HomeMy WebLinkAboutWPO201700062 Permit 2017-07-25 Registration Statement
General VPDES Permit for Discharges of Stormwater from Construction Activities (VAR10)
(Please Type or Print All Information)
1. Construction Activity Operator: (General permit coverage will be issued to this operator. The Certification in Item#12 must be
signed by the appropriate person associated with this operator.)
Name:SM Charlottesville, LLC
Contact:Jeremy Swink
Mailing Address:200 Garrett Street, Suite B
City Charlottesville State:VA Zip:22902 Phone:434-975-7445
Email address(if available):SwinkJW@stanleymartin.com; MCartwright@res.us
Indicate if DEQ may transmit general permit correspondence electronically. Yes m No❑
2. Existing General Permit Registration Number(for renewals only):N/A
3. Name and Location of the Construction Activity:
Name:Avinity
Address(if available):Avinity Drive
City:Charlottesville State:Virginia Zip.22902
County(if not located within a City):Albemarle
Latitude(decimal degrees):37.994875 Longitude(decimal degrees):-78.500309
Name and Location of all Off-site Support Activities to be covered under the general permit:
Name:N/A
Address(if available):
City State: Zip:
County(if not located within a City):
Latitude(decimal degrees): Longitude(decimal degrees): -_
4. Status of the Construction Activity(check only one): Federal❑State❑ Public❑Private 171
5. Nature of the Construction Activity(e.g.,commercial,industrial,residential,agricultural,oil and gas,etc.):
Residential - Construction of Townhomes
6. Name of the Receiving Water(s)and Hydrologic Unit Code(HUC):
Name:Moores Creek Name:
HUC:JR15 HUC:
7. If the discharge is through a Municipal Separate Storm Sewer System(MS4),the name of the MS4 operator:
N/A
8. Estimated Project Start and Completion Date:
Start Date(mm/dd/yyyy):8/15/2017 Completion Date(mm/dd/yyyy):8/15/2018
9. Total Land Area of Development(to the nearest one-hundredth acre): 18.71
Estimated Area to be Disturbed(to the nearest one-hundredth acre): 1.41
10. Is the area to be disturbed part of a larger common plan of development or sale? Yes❑✓ No❑
11. 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 this Registration Statement.
By signing this Registration Statement the operator is certifying that the SWPPP has been prepared.
12. 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 imprisonmen for knowing violations."
Printed Name: Cr[ -SWIII1 . Title: Ntu. P
i
Signature: Date: °
(Please sign in INK. rti i be signed by the appropriate person associated with the operator identified in
Item#1.)
01/2014 Page 1 of 1
Instructions for Completing the Registration Statement
General VPDES Permit for Discharges of Stormwater from Construction Activities (VAR10)
GENERAL stormwater pollution prevention plan or comply with other permit
conditions).
A.Coverage Under this General Permit.
The entities that are considered operators will commonly consist of the
Any operator applying for coverage under this general permit who is owner or developer of a project(the party with control of project plans
required to submit a Registration Statement (see Section B below) and specifications)or the general contractor(the party with day to day --
must submit a complete Registration Statement to the Department. operational control of the activities at the project site which are
The Registration Statement serves as a Notice of Intent for coverage necessary to ensure compliance with the general permit).
under the General VPDES Permit for Discharges of Stormwater from
Construction Activities(VAR10). Provide the legal name(do not use a colloquial name),contact,mailing
address, telephone number, and email address (if available) of the
B.Single-family Residences, construction activity operator;general permit coverage will be issued to
this operator Indicate if the Department may transmit general permit
Operators with an existing stormwater discharge or proposing a new correspondence electronically
stormwater discharge associated with the construction of a single-
family residence separately built, disturbing less than one acre and Item 2:Existing General Permit Registration Number.
part of a larger common plan of development or sale is not required to
submit a Registration Statement, provided that the stormwater For reapplications only,provide the existing general permit registration
management plan for the larger common plan of development provides number for the construction activity This item does not need to be
permanent control measures (i.e., stormwater management facilities) completed for new construction activities applying for general permit
encompassing the single family residence. coverage.
