HomeMy WebLinkAboutWPO201700004 Permit 2017-07-13 Registration Statement
General VPDES Permit for Discharges of Stormwater from Construction Activities (VAR10)
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1. Construction Activity Operator: (General permit coverage will be issued to this operator. The Certification in item #12 must be
signed by the annropriate person associated with this operator.)
Name: seVe.n_DtV J (fYlQA&*
Contact: eitiVa-A (f,(E-12-12 V l
Mailing Address: 1`100 Ai-t 1 n c do ,B I vd 3 -A-tlK A
City: C O1„jLtQtS1/U1,a, State: VA Zip: 22-903 Phone:(11 ) i(p2 IyLq
Email address(if available): talArtlaC�J SeA/'ndQV-Q I apfykokk. CO
Indicate if DEQ may transmit general permit correspondence electronically: Yesix No
2. Existing General Permit Registration Number(for renewals only):
3. Name and Location of the Construction Activity:
Name: carn`Ylenwo.aQ3(\ NpattI Cxts
Address(if available):
City: State: V-A Zip:2-2.q 0
County(if not located within a City): Aw,(nQnt
Latitude(decimal degrees):38.0107 2-0 Longitude(decimal degrees):-7 g. y9 a I 2.3
Name and Location of all Off-site Support Activities to be covered under the general permit:
Name:
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): Federalf 1 State Public n Private
5. Nature of the Construction Activity(e.g.,commercial,industrial, residential,agricultural, oil and gas, etc.):
s,dervh a(_
6. Name of the Receiving Water(s)and Hydrologic Unit Code(HUC):
Name: )ZlV(AI\NCX VIVC42=MC:QfioW (-LW( Name:
HUC: 020 g 0 ZOL-(OL(01 HUC:
7. If the discharge is through a Municipal Separate Storm Sewer System(MS4),the name of the MS4 operator:
8. Estimated Project Start and Completion Date:
Start Date(mm/dd/yyyy): I b/ I S l 7 Completion Date(mm/dd/yyyy): f rj 1 1 S/
9. Total Land Area of Development(to the nearest one-hundredth acre): ( .►S /j
Estimated Area to be Disturbed(to the nearest one-hundredth acre): 7 .(? (A,ULz
10. is the area to be disturbed part of a larger common plan of development or sale? Yes f]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 imprisonment for knowing violations."
Printed Name: rd C Carrington VII Title: Manager
Signature: Date: 7/13/17
(Please sign in INK. Thi edification must be signed by the appropriate person associated with the operator identified in
Item#1.)
07/2014
Page 1 of 1
Section 2. Notice of general permit coverage
(This notice is to be posted near the main entrance according to 9VAC25-880-70, Part II, section C.)
Issued— 10/2014 Stormwater Pollution Prevention Plan(SWPPP) Albemarle County