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Home My WebLink AboutWPO202000038 Correspondence 2022-01-06VIRGINIA DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT N: GENERAL VPDES PERMIT FOR DISCHARGES OF STORMWATER FROM PLAN/ID p: CONSTRUCTION ACTIVITIES (VAR10) TECHNICAL CRITERIA: 110 _. IIC G 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 certifica ion in Section V. (per Part Ill. K. of the VAR10 Permit), Operator Name: AT? U^A� O Contact Gy Z-L� Coontact person: TRAVIS MEYER Sect-- --Sect -- _ Address: 2_050 CIRCLE HWY 30A WEST BLD_G _M-1,SectUNIT 231 City, State and Zip Code: SANTA ROSA BEACH, FL 32459 Primary and CC Email: tmeyer@serdllc.corn AND jquinn@30aip.com B. Electronic correspondence. To receive an emailed coverage letter or to pay by credit card, you must choose YES—] and include a valid email. May we transmit correspondence electronically? YES 7NO Sect-_. ... - _Y_ Section II, Construction Activity 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 waterbodies receiving stormwater discharges from the site. B. Project site location information. Construction Activity Name: SLEEP NUMBER City and/or County and Zip Code: CHARLOTTESVILLE VA 22901 Construction Activity Entrance Location (description, street address and/or 38.075857,-78.478819 latitude/longitude in decimal degrees): - Sect - Sect Sect --- Sect _.i.Sect Latitude and Longitude (6-digit, decimal degrees format): 38,075857,-78.478819 C. 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 (include entire area to be disturbed as approved in the stormwater Management Plan): 1.14 AC Primary estimated area to be disturbed (include portions with 1.14 AC Erosion and Sediment Control Plan approval only): Off -site estimated area to be disturbed (if applicable): 0,58 AC P Y D. Pro ert Owner Status: FEDERAL. ' STATE . ; PUBLIC ._- PRIVATE �! ._ - Sect_ E. Nature of the Construction Activity Description (i.e. commercial, COMMERCIAL industrial, residential, agricultural, environmental, utility): F. Municipal Separate Storm Sewer System (MS4) name(s) (if the site is discharging to a MS4): ALBEMARLE COUNTY G. Estimated_ Project Dates (MM/DD/YYYY). Start Date: 9 15 2020 Completion Date:_ 11/OIZ2021 H. Is this construction activity part of a larger common plan of YES NO ✓'. development or sale? Rev 11/2020 PAGF 1 I G CONSTRUCTION GENERAL PERMIT (VAR10) REGISTRATION STATEMENT 2019 I. 611' Order Hydrologic Unit Code (HUC) and Receiving Water Name(s). Include additional areas on a separate page. HUC _ NAME(S) OF RECEIVING WATERBO_DY 020802040401 MEADOW CREEK av�awn m• W!"MM jU000R ACLIVILV Locannn Intormatnn List all off -site support activities and excavated material disposal areas being utilized for this project. Include additional areas on a separate page. Off -site Activity Name: SLEEP NUMBER (ENTRANCE IMPROVEMENTS) Address: 1425 SEMINOLE TRAIL CHARLOTTESVILLE, VA 22901 _ City or County: Off -site Activity Entrance location (description, street _ address and/or latitude/longitude in decimal degrees); 3$.075857, 78.478819 Latitude and Longitude (6-digit, decimal degrees format): — 38.075857,-78,478819 Is this off -site activity an excavated material disposal YES NO oZ' _ area? If this off -site activity is an excavated material disposal area, list the contents of the excavated fill material: Will a separate VPDES permit cover this off -site activity? YES _ . NO vI Section IV. 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 YES Z NO L submitted to the VESC Authority for review? Erosion and Sediment Control Plan Approval Date (for the estimated area to be disturbed MM/DD/YYYY): C. Has land -disturbance commenced? YES :-: NO D. _ Annual Standards and Specifications. If this project Is utilizing approved Annual Standards and Specifications (AS&S), attached the completed AS&S Entity Form. AS&S Entity Name (if different from the Operator _ identified in Section I). E. Billing information (leave blank if same as the Operator identified in Section I. above). This entity will receive Annual Permit Maintenance and Permit Modification Fee invoices (if applicable). Billing Name: I _ Contact Name: Address: City, State and Zip Code: Phone Number. Primary and CC Email: - Rev 1112020 PACF 2 1 6 CONSTRUCTION GENERAL PERMIT (VAR10) REGISTRATION STATEMENT 2019 Section V. 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 faciht y or activity sub;ect to the Act and this chapter. In the context of stormwater associated with o large or small construction activity, operato• memrs any person associated with a construction project that meets either of the following two criteria: it) the person has direct operational control over construction plans and specifications, rnc'udmg the ability to make modifications to those plans and specficatons or (i:) the person has day to day operational control of those activities of o project that are necessary to ensure compliance w+th d stormwater pollution prevention plan for the site or other state permit or VSMP authority permit conditions (i.e , they ore authorized to direct workers at a site to carry out activities required by the stormwater pollution pre✓enlarn plan or comply with other pernul conditions/ In the cattle." of slorrnweter discharges from Municipal Separate Storm Sewer Systems (MS4s), operator means (he operator a) the regulated MS4 system 9VAC25-880-70. Pa-t W. K. Signatory Re Quire men ts. Registrar on Statement. All Regutration Statements shall be signed os fuRows o. For a corporation: by a responsible corporate officer For the purpose of this chapter, a responsible corporate officer means. fit 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-mokina or decision making functions for the corporation; or fit) the manager of one or more monufucturing, production, or operating facilities, provided the manager is authorized to make manogement decisions that govern the operation of the regulated,racilitir including having the explicit or implicit duty of making major capital investment recommendations. and initiating and directing other comprehensive meowres in assure Icing -term compliance with environmental lows and regulations, the manager can ensure that the neceswry systems ore e%tab6shed at actions token to gother complete and accurate information for state permit application requirements, and where ou(hority to sign documents has been assigned or delegated to the manager in accordance with corporate procedures: b. For a portnenhip or sole proprietorshipby a general partner or the proprietor, respectively, or c For a municipality, %tote, federal, or other public agency by either a principal executive office! 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 responsibility for 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: i, �.H t yw I P %e_y Signature „vneu �n inq:�� r1'tGL" Dale Signed: —r Section VI. 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 If DEQ r, the VSMP Authority plt. ri, c,id 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 const ructionepPdecl.yi rginia.goy ,{cv 11,120.10 PAG1 2 ! 6 Section 9 - Signed Certification CERTIFICATION "I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate 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 knowtedge 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." Operator Name Company: TRAVIS MEYER Title: MANAGING MEMBER Signature: Date: Section 10 - Delegation of Authority Delegation of Authority I, TRAVIS MEYER (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 SLEEP NUMBER construction site. The designee is authorized to sign any reports, stormwater pollution prevention plans and all other documents required by the permit. +-CrrU (name of person or position) 2vyrt I ESN vet ` ^ e - _ (company) if r �-� tTU�uu. Dr (address) (city, state, zip) (phone) I By signing this authorization, I confirm that I meet the requirements to make such a designation as set forth in the Construction General Permit (CGP), and that the designee above meets the definition of a "duly authorized representative". Operator Name: TRAVISMEYQER� Company: t" „"'� I Title: MANAGING MEMBER Signature: r I Date: T i