HomeMy WebLinkAboutWPO202000034 VSMP - SWPPP 2020-11-04 (2)VIRGINIA DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT #:
GENERAL VPDES PERMIT FOR DISCHARGES OF STORMWATER FROM PLAN/ID #:
CONSTRUCTION ACTIVITIES (VAR10) TECHNICAL CRITERIA: 1113 ❑ IIC ❑
REGISTRATION STATEMENT 2019
Application type. ® NEW PERMIT ISSUANCE
(CHOOSE ONE) ❑ MODIFICATION WITH ACREAGE INCREASE
❑ MODIFICATION WITHOUT ACREAGE INCREASE
❑ EXISTING PERMIT RE -ISSUANCE
Section I. 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 VAR10 Permit).
Operator Name:
Contact person:
Address:
City, State Zip Code:
Phone Number:
Primary Email:
New Belvedere Inc.
610 West Rio Rd.
Charlottesville, VA 22901
434-242-6122
skrohn@resortcompanies.com
CC Email: riki@roudabush.com
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 lettervia email: YES ® NO ❑
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: Belvedere Phase 5
Address: Intersection of Farrow Dr. and Fowler St.
City and/or County and Zip Code: Charlottesville, VA 22901
Latitude and Longitude
(6-digit, decimal degrees format): 38.075962,-78.452513
C. Construction Activity Entrance Location
(description, street address and/or
latitude/longitude in decimal degrees): 38.075962,-78.452513
Rev 01/2020 PAGE 1 1 6
CONSTRUCTION GENERAL PERMIT (VAR10) REGISTRATION STATEMENT 2019
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 format):
B. Offsite Activity Entrance Location
(description, street address and/or
latitude/longitude in decimal degrees):
Section IV. Site Information.
A. Property Owner Status:
B. Nature of the Construction Activity Description (i.e.
commercial, industrial, residential, agricultural,
environmental):
C. Municipal Separate Storm Sewer System (MS4)
name(s) (if the site is discharging to a MS4):
FEDERAL ❑ STATE ❑ PUBLIC ❑ PRIVATE IN
Residential
D. 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
15 acres
Management Plan):
Primary estimated area to be disturbed (portions with
Erosion and Sediment Control Plan approval only):
14.46
Offsite estimated area to be disturbed (if applicable):
E. Estimated Project Dates
(M M/DD/YYYY)
Start date:
11/09/2020
Completion date:
05/31/2024
F. Is this construction activity part of a common plan of development or sale? YES ❑ NO
G. 6" Order Hydrologic Unit Code (HUC) and Receiving Water Name(s). Attach a separate list if needed.
HUC
I RECEIVING WATERBODY(S)
1R14 (HUCO20802040401)
Rivanna River -Meadow Creek
1R08 (HUCO20802040203)
South Fork Rivanna River
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 submitted to the VESC Authority for review? YES ® NO ❑
C.
Erosion and Sediment Control Plan Approval Date (for estimated area to be disturbed).:
Has land disturbance has commenced? YES ❑ NO IN
D. Annual Standards and Specifications. If this project is utilizing 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.):
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CONSTRUCTION GENERAL PERMIT (VAR10) 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 or 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 criteria: (i) the person has direct operational control over construction plans and specifications, including
the ability to make modifications to those plans and specifications or (H) 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
stormwater 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. 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 function, or
any other person who performs similar policy -making or decision -making functions for the corporation; or (ii) 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 lows 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 a partnership 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: (I) the chief executive officer of the
agency or (ii) 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 fjnle and imprisonment for knowing violations."
Printed Name:
Signature (signed In Ink):
Date Signed:
Section VII. Submittal Instructions. Submit this form to the 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 DEQ is the VSMP Authorityplease 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 2321E
constructionup@dea.vi rginia.eov
marle County Office of Community
McIntire Rd.
Charlottesville, VA 22902
(434)296-5832
Rev 01/2020 PAGE 3 16
APPX D- Delegation of Authority
Delegation of Authority
1, s CAM t, ! r[)Mu (name), hereby designate the person or specifically described position
below to be a duly authorized representative for the purpose of overseeing compliance with environmental
requirements, including the Construction General Permit, at the 6Ql�C(iQ1 e QVIrAS? C)
construction site. The designee is authorized to sign any reports or other documents required by the permit.
Construction Activities Inspector (name of person or position)
Roudabush, Gale & Associates (company)
Nicole Jamison, Kent Rain or any other
Oualified Personnel from Roudabush
999 2nd St. SE (address)
Charlottesville, Va. 22902 (city, state, zip)
(434) 977-0205 (phone)
By signing this authorization, I confirm that I meet the requirements to make such a designation as set forth in
Virginia's General VPDES Permit for Discharges of Stormwater from Construction Activities (CGP), and that
the designee above meets the definition of a "duly authorized representative" as set forth in in the CGP.
I certify under penalty of law that I have read and understand this document 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.
Name:
Company:
Title:
Signature:
Date:
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