HomeMy WebLinkAboutWPO201800014 Other 2022-01-25VIRGINIA DEPARTMENT OF ENVIRONMENTAL QUALITY
GENERAL VPDES PERMIT FOR DISCHARGES OF STORMWATER FROM CONSTRUCTION ACTIVITIES (VAR10)
NOTICE OF TERMINATION 2019
Permit Coverage Number (VAR10# ): LIM to @-
Section 1. Operator/PermRtee Information. The person or entity that has active permit coverage approval and 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 VII (per Part III. K. of the VAR10 Permit).
Construction Activity„
Operator Name:
Contact Person:
Address: f &9i ,
City, State, Zip Code: '�5�s tAa�tOd
Phone Number: � , , T699 L I
Primary Email: g2 0 �oer„srf.�ow
CC Email: �t��ras".r- +
Section 11. Construction Activity Location Information. Project site Information.
Construction Activity Name: a+Uee'tf
Address: kwkp/504 ju&wetr w.4 (15-5 PNJ50q AP-)
City and/orCounty and Zip Code: .€€
Latitude and Longitude
(6-digit, decimal degrees format): Lam- - ID5b6 0 S' L DA6 - 7S.407954
Section -Ill. Reason for Terminating Coverage under the General Permit. The operator shall submit a Notice of Termination within
30 days after meeting one or more of the following conditions (select one or more):
IDAA. 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;
❑ 0. 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, the operator has provided written
notification to the homeowner about the importance of final stabilization and incorporating a copy of the notification and
signed certification statement into the SWPPP, and the residence has been transferred to the homeowner.
Rev 04/2019 PAGE 1 ; 6
CONSTRUCTION GENERAL PERMIT (VAR10) NOTICE OF TERMINATION 2019
V;' Section IV. Participation in a Regional Stormwater Management Plan. If your site discharges to a regional stormwater
management facility, provide information related to the regional stormwater management plan. Attach a separate list if discharging
multiple regional facilities.
Regional Storrwater Management
Facility Type:
�(;GitONKL STort+'MN 1Li3ASa.�—Co�w'N 5{p2ruw.Kt?Z, r-ta�,tLA
Address:
1p. # OWF0' Of ot. K rN)2oArD
City and/or County and Zip Code:
C14rota Lo44E7LAWC, ✓A. Z2.9/IF
Latitude and Longitude
(6-digit, decimal degrees format :
�� % 38. 0 2? (0' CP 8 ' 7 � �(
Total Acres Treated by Regional Facility
• (� AL
(report to one -hundredth of an acre):
Impervious Acres Treated by Regional Facility
Z.g50.C.
(report to one -hundredth of an acre):
Section V. Perpetual Nutrient Credits. If your site is utilizing nutrient credits, provide information related to the perpetual nutrient
14'& credits that were acquired in accordance with § 62.1-44.15:35 of the Code of Virginia. Attach a separate list if needed. .
Nonpoint Nutrient Credit Generating Entity
(Bank Name):
Perpetual Nutrient Credits Acquired
(pounds/acres/year):
include the affidavit of sale for all nutrient credits acquired. Is the affidavit of sale of nutrient credits attached? OYES ONO
p:: Section VI. Permanent Control Measures. If applicable, list the post -development stormwater management facilities or best
management practices (BMPs) that were constructed and installed as part of this activity to comply with the stormwater
management technical criteria (structural and nonstructural, on -site and off -site). Attach a separate list if needed.
If you have permanent control measures, the following items are required to be included with this form in order to complete your
Notice of Termination submittal:
❑ A. Engineer's Certification Statement
❑ B. As -built plans (construction record drawings) — digital
[3C. As -built plans (construction record drawings) —full-sized, paper
❑D. StormwaterManagementPlans—digital
CIE. BMP Maintenance Agreement — notarized original, for public and private projects under DEQ s VSMP Authority
Stormwater Management Facility Types fp)ease choose from the fogowfna hmv types).
Bioretention 1
Bioretention 2
Bioretention basin
Bioretention filter
Constructed Wetland 1
Constructed Wetland 2
Constructed wetlands
Dry Swale 1
Dry Swale 2
Extended detention (2 x WQ Vol)
Extended Detention Pond 1
Extended Detention Pond 2
Extended detention -enhanced
Filtering Practice 1
Filtering Practice 2
Grass Channel
Grassed swale
infiltration (1 x WQVol)
infiltration (2 x WQVop
Infiltration 1
nfiltration 2
Other 116 (manufactured
treatment device, etc.)
Other IIC (manufactured
treatment device, etc.)
Permeable Pavement 1
Permeable Pavement 2
Rainwater Harvesting
Retention basin 1(3 x WQ Vol)
Retention basin II (4 x WQ Vol)
Retention basin 111(4 x WQ Vol
with aquatic bench)
Sand filter
Sheetflow to Vegetated Filter or
Conserved Open Space 2
Soil Amendments
Urban Bioretentlan
Vegetated filter strip
Vegetated Roof 1
Vegetated Roof 2
Wet Pond 1
Wet Pond 2
Wet Swale 1
Wet Swale 2
ry
Rev 0412019
PAGE 2I6
CONSTRUCTION GENERAL PERMIT (VAR10) NOTICE OF TERMINATION 2019
Stormwater Management Facility #1
BMP Type:
Date BMP Became Functional:
Address (If available):
City and/or County and Zip Code:
Latitude and Longitude
6-digit, decimal degrees format):
Receiving Water(s)
(outfall discharge):
Total Acres Treated
(report to one -hundredth of an acre):
Impervious Acres Treated
(report to one -hundredth of an acre):
Stormwater Management Facilfty#2
BMPT e:
Date BMP Became Functional:
Address (if available):
CitV and/or County and Zl ;Code:
Latitude and Longitude
(6dl It, decimal degrees format):
Receiving Water(s)
(outfall discharge):
Total Acres Treated
(report to one -hundredth of an acre):
Impervious Acres Treated
(report to one -hundredth of aniacre):
Stormwater Management Faculty#3
BMP Type:
Date BMP Became Functional:
i
Address (if available):
City and/or County and ZipjCcde:
Latitude and Longitude
(6digit, decimal degrees format):
Receiving Water(s)
(outfail disch'a e):
Total Acres Treated
(report to one -hundredth of an!acre):
Impervious Acres Treated
(report to one -hundredth of an acre):
Rev 04/2019 PAGE 3 16
CONSTRUCTION GENERAL PERMIT (VAR10) NOTICE OF TERMINATION 2019
Section VII, Certification. This Certification must be signed by a person representing the operator identified in Section I. and
meeting the requirements of 9VAC25-880-70 Part III K.
Certification: "I certify under penalty of law that I have read and understand this Notice of Termination and thatthis 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:
Signature (signed in Ink):
Date:
Section Vill. Submittal Instructions. Please submit this form to the Virginia Stormwater Management Program (VSMP) Authority
that has jurisdiction for your construction activity. If the locality is the VSMP Authority, please submit your form directly to the
locality, do NOTsend this form to DEC, A list of local VSMP Authorities is available here: VSMP Authorities.
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
constructiongp0clep vireinia eov
if the locality is the VSMP Authorityplease send to:
Permit terminations may be delayed if there are
outstanding annual permit maintenance fee balances due.
Rev 04/2019 PAGE 4 16