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HomeMy WebLinkAboutWPO201600046 Permit WPO VSMP 2016-10-20 Swol ''44001 Registration Statement General VPDES Permit for Discharges of Stormwater from Construction Activities(VAR10) (Please Type or Print All Information) 1. Construction Activity Operator.(General penult coverage will be issued to this operator. The Codification in Item#12 must be signed by the approptlate person associated with this operator:) Name:Holli mead 29, LLC Contact: WILL L-t 0 R D 0(J Mailing Address: 3 E. Te.�F.1</tScDfv City;Charlottesville State:VA zip:,''ZZ3O . Phone:434-9S/ 1110 Email address(if avelleble):.._ •GPO-Do/44 Boa i►N4LES.GoM Indicate if DEC may transmit general permit correspondence electronically: Yea al No 0 2. Existing General Permit Registration Number(for renewals only): 3. Name and Location of the Construction Activity: Name:Hollymead Town Center Bolangles Address(if available):_. city:Charlottesville state:VA ZIp:22911 County(if not located within a City):Albemarle Latitude(decimal degrees):38.129322 N Longitude(decimal degrees):78.439291 W Name and Location of all OWetta Support Activities to be covered under the general permit: Name: W,LL 4,10R01,p.3 Address(if available); 3 e• •1-effe44°r-1 i• City: CrrArue-rresvrec-E State: VA Zip: S/901. County(if not located within a City): Latitude(decimal degrees): Longitude(decimal degrees): 4. Status of the Construction Activity(check only one): Federal 0 State 0 Public 0 Private a. Nature of the Construction Activity(e.g.,commercial,Industrial,residential,agricultural,oil and gas,etc.): Restaurant with Drive-Through Window and Off-Site Travelway S. Name of the Receiving Water(e)and Hydrologic Unit Code(HUC): Name:South Folk Rivanna River NOM;_ HUC:020802040203 HUC: T. If the discharge Is through a Municipal Separate Storm Sewer System(M84),the name of the 1484 operator, S. Estimated Project Start and Completion Data: _.______• Start Date(mm/dd/yyyy):07/15/2016 completion Date(nun/dd/yyyy):10/23/2010 D. Total Land Area of Development(to the newest one-hundredth acre):2.00 Estimated Area to be Disturbed(to the nearest one-hundredth acre):1.95 10. is the area to be disturbed part of a larger common plan of development or sale? Yes 0 No 11 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,end complete. I am swam that there are significant penalties for submitting false Information including the possibiliy of tine and imprison t for knowing violations." Printed Nnrne: _._. 1 L !l J. 4o/.00N V Q. __ _�._.._w_,,_�._.:. 'liu�:w�M�"'te(�- MJ4••t,n•4Ei(L- Signeturo' • rt. _ Date:----I`., so/24;11(Please sign in I K. This don must be signed bythe appropriate pf item M1.) g person assoota with the operator Identified in 01/2014 Page 1 of 1 � r dfcblo , )3 /& / rd loft Err ihn Rcmrd: .r nu) ,t of Aiiki Berriedby: _s� I' iii\ lr,tnke: irn• la 14 natrmnn aartyr Al REQUEST TO ESTABLISH A BOND W00 tfts APPROVED PLAN# -SDP 2016 -00 d PROJECT NAME. H�iy rte) Town C-e'rte! As listed on the approved plan) All parcels in the project,including any off-site+%oik rf easements are not provided,and current owners. Use a separate sheet it more owners are required Owner and tax map Information must be correct,and plans must be approved prior to bone estimates being prepared TAX MAPs l PARCELS: 31- i i 03_ OWNERS NAME 13.4,5 17101 Tr61t+- r SIGNATURE ,,�'' tJf : � �t�..� � date TAX MAPs/PARCELS .-rit 4 OWNER'S N..Mf,?J4o fly rvl s. Zq L.L� SIGNATURE. „. date TAX MAPs i PARC ELs ?) LII D c OWNER'S NAM tr J SIGNATURE: tete i >;tt TAX MAPS/PARCELS: 31.-4 f p OWNER'S Nypt Rol t Comer' 1-1-C SIGNATURE: ` s'=!r 'w *' ' date TAX MAPs/PARCELS: OWNER'S NAM't• SIGNATURE: date: NOTE: if ownership of the property is in the name of any type of legal entity or organization including,but not limited to the name of corporation,partnership,limited liability company, trust,association.etc.,documents acceptable to the County must be submitted certifying that the person signing above has the authority to do sa. The requested estimates are, O VESCP Erosion&Sediment Control per Water Protection Ordinance section I 7-207;SO fee • VSMP Erosion arid Sediment Control,Storn,water Management and Mitigation per Water Protection Ordinance section 17.208;S250 fee required © Subdivision(roads,drainage,etc.)per Subdivision Ordinance section 14-43), & Water&Sewer per Subdivision Ordinance section 14-435:5269 fee required A bond estimate will be prepared by the plan reviewer The estimate,rust be sent to the owner, Please provide contact information EMAIL:— a neirc W @ co,- c,v'lie.e-orn OR REGULAR MAIL ADDRESS Revi rd 6120/2014,1 trSntlt S i )(i' ■ _ m� aCI/ ` ,••••, 0); ]) SNMIw 1.41 /� c\ 4Ila \ o , \ / ( v_iis ( % N ] . lii 'ii !1 2 0 ) _ 4 V \ u . , ] ' _ I m Rt ru /p . o 1 ru . \ 2 \ \\k i n / Q r . �_<S m | § / �z ru S \ . \ \ ° ~ / 0 \ / ).%1\X-- - ` � � - ° ( - eu a. U ) '1- .. w 03 COm ® _ \ I 12 c 0 0 � 4 110;1 � _ X ° § 1: 1 � ) ; r ..1 > G $ El - | - \ } �0 / E0 ru . 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