HomeMy WebLinkAboutWPO201700005 Application 2017-01-20 (2)2.
3.
Registration Statement
General VPDES Permit for Discharges of Stormwater from Construction Activities (VAR10)
(Please Type or Print All Information)
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: Timberland Park Apartments VA LLC
Contact: Jen Surber
Mailing Address: 2021 Cross Beam Drive
City: Charlotte State: NC
Email address (if available): lensurber@surberdev.com
Zip:28217 Phone:704-357-6000
Indicate if DEQ may transmit general permit correspondence electronically: Yes ❑■
Existing General Permit Registration Number (for renewals only):
Name and Location of the Construction Activity:
Name: Timberland Park Apartments
Address (if available):
City:
State: VA
No ❑
County (if not located within a City): Albemarle
Latitude (decimal degrees): 38.0092 Longitude (decimal degrees):-78.5206
Name and Location of all Off -site Support Activities to be covered under the general permit:
Name: N/A
Address (if available):
City
State:
Zip: 22903
Zip.
County (if not located within a City)
Latitude (decimal degrees): Longitude (decimal degrees):
4. Status of the Construction Activity (check only one): Federal [:1 State ❑ Public ❑ Private ❑N
5. Nature of the Construction Activity (e.g., commercial, industrial, residential, agricultural, oil and gas, etc.):
Residential
6. Name of the Receiving Water(s) and Hydrologic Unit Code (HUC):
Name: Moores Creek Nam
H U C: 020802040402
HUC
7. If the discharge is through a Municipal Separate Storm Sewer System (MS4), the name of the MS4 operator:
Albemarle County
8.
9
Estimated Project Start and Completion Date:
Start Date (mm/dd/yyyy): 03/01/2017 Completion Date (mm/dd/yyyy): 03/01/2019
Total Land Area of Development (to the nearest one -hundredth acre): 7.76
Estimated Area to be Disturbed (to the nearest one -hundredth acre): 5.50
10. Is the area to be disturbed part of a larger common plan of development or sale? Yes ❑ 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: E. K. Title: 4-izngrfdr-t
Signature:
(Please sign in INK.
Item #1.)
Date: 0Cvt"- t iA/7 ~ (LA"W-11A4r LCl7
must be signed by the appropriate person associated with the operator identified in
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