Operators of these types of discharges are authorized to discharge Item 3: Name and Location of the Construction Activity
under this general permit immediately upon the general permit's Information.
effective date of July 1,2014
Provide the official name,street address(if available),city or county(if
C.To Apply for Permit Coverage. not located within a City)of the construction activity Also,provide the
latitude and longitude in decimal degrees of the approximate center of
1. New Construction Activities. Any operator proposing a new the construction activity(e.g.,N 37.5000,W 77.5000).
stormwater discharge from construction activities shall submit a
complete Registration Statement to the Department prior to the Name and Location of Off-site Support Activity Information.
commencement of land disturbance, unless exempted by Section B
above. Any operator proposing a new stormwater discharge from This general permit also authorizes stormwater discharges from
construction activities in response to a public emergency where the support activities (e.g., concrete or asphalt batch plants, equipment
related work requires immediate authorization to avoid imminent staging yards, material storage areas, excavated material disposal
endangerment to human health or the environment is immediately areas, borrow areas) located on-site or off-site provided that (i) the
authorized to discharge under this general permit and must submit a support activity is directly related to a construction activity that is
complete Registration Statement to the Department no later than 30 required to have general permit coverage;(ii)the support activity is not
days after commencing land disturbance; documentation to a commercial operation, nor does it serve multiple unrelated
substantiate the occurrence of the public emergency must construction activities by different operators; (iii) the support activity
accompany the Registration Statement. does not operate beyond the completion of the construction activity it
supports; (iv) the support activity is identified in the registration
2. Existing Construction Activities. Any operator that was statement at the time of general permit coverage; (v) appropriate
authorized to discharge under the general permit issued in 2009, control measures are identified in a SWPPP and implemented to
and who intends to continue coverage under this general permit, address the discharges from the support activity areas; and (vi) all
shall submit a complete Registration Statement to the Department applicable state, federal, and local approvals are obtained for the
on or before June 1,2014,unless exempted by Section B above. support activity
D.Where to Submit Registration Statements. Provide the official name,street address(if available),City and County
(if not located within a City) of all off-site support activities to be
All Registration Statements should be submitted to: covered under this general permit. Also, provide the latitude and
longitude in decimal degrees of the approximate center of the off-site
Department of Environmental Quality support activities (e.g., N 37.5000, W 77.5000). Also, if an off-site
Office of Stormwater Management,10th Floor support activity is going to be covered under this general permit the
P.O.Box 1105 total land area of the off-site support activity and the estimated area to
Richmond,VA 23218 be disturbed by the off-site support activity need to be included in Item
#9.
LINE-BY-LINE INSTRUCTIONS
Item 4:Status of the Construction Activity.
Item 1:Construction Activity Operator Information.
Indicate the appropriate status (Federal, State, Public, or Private) of
"Operator" means the owner or operator of any facility or activity the construction activity
subject to the Stormwater Management Act and regulations. In the
context of stormwater associated with a large or small construction Item 5:Nature of the Construction Activity.
activity, operator means any person associated with a construction
project that meets either of the following two criteria:(i)the person has Provide a brief description of the construction activity, such as
direct operational control over construction plans and specifications, commercial, residential,agricultural,oil and gas,etc.This list is not all
including the ability to make modifications to those plans and inclusive.
specifications or(ii) the person has day-to-day operational control of
those activities at a project that are necessary to ensure compliance Item 6:Receiving Waters(s)and HUC Information.
with a stormwater pollution prevention plan for the site or other state
permit or VSMP authority permit conditions(i.e.,they are authorized to Provide the name of the receiving water(s)and corresponding HUC for
direct workers at a site to carry out activities required by the all stormwater discharges including any stormwater discharges from
off-site support activities to be covered under this general permit.
