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WPO201400024 Permit 2014-10-16
4��A 0 i'IRGIN�P COUNTY OF ALBEMARLE Community Development 401 Mc Intire Road Charlottesville,Virginia 2 29 02-4 59 6 (434)296-5832 EROSION CONTROL PERMIT Date of Application: 3/20/2014 WPO-2014-00024 Permit Effective Date: 10/16/2014 Number: Barracks Heights LLC 195 Riverbend Dr. LANDOWNER: Charlottesville,VA 22911 Phone: (434)531-2192 CONTRACTOR: Vito Cetta Phone: (434)531-5192 1730 Owensfield Dr. Charlottesville,VA 22901 RESPONSIBLE Earthworks Phone: (434)531-6557 LAND 2114 Angus Rd. DISTURBER: Charlottesville,VA 22901 Certification/ License No.: 42712 Type: RLD Plans Prepared by: Shimp Engineering P.C. Plans Dated: 4/11/2014 Last Revised: 8/22/14 Plans Entitled: Erosion and Sediment Control and Location: Intersection of barracks road and Stormwater Plan Out Of Bounds TMP georgetown road 06000-00-00-06500 Jack Jouett District, Albemarle County,Virginia Tax Map 60 Parcel:65 Dist.Acreage 9.65 Hydrologic Unit H28 Issued by: Kenny Thacker Title: Erosion Control Officer /D" gnature Date Registration Statement '- - qt� 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: v o Ce Contact: Mailing Annddress: 41,O ©I„rP.ctiSc,e1 , 'Or City: V�.t�t CSV Axe_ State: P Zip: -Z,ZAO( Phone: Email address(if available): V IA 0 Cer404,Tvvv' .CAM Indicate if DEQ may transmit general permit correspondence electronically: Yes No❑ 2. Existing General Permit Registration Number(for renewals only): VAR. E I(08 3. Name and Location of the Construction Activity: Name: OL -C)c- eCkit N& Address(if available): /� ' O{' PLO& '2a C City: Gr rsvctIe State: VA- Zip: 22x0 County(if not located within a City): Albe,mo►r-e_ Latitude(decimal degrees): 3 S°6-510.541"hi Longitude (decimal degrees): 78°30 32,27114 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): Federal ❑ State❑ Public❑ Private RI 5. Nature of the Construction Activity(e.g., commercial, industrial, residential,agricultural,oil and gas,etc.): ge5Iden-lia1 6. Name of the Receiving Water(s)and Hydrologic Unit Code(HUC): Name: Mec► Creek Name: HUC: (b208-02 (0g6I 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): Og I O\ 2Oi9 Completion Date/4mm/dd/yyyy): 0'5 Jot ' 7XD( 9. Total Land Area of Development(to the nearest one-hundredth acre): (4 6.5 A Estimated Area to be Disturbed(to the nearest one-hundredth acre): SAL 10. Is the area to be disturbed part of a larger common plan of development or sale? Yes❑ No NI 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 imprison e t f�knowing yi.Qlations."_, Printed Name: 0 ( `T-`r Title: Signature: Date: -[ b' (Please sign in is C i ation must be signed by the appropriate person associated with the operator identified in Item#1.) 01/2014 Page 1 of 1