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Home My WebLink AboutWPO201600082 Permit WPO VSMP 2017-10-10Registration 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 Certficabon in Item #12 must be signed by the appropriate person associated with this operator.) Name: PIEDMONT DEVELOPMENT GROUP Contact:__KATURAH ROELL Mailing Address: 2811 HYDRAULIC ROAD City: CHARLOTTESVILLE State: VA Zip: 22901 Phone. Ci _ 434-906-2702 Email address (if available): katurahSrOgmail.com Indicate if DEQ may transmit general permit correspondence electronically: Yes ® No ❑ 2. Existing General Permit Registration Number (for renewals only):: 3. Name and Location of the Construction Activity: Name: 5TH STR Address (if available):_ STH STREET City: CHARLOTTESVILLE State: VA Zip: 22902 County (if not located within a City): ALBEMARLE Latitude (decimal degrees): 38,009461 Longitude (decimal degrees): -78,505267 Name and Location of all Off-site Support Activities to be covered under the general permit: 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 5. Nature of the Construction Activity (e.g., commercial, industrial, residential, agricultural, oil and gas, etc.): COMMERCIAL 6. Name of the Receiving Water(s) and Hydrologic Unit Code (HUC): Name: MOORES CREEK Name: HUC: 020802040402 (JR15) HUC: 7. If the discharge is through a Municipal Separate Stone Sewer System (MS4), the name of the MS4 operator: S. Estimated Project Start and Completion Date: Start Date (mm/dd/yyyy): Completion Date (mm/dd/yyyy): 9. Total Land Area of Development (to the nearest one-hundredth acre): 10,17 AC Estimated Area to be Disturbed (to the nearest one-hundredth acre):_ 4.94 AC 10. is the area to be disturbed part of a larger common plan of development or sale? Yes ❑ No 11. 12. 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. 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 imorisonment foc_knowinn vinlati Printed Signatu (Please sign in INK. Item #1.) Title: Mc4) e, P/ Date:—] This Certification must be signed by the appropriate person associ with the operator Identified in 07/2014 Page 1 of 1 Instructions for Completing the Registration Statement General VPDES Permit for Discharges of Stormwater from Construction Activities (VAR10) GENERAL A. Coverage Under this General Permit. Any operator applying for coverage under this general permit who is required to submit a Registration Statement (see Section B below) must submit a complete Registration Statement to the Department. The Registration Statement serves as a Notice of Intent for coverage under the General VPDES Permit for Discharges of Stormwater from Construction Activities (VAR10). B. Single-family Detached Residential Structures. Operators with an existing stormwater discharge or proposing a new stormwater discharge associated with the construction of a single- family detached residential structure are not required to submit a Registration Statement or the Department of Environmental Quality (DEQ) portion of the general permit fee. Operators of these types of discharges are authorized to discharge under this general permit immediately upon the general permit's effective date of July 1, 2014. C. To Apply for Permit Coverage. 1. New Construction Activities. Any operator proposing a new stormwater discharge from construction activities shall submit a complete Registration Statement to the Department prior to the commencement of land disturbance, unless exempted by Section B above. Any operator proposing a new stormwater discharge from construction activities in response to a public emergency where the related work requires Immediate authorization to avoid imminent endangerment to human health or the environment is immediately authorized to discharge under this general permit and must submit a complete Registration Statement to the Department no later than 30 days after commencing land disturbance; documentation to substantiate the occurrence of the public emergency must accompany the Registration Statement. 2. Existing Construction Activities. Any operator that was authorized to discharge under the general permit issued in 2009, and who intends to continue coverage under this general permit, shall submit a complete Registration Statement to the Department on or before June 1, 2014, unless exempted by Section B above. D. Where to Submit Registration Statements. All Registration Statements should be submitted to: Department of Environmental Quality Office of Stormwater Management, 10'" Floor P.O. Box 1105 Richmond, VA 23218 LINE -BY-LINE INSTRUCTIONS Item 1: Construction Activity Operator Information. "Operator" means the owner or operator of any facility or activity subject to the Stormwater Management Act and regulations. In the context of stormwater associated with a large or small construction activity, operator means any person associated with a construction project that meets either of the following two criteria: (I) the person has direct operational control over construction plans and specifications, Including the ability to make modifications to those plans and specifications or (Ii) the person has day -today operational control of those activities at a project that are necessary to ensure compliance with a stormwater pollution prevention plan for the site or other state permit or VSMP authority permit conditions (i.e., they are authorized to direct workers at a site to carry out activities required by the stormwater pollution prevention plan or comply with other permit conditions). The entities that are considered operators will commonly consist of the owner or developer of a project (the party with control of project plans and specifications) or the general contractor (the party with day to day operational control of the activities at the project site which are necessary to ensure compliance with the general permit). Provide the legal name (do not use a colloquial name), contact, mailing address, telephone number, and email address (if available) of the construction activity operator; general permit coverage will be issued to this operator. Indicate if the Department may transmit general permit correspondence electronically. Item 2: Existing General Permit Registration Number. For reapplications only, provide the existing general permit registration number for the construction activity. This item does not need to be completed for new construction activities applying for general permit coverage. Item 3: Name and Location of the Construction Activity Information. Provide the official name, street address (if available), city or county (if not located within a City) of the construction activity. Also, provide the latitude and longitude in decimal degrees of the approximate center of the construction activity (e.g., N 37.5000, W 77.5000). Name and Location of Off-site Support Activity Information. This general permit also authorizes stormwater discharges from support activities (e.g., concrete or asphalt batch plants, equipment staging yards, material storage areas, excavated material disposal areas, borrow areas) located on-site or off-site provided that (i) the support