01/2014 Page 1 of 2
Hydrologic Unit Code or HUC is a watershed unit established in the gather complete and accurate information for permit application
most recent version of Virginia's 6th order national watershed boundary requirements; and where authority to sign documents has been
dataset. assigned or delegated to the manager in accordance with
corporate procedures.
Item 7:MS4 Information.
b. For a partnership or sole proprietorship: by a general partner or
If stomiwater is discharged through a municipal separate storm sewer the proprietor,respectively
system(MS4),provide the name of the MS4 operator The name of the
MS4 operator is generally the Town,City, County, Institute or Federal c. For a municipality,state,federal,or other public agency by either
facility where the construction activity is located. a principal executive officer or ranking elected official. For purposes
of this part,a principal executive officer of a public agency includes:
Item 8: Construction Activity Start and Completion Date
Information. (i)The chief executive officer of the agency,or
Provide the estimated start date(month/day/year)of the construction (ii)A senior executive officer having responsibility for the overall
activity Provide the estimated completion date (month/day/year) of operations of a principal geographic unit of the agency
the construction activity
Item 9:Construction Activity Area Information.
Provide the total area (to the nearest one-hundredth acre) of the
development (i.e.., the total acreage of the larger common plan of
development or sale). Include the total acreage of any off-site support
activity to be covered under this general permit.
Provide the estimated area(to the nearest one-hundredth acre)to be
disturbed by the construction activity Include the estimated area of
land disturbance that will occur at any off-site support activity to be
covered under this general permit.
Item 10:Common Plan of Development or Sale Information.
Indicate if the area to be disturbed by the construction activity is part of
a larger common plan of development or sale. Larger common plan of
development or sale is defined as a contiguous area where separate
and distinct construction may be taking place at different times on
different schedules. Plan is broadly defined as any announcement or
documentation, including a sign, public notice or hearing, sales pitch,
advertisement, drawing, permit application, zoning request, etc., or
physical demarcation such as boundary signs, lot stakes, or surveyor
markings indicating that construction activities may occur '
Item 11:Stormwater Pollution Prevention Plan(SWPPP).
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(VAR10)prior to
submitting this Registration Statement. By signing this Registration
Statement the operator is certifying that the SWPPP has been
prepared.
Item 12:Certification.
A properly authorized individual associated with the operator identified
in Item 1 of the Registration Statement is responsible for certifying and
signing the Registration Statement. Please sign the Registration
Statement in INK.
State statutes provide for severe penalties for submitting false
information on the Registration Statement. State regulations require
that the Registration Statement be signed as follows:
a. For a corporation: by a responsible corporate officer For the
purpose of this part,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 govem 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
01/2014 Page 2 of 2
LOT NUMBER LOT AREA
10 1,923
11 1,806
12 1,913
13 2,292
14 2,797
15 2,065
16 1,935
17 1,805
18 2,620
19 2,038
20 1,706
21 1,715
22 2,178
23 2,195
24 1,775
25 1,839
26 3,759
94 2,075
95 1,644
96 1,644
97 1,644
98 1,644
99 1,644
100 2,042
101 2,102
102 1,660
103 1,660
104 1,660
105 1,660
106 1,660
107 2,065
61,165 Sq.Ft.
1.41 ac Acres
Notice of Termination
General VPDES Permit for Discharges of Stormwater from Construction Activities (VAR10)
(Please Type or Print All Information)
1. Construction Activity Operator:
Name:
Contact:
Mailing Address:
City: State: Zip: Phone:
Email address(if available):
2. Name and Location of the Construction Activity: (As listed on the Registration Statement.)
Name:
Address(if available):
City State: Zip
County(if not located within a City):
Latitude(decimal degrees): Longitude(decimal degrees):
3. General Permit Registration Number:
4. Reason for Terminating Coverage Under the General Permit: (The operator shall submit a Notice of Termination after one or
more of the following conditions have been met.)
