or (Ill 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 authoritypermit conditions tl.e., they are authorized to direct workers at a site to carry out activities required by the stormwater pollution prevention plan or comply with other permit conditions). In the context of stormwater discharges from Municipal Separate Storm Sewer Systems (M54s), operator means the operator of the regulated MS4 system. 9VAC25-880-70. Part III. K. Signatory Requirements. 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: (i) a president, secretary, treasurer, or vice-president of the corporation in charge of a principal business functlon, or any other person who performs similar policy -making or decision -making functions for the corporation; or till the manager of one or more manufacturing, production, or operating focilitles, provided the manager is authorized to make management decisions that govern the operation of the regulated facillty 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. Fora partnership or sole proprietorship: by a general partneror 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 responsibility far 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: p()4% PL Signature (signed in Ink): Date: 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 DEO is the VSMP Authority, please send to: If the locality 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 P.O. Box 400218 Rev 04/2019 PAGE 4 17