activity is directly related to a construction activity that is required to have general permit coverage; (ii) the support activity is not a commercial operation, nor does it serve multiple unrelated construction activities by different operators; (iii) the support activity does not operate beyond the completion of the construction activity it supports; (iv) the support activity is identified in the registration statement at the time of general permit coverage; (v) appropriate control measures are identified in a SWPPP and implemented to address the discharges from the support activity areas; and (vi) all applicable state, federal, and local approvals are obtained for the support activity. Provide the official name, street address (if available), City and County (if not located within a City) of all off-site support activities to be covered under this general permit. Also, provide the latitude and longitude in decimal degrees of the approximate center of the off-site support activities (e.g., N 37.5000, W 77.5000). Also, if an offsite support activity is going to be covered under this general permit the total land area of the off-site support activity and the estimated area to be disturbed by the off-site support activity need to be included in Item #9. Item 4: Status of the Construction Activity. Indicate the appropriate status (Federal, State, Public, or Private) of the construction activity. Item 5: Nature of the Construction Activity. Provide a brief description of the construction activity, such as commercial, residential, agricultural, oil and gas, etc. This list Is not all inclusive. Item 6: Receiving Waters(s) and HUC Information. Provide the name of the receiving water(s) and corresponding HUC for all stormwater discharges including any stormwater discharges from off-site support activities to be covered under this general permit. Hydrologic Unit Code or HUC is a watershed unit established In the most recent version of Virginia's 61' order national watershed boundary dataset. 07/2014 Page 1 of 2 Item 7: MS4 Information. If stormwater is discharged through a municipal separate stone sewer system (MS4), provide the name of the MS4 operator. The name of the MS4 operator is generally the Town, City, County, Institute or Federal facility where the construction activity is located. Item 8: Construction Activity Start and Completion Date Information. Provide the estimated start date (month/day/year) of the construction activity. Provide the estimated completion date (month/day/year) of the construction activity. Item 9: Construction Activity Area Information. Provide the total area (to the nearest one-hundredth acre) of the development (Le... the total acreage of the larger common plan of development or sale). Include the total acreage of any off-site support activity to be covered under this general permit. Provide the estimated area (to the nearest one-hundredth acre) to be disturbed by the construction activity. Include the estimated area of land disturbance that will occur at any off-site support activity to be covered under this general permit. Item 10: Common Plan of Development or Sale Information. Indicate if the area to be disturbed by the construction activity is part of a larger common plan of development or sale. Larger common plan of development or sale is defined as a contiguous area where separate and distinct construction may be taking place at different times on different schedules. Plan is broadly defined as any announcement or documentation, including a sign, public notice or hearing, sales pitch, advertisement, drawing, permit application, zoning request, etc., or physical demarcation such as boundary signs, lot stakes, or surveyor markings indicating that construction activities may occur. Item 11: Stormwater Pollution Prevention Plan (SWPPP). 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 (VAR10) prior to submitting this Registration Statement. By signing this Registration Statement the operator is certifying that the SWPPP has been prepared. Item 12: Certification. A properly authorized individual associated with the operator identified in Item 1 of the Registration Statement is responsible for certifying and signing the Registration Statement. Please sign the Registration Statement in INK. State statutes provide for severe penalties for submitting false information on the Registration Statement. State regulations require that the Registration Statement be signed as follows: a. For a corporation: by a responsible corporate officer. For the purpose of this part, a responsible corporate officer means: (I) 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-making or decision-making functions for the corporation, or (it) the manager of one or more manufacturing, production, or operating facilities, provided the manager Is authorized to make management decisions that govern the operation of the regulated facility including having the explicit or implicit duty of making major capital Investment recommendations, and Initiating and directing other comprehensive measurek'to' assure long-term compliance with environmental laws,and regulagons; the manager can ensure that the necessary systems are established or actions taken to gather complete and accurate information for permit application requirements; and where authority to sign documents has been 07/2014 assigned or delegated to the manager in accordance with corporate procedures. b. For a partnership or sole proprietorship: by a general partner or the proprietor, respectively. c. For a municipality, state, federal, or other public agency: by either a principal executive officer or ranking elected official. For purposes of this part, a principal executive officer of a public agency includes: (i) The chief executive officer of the agency, or (it) A senior executive officer having responsibility for the overall operations of a principal geographic unit of the agency. Page 2 of 2 COUNTY OF ALBEMARLE Community Development 401 McIntire Road Charlottesville, Vriginia 22902-4596 (434) 296-5832 EROSION CONTROL PERMIT Date of Application: I2/12/2016 Permit Effective Date: 09/11/2017 LANDOWNER: FTV INVESTMENTS LLC 943 GLENWOOD STATION LN SUITE 101 CHARLOTTESVILLE VA22901 CONTRACTOR: DESIGN BUILDERS, LLC 325 BARRACKS HILL CHARLOTTESVILLE VA22901 REPONSIBLE LAND ISAIAH NISOS DISTURBER: 325 BARRACKS HILL CHARLOTTESVILLE VA22901 Certification/License #: RLD07186 Plans Prepared By: COLLINS ENGINEERING PIans Dated: 12/12/2016 Number: WPO -2016-00082 Phone: Phone: (434) 906-2702 Phone: (434) 906-2702 Type: Responsible Land Disturber Last Revised: 05/03/2017 Plans Entitled: 5TH STREET COMMERCIAL DEVELOPMENT VSMP Location: PLAN Tax Map: 07600-00-00-055AO 076M l -00-00-00100 Dist. 4.41 Acreage: Hydrological JR15 Unit: Additional Information: Annual Maintenance Fees [Sections 17-207 & 208 of the Albemarle County Code] — Annual maintenance fees will be assessed in March of every year this permit is active. Fees cannot be prorated after the first year of permit issuance. Issued By: Kenny Thacker ignature Title: Erosion Control Officer 9--//- //--*" Date