❑ A. Necessary permanent control measures included in the SWPPP for the site are in place and functioning effectively and final
stabilization has been achieved on all portions of the site for which the operator is responsible. When applicable, long-term
responsibility and maintenance requirements for permanent control measures shall be recorded in the local land records prior
to the submission of a notice of termination,
❑ B.Another operator has assumed control over all areas of the site that have not been finally stabilized and obtained coverage
for the ongoing discharge;
❑ C.Coverage under an alternative VPDES or state permit has been obtained;or
❑ D For residential construction only,temporary soil stabilization has been completed and the residence has been transferred to
the homeowner.
The notice of termination should be submitted no later than 30 days after one of the above conditions being met.Authorization to
discharge terminates at midnight on the date that the notice of termination is submitted for the conditions set forth in subsections B
through D above, unless otherwise notified by the VSMP authority or the Department. Termination of authorizations to discharge
for the conditions set forth in subsection A above shall be effective upon notification from the Department that the provisions of
subsection A have been met or 60 days after submittal of the notice of terminations, whichever occurs first.
5. Permanent Control Measures Installed: (When applicable, a list of the on-site and off-site permanent control measures (both
structural and nonstructural)that were installed to comply with the stormwater management technical criteria.Attach a separate list
if additional space is needed.)
Permanent Control Measure#1
Type of Permanent Control Measure:
Date Functional:
Address(if available):
City State: Zip
County(if not located within a City):
Latitude(decimal degrees): Longitude(decimal degrees):
Receiving Water.
Total Acres Treated: Impervious Acres Treated:
01/2014 Page 1 of 2
Permanent Control Measure#2
Type of Permanent Control Measure:
Date Functional:
Address(if available):
City State: Zip.
County(if not located within a City):
Latitude(decimal degrees): _Longitude(decimal degrees):
Receiving Water
Total Acres Treated: Impervious Acres Treated:
Permanent Control Measure#3
Type of Permanent Control Measure:
Date Functional:
Address(if available):
City State: Zip:
County(if not located within a City):
Latitude(decimal degrees): Longitude(decimal degrees):
Receiving Water
Total Acres Treated: Impervious Acres Treated:
6. Participation in a Regional Stormwater Management Plan: (When applicable, information related to the participation in a
regional stormwater management plan.Attach a separate list if additional space is needed.)
Regional Stormwater Management Facility
Type of Regional Stormwater Management Facility
Address(if available):
City State: Zip.
County(if not located within a City):
Latitude(decimal degrees): Longitude(decimal degrees):
Total Site Acres Treated: Impervious Site Acres Treated:
7. Perpetual Nutrient Credits: (When applicable, information related to perpetual nutrient credits that were acquired in accordance
with§62.1-44 15:35 of the Code of Virginia.Attach a separate list if additional space is needed.)
Nonpoint Nutrient Credit Generating Entity
Name:
Perpetual Nutrient Credits Acquired(lbs/acre/year):
8. Certification:"I certify under penalty of law that I have read and understand this Notice of Termination 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: Title:
Signature: Date:
(Please sign in INK. This Certification must be signed by the appropriate person associated with the operator identified in
Item#1.)
01/2014 Page 2 of 2
Instructions for Completing the Notice of Termination
General VDPES Permit for Discharges of Stormwater from Construction Activities (VAR1O)
GENERAL
b.The date that the permanent control measure became functional
A Notice of Termination must be submitted when an operator no longer as a post-development stormwater management control;
wishes to be covered under the General VPDES Permit for Discharges
of Stormwater from Construction Activities(VAR10). c. The street address (if available), City or County (if not located
within a City)of the permanent control measure;
All Notice of Terminations should be submitted to:
d.The latitude and longitude in decimal degrees of the approximate
Department of Environmental Quality center of the permanent control measure;
Office of Stormwater Management,10th Floor
P.O.Box 1105 e.The receiving water of the permanent control measure;and
Richmond,VA 23218
f. The number of total and impervious acres treated by the
LINE-BY-LINE INSTRUCTIONS permanent control measure(to the nearest one-tenth of an acre).
