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Home My WebLink AboutWPO201400028 Correspondence 2019-04-11DRAFT VIRGINIA DEPARTMENT OF ENVIRONMENTAL QUALITY GENERAL VPDES PERMIT FOR DISCHARGES OF STORMWATER FROM CONSTRUCTION ACTIVITIES STATEMENT NEW ISSUANCE ❑ MODIFICATION WITH ACREAGE INCREASE ❑ VAR101s170 Existing Permit Coverage Number (if ap f mops Comer Pwops comer 1.0 RE -ISSUANCE 10 FOR OFFICE USE ONLY ID Number: Technical Criteria: IIB ❑ IIC ❑ WITHOUT ACREAGE INCREASE ❑ Section I. Operator/Permittee Informa• A. Construction Activity Operator (Pern.__, orr r,ng 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 VARM Permit). Construction Activity Operator Name: paA4005 fAe GG W�DaO f�ap82S Contact person: 1il %c f A( ei 66wch Address: {27ok Cf:msoA GM 5f�e lot City, State Zip code: 2 3 Z 3 3 Phone number. Primary email: _ 4 a,, air ITSITSO 12 o,y ,:I Lava 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 orderto pay by credit card and to receive your permit coverage approval letter via email: YES lor� NO ❑ DEQ 199-DRAFT PAGE119 r CONSTRUCTION GENERAL PERMIT (VAR30) REGISTRATION STATEMENT Section IL 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): P A.n.S:.aa C G001AQ/- I7Ld Qj kmd did C1,Arla1-4&u'Uf (/fir Z2tI( *39, 0;:(-1 r4 s - —77 40011 U 1 f 7 $ fon�r Qgk,1� {�Trf lo,sil,'! "(/,W 224 Y( 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. Offslte 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. A. Acreage totals for, all Land-disturbiaactivities to be included under this permit coverage. to the nearest one -hundredth of an acre Total land area of development (include the entire area to be disturbed under the approved Stormwater Management PIan): Estimated area to be disturbed (portions with Erosion and Sediment Control Plan approval only): T 0 S Offsite estimated area to be disturbed (if applicable): r C. Property owner status: D. Nature of the construction activity description (i.e. commercial, Industrial, residential, agricultural, environmental): B. Estimated Project Dates (MM/DDtffM Start date: d b/061UN Completion date: 06/011ZOt,) FEDERAL ❑ STATE ❑ PUBLIC ❑ PRIVATE 0 _ GoynMz(��gl E. Municipal Separate Storm Sewer System (MS4) name (if discharging to a M54): • < r��„ •._ ..... ,-.-_1:.; `. /..; , DEQ 199-DRAFT PAGE 2 18 GENERAL PERMIT REGISTRATION F. This construction activity is part of a common plan of development or sale: YES ❑ NO IM ologic Unit Code (HUC) andassociated Receiving Water Name(s). Include additionalHUCs and rs on a separate RECEIVING WATERBODY(S) 0Ko l r Rim IZj`+ v� Mc�}ow G��G Section V. Other Information. A. A stonnwater pollution prevention plan (SWPPP) must be prepared in accordance with the requirements of the General VPDES Permit for Discharges of Stormwater from Construction Activities orlor 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 Section IV. A.? YES f NO ❑ If yes, provide the date of Erosion and Sediment Control Plan approval: 6 ZS-/z,01 y C. Land disturbance has commenced: YES I$L NO ❑ D. Stormwater management maintenance agreement Included (if applicable): YES ❑ Not Applicable 9 E. If this pro)ect is using approved Annual Standards and Specifications (ASKS), attach the completed AS Entity Form. ASBS Entity Name (if different from the Operator identified in Section II. A.): 1,40 SEE THE FOLLOWING PAGE FOR SIGNATURE AND CERTIFICATION REQUIREMENTS AND INFORMATION DEQ 199-DRAFT PAGE 3 18 CONSTRUCTION GENERAL PERMIT (VAR10) REGISTRATION STATEMENT Section VI. Certification. This Certification must be signed by a person representing the operator identified in Section I. 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 stormwater associated with a large orsmall construction acilvity, operator means any person associated with a construction project that meets either of the following two criteria: (Q the person has direct operationol control over construction plans and speelficatiom including the ability to make modUkatlons to those plans and spect/katlons or 01) the person has day-to-doy operational control of those activities at a project that are necessary to ensure compliance with a stormuater 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 starmwater pollution prevention plan or comply with other permit conditions). in the context of starmwater discharges from Municipal Separate Storm Sewer Systems (MS4s), operator means the operator of the regulated MS4 system. 9VAC25-880-70. Part III. K Sigriatory Requirements: 1. Registration statement Ag registration statements shall be signed as follows: a. For a corporation: by a responsible corporate after. For the purpose of this chapter, a responsible corporate oflicer means., (1) a president, secretary, treasurer, or vice-president of the corporation In charge of a principal businessfunction, or any otherperson who performs similar policy -making or dedslon-making functions far the corporation; or (11) the manager of one or more manufacturing, production, or operating focllRles, provided the managerls authorized to make management decisions that govern the operation of the regulated facility Including having the explicit or implhit duty of making major copltol investment recommendation, and inittating and directing other comprehensive measures to assure long-term compliance with environmental laws and regulations; the managercan ensure that the necessary systems are established or actions taken to gather complete and accurate Infornation forstate permit application requirements; and where authority to sign documents has been assigned or delegated to the manager In accordance with corporate procedures; b. For a partnership or sole proprietorship: by u general partner or the proprietor, respectively; or c. For a munklpagty, state, federo4 or otherpublic agency: by either a principal executive officer or ranking elected offlcial. For purposes of this chapter, a indndpoI executive officer of a public agency includes: (1) the chief executive officer of the agency or (g) a senior executive offlcer h oving responsibility for the overall operations of a prindpal 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: r ' y 4{ iG`'F fs. F,(1ri/w 1, Signature (syned In Ink): t r I -- Date: r -t-i I f . ZO / f Submit this form to the VSMP Authority. 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 constructioneoMdea vindnia aov DEQ 199-DRAFT PAGE 4 18