HomeMy WebLinkAboutWPO201400013 Permit 2014-12-10 pF AL
Nor, Nease
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Alt)er
COUNTY OF ALBEMARLE
Community Development
401 McIntire Road
Charlottesville,Virginia 22902-4596
(434)296-5832
EROSION CONTROL PERMIT
Date of Application: 2/19/2014
WPO-2014-00013
Permit Effective Date:
12/10/2014 Number:
Trem Commercial Rentals LLC
LANDOWNER: P.O. Box 818 Phone: (434)293-5455
Keswick VA,22947
CONTRACTOR: Momentum Earthworks,LLC Phone: (540)607-0986
1500 Pleasants Dr.
Harrisonburg VA,22801
RESPONSIBLE Patrick Tracy Phone: (540)607-0986
LAND 1500 Pleasants Dr.
DISTURBER: Harrisonburg VA,22801
Certification/
License No.: 31295 Type: RLD
Plans Prepared by: Meridian Planning Group,LLC
Plans Dated: 2/17/2014 Last Revised:
Plans Entitled: Major Site Plan Amendment For Festiv Location:
Fare Tax Map 77,Parcel 40N Scottsville
District,Albemarle County,VA
Tax Map 77 Parcel:40N Dist.Acreage 0.7
Hydrologic Unit H28
Issued by: Kenny Thacker Title: Erosion Control Officer
Si ature Date
wow ,Noe
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.)
p
Name: A 0,A,\ei- .� Ec-t ,,o
)i,,, j -
Contact: I V✓AN tt r �--`Mean
Mailing Address: /.5-4.''e- .f ie ,`e.-1' _ .
City: 1-44/760-,6-'0 '^ State: U A- Zip- / ,- I Phone: -r`icy ,�C c1.. r'1 '4-
Email address(if available): l"lc 15 (,;.-).PA et";e.-,4-..,---, ec•/)c-,--%:,1I(j• e''rll
Indicate if DEQ may transmit general permit correspondence electronically: Yes❑ No ❑
2. Existing General Permit Registration Number(for renewals only): ,'f/%/'
3. Name and Location of the Construction Activity:
Name: /' s7iY.:L ,F/)>t E
Address(if available): /75/ Y F.:;/:;, :,/),9(.4,/,) ,7 7"1?c Ty
City. l:I ,i, i i :i1. .r i' +f .6. State, ti,' Zip: w .d>
County(if not located within a City):_ %,�J r/3 t,~Jr__1 L
Latitude(decimal degrees).A" :i{'.-oi, '' Longitude (decimal degrees): () _7"' - .%, 5
Name and Location of all Off-site Support Activities to be covered under the general permit:
Name: ilijiii
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 kv
5. Nature of the Construction Activity(e.g.,commercial, industrial,residential,agricultural,oil and gas,etc.):
C.rainMEj:,`c11J L
6. Name of the Receiving Water(s)and Hydrologic Unit Code(HUC):
Name: TO 001i f i C i'. t R Name:
HUC: ,J* 1 5 -IUC:
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/ddiyyyy). Completion Date(mm/dd/yyyy): _, _ _
9. Total Land Area of Development(to the nearest one-hundredth acre): --:%i./ ..j /;:. a: 'a
Estimated Area to be Disturbed(to the nearest one-hundredth acre): 1 .c._') .`J C( e..=
10. Is the area to be disturbed part of a larger common plan of development or sale? Yes U 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 beiief true,
accurate, and omplete I am aware that there are significant penalties for submitting false information including the possibility of
tine and im 's+�nme t for knowing vio`ations." 11,74' `PrintedNa c,1 - i c, Title: : -e,7
Signature: ( Date: ,/ cx1 i`7
(Please sign in INK. Th s ert ca -ii ' a� rg ed by the appropriate person associated with the operator identified in
Item#1.) ,,
.si.. i
�;s� I 1 211{
01/2014 PV,04-Ton Page 1 of 1
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DEPARTMENT OF ENVIRONMENTAL QUALITY
CONSTRUCTION ACTIVITY OPERATOR PERMIT FEE FORM
(Please Type or Print All Information)
Instructions: Applicants for a Construction Activity Individual Permit are required to pay permit application fees. Fees are
also required for registration for coverage under a Construction Activity General Permit. Fees must be paid when
applications for state permit issuance, reissuance, modification or transfer are submitted. Applications will be considered
incomplete if the proper fee is not paid and will not be processed until the fee is received.
The fee schedule for state permits is included with this form. Fees for state permit issuance, reissuance, maintenance,
modification and transfer are included. Once you have determined the fee for the type of application you are submitting,
complete this form. The original copy of the form and your check or money order payable to "Treasurer of Virginia"
should be mailed to:
Department of Environmental Quality
Receipts Control
P.O.Box 1104
Richmond,VA 23218
A copy of this form and a copy of your check or money order should accompany the permit application (or registration
statement).You should retain a copy for your records.
Construction Activity Operator:
Name: Al 014 Jt r,ZI 4/W4,r -
Contact: ,,21:7n:f /.r/ Z m
Mailing Address: /S47& f?4t fiQi'1 J pie/we
City: iO/Zt d SO/"f 'fl G State: V/2 Zip:22 8 �I Phone:Sri,.5(11--/
Email address(if available):./,lXWJe/14 2, tify), r i' rtol1/ tt:$. Cll/Ls
Name and Location of the Construction Activity:
Name: %=, 1JI /,tO1Z L
City: CaYLLd1T Y/ L.t. State: ItAl Zip: 2"2-9' 2.
County: 4Z. c} 7/t?t t. F
Type of State Permit: ❑Construction Activity Individual Permit 72 Construction Activity General Permit
(from Fee Schedule)
Type of Action: 21 New Issuance ❑ Reissuance
❑ Maintenance
❑ Modification ❑Transfer
Amount of Fee Submitted (from Fee Schedule): 1 o., 0 v
Existing General Permit Registration Number(if applicable):
FOR DEQ USE ONLY
Date: DC#:
01/2014
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