Item 1: Construction Activity Operator Information. Attach a separate list if additional space is needed.
Provide the legal name(do not use a colloquial name),contact,mailing Item 6: Participation in a Regional Stormwater Management Plan
address, telephone number, and email address (if available) of the (when applicable).
construction activity operator that was issued general permit coverage.
For each Regional Stormwater Management Facility provide the
Item 2: Name and Location of the Construction. Activity following information:
Information.
a.The type of regional facility to which the site contributes;
Provide the official name,street address(if available),city or county(if
not located within a City)of the construction activity Also,provide the b. The street address (if available), City or County (if not located
latitude and longitude in decimal degrees of the approximate center of within a City)of the regional facility;
the construction activity (e.g., N 37.5000, W 77.5000). NOTE: This
information can be obtained from the previously submitted Registration c.The latitude and longitude in decimal degrees of the approximate
Statement. center of the regional facility;and
Item 3:General Permit Registration Number. d. The number of total and impervious site acres treated by the
regional facility(to the nearest one-tenth of an acre).
Provide the existing general permit registration number for the
construction activity identified in Item 2. Attach a separate list if additional space is needed.
Item 4:Reason for Termination. Item 7:Perpetual Nutrient Credits(when applicable).
Indicate the appropriate reason for submitting this Notice of Provide the following information related to perpetual nutrient credits
Termination. The Notice of Termination may only be submitted after that were acquired in accordance with §62.1-44.15:35 of the Code of
one or more of the following conditions have been met: Virginia:
a. Necessary permanent control measures included in the SWPPP a. The name of the nonpoint nutrient credit generating entity from
for the site are in place and functioning effectively and final which perpetual nutrient credits were acquired;and
stabilization has been achieved on all portions of the site for which
the operator is responsible.When applicable,long-term responsibility b. The number of perpetual nutrient credits acquired (lbs. per acre
and maintenance requirements for permanent control measures shall per year).
be recorded in the local land records prior to the submission of a
notice of termination; Attach a separate list if additional space is needed.
b. Another operator has assumed control over all areas of the site Item 8:Certification.
that have not been finally stabilized and obtained coverage for the
ongoing discharge; A properly authorized individual associated with the operator identified
in Item 1 of the Registration Statement is responsible for certifying and
c. Coverage under an alternative VPDES or state permit has been signing the Registration Statement. Please sign the Registration
obtained;or Statement in INK.
d. For residential construction only, temporary soil stabilization has State statutes provide for severe penalties for submitting false
been completed and the residence has been transferred to the information on the Registration Statement. State regulations require
homeowner that the Registration Statement be signed as follows:
The Notice of Termination should be submitted no later than 30 days a. For a corporation: by a responsible corporate officer For the
after one of the above conditions being met. purpose of this part,a responsible corporate officer means:
Item 5:Permanent Control Measures(when applicable). (i) A president, secretary, treasurer, or vice-president of the
corporation in charge of a principal business function,or any other
For each on-site and off-site permanent control measure (both person who performs similar policy-making or decision-making
structural and non-structural) that was installed to comply with the functions for the corporation,or
stormwater management technical criteria provide the following
information: (ii) the manager of one or more manufacturing, production, or
operating facilities, provided the manager is authorized to make
a.The type of permanent control measure; management decisions that govem the operation of the regulated
01/2014 Page 1 of 2
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 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
c. For a municipality,state,federal,or other public agency by either
a principal executive officer or ranking elected official. For purposes
of this part,a principal executive officer of a public agency includes:
(i)The chief executive officer of the agency,or
(ii)A senior executive officer having responsibility for the overall
operations of a principal geographic unit of the agency
01/2014 Page 2 of 2