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WPO201700079 Permit WPO VSMP 2018-06-01
4 pF At, N - r9 4.; I‘ x 0'1 COUNTY OF ALBEMARLE Community Development 401 McIntire Road Charlottesville,Vriginia 22902-4596 434)296-5832 EROSION CONTROL PERMIT Date of Application: 12/07/2017 Permit Effective Date: 06/01/2018 Number: WPO-2017-00079 DEQ Permit#: VAR101129 LANDOWNER:WILSON,BENJAMIN B JR&CAROL WILSON Phone: 8047314924 19607 WHITE OAK RD SUTHERLAND VA 23885 CONTRACTOR:GIBSON MAGERFIELD EDENALI Phone: 434)960-2076 1142 E HIGH ST CHARLOTTESVILLE,VA22902 REPONSIBLE LAND Robert Brugh Phone: 434)242-6027 DISTURBER: 3002 Berkmar Dr Charlottesville,VA22901 Certification/License#: 37179 Type: Responsible Land Disturber Plans Prepared By: Water Street Studio Plans Dated: 12/07/2017 Last Revised: 01/16/2018 Plans Entitled: Erosion&Sediment Control Plan Location: Dist. 6 Acreage: Tax Map: 08800-00-00-002H0 Hydrological JM46 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 Title:Erosion Control Officer Signature Date 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.) Name:Ben Wilson Contact: Mailing Address:19607 White Oak Road City:Sutherland State:VA Zip:23885 Phone:804731-4924 Email address(if available):wilsongrpac©rcn.com Indicate if DEQ may transmit general permit correspondence electronically: Yes© No 0 2. Existing General Permit Registration Number(for renewals only): 3. Name and Location of the Construction Activity: Name:Wilson Residence In Blandemar Farms Address(if available):Lot 9,Blandemar Farms City: State: Zip: County(if not located within a City):Albemarle Latitude(decimal degrees):38.0011 N Longitude(decimal degrees):-78.3702 W 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 0 State 0 Public 0 Private Q 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:North Fork Hardware River Name: HUC:JM.48 HUC: 7. if the discharge is through a Municipal Separate Storm Sewer System(MS4),the name of the MS4 operator: Albemarle County 8. Estimated Project Start and Completion Date: Start Date(mm/dd/yyyy):04/01/2018 Completion Date(mm/dd/yyyy):04/18/2019 9. Total Land Area of Development(to the nearest one-hundredth acre):21.00 Estimated Area to be Disturbed(to the nearest one-hundredth acre):6.00 10. Is the area to be disturbed part of a larger common plan of development or sale? Yes© No 0 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 alt attachments were prepared in accordance with a system designed to assure that qualified personnel property gathered andevaluatedtheinformationsubmitted. 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 offineandImprisonmenntknowingviolatio ." Printed Name: , ice//i ..' Title: 4 d...c „ Signature: Date: /2 --s' —1, Please sign In INK. This Certification must fined by the appropriate person associated with the operator identified Initem#1.) 01/2014 Page 1 of 1 Instructions for Completing the Registration Statement General VPDES Permit for Discharges of Stormwater from Construction Activities (VAR10) GENERAL stormwater pollution prevention plan or comply with other permit conditions). A.Coverage Under this General Permit. The entities that are considered operators will commonly consist of the Any operator applying for coverage under this general permit who Is owner or developer of a project(the party with control of project plans required to submit a Registration Statement (see Section B below) and specifications)or the general contractor(the party with day to day must submit a complete Registration Statement to the Department. operational control of the activities at the project site which are The Registration Statement serves as a Notice of Intent for coverage necessary to ensure compliance with the general permit). under the General VPDES Permit for Discharges of Stormwater from Construction Activities(VAR10). Provide the legal name(do not use a colloquial name),contact,mailing address, telephone number, and email address (if available) of the B.Single-family Residences. construction activity operator,general permit coverage will be issued to this operator. Indicate if the Department may transmit general permit Operators with an existing stormwater discharge or proposing a new correspondence electronically. stormwater discharge associated with the construction of a single- family residence separately built, disturbing less than one acre and Item 2:Existing General Permit Registration Number. part of a larger common plan of development or sale is not required to submit a Registration Statement, provided that the stormwater For reapplication only,provide the existing general permit registration management plan for the larger common plan of development provides number for the construction activity. This item does not need to be permanent control measures (I.e., stormwater management facilities) completed for new construction activities applying for general permit encompassing the single family residence. coverage. Operators of these types of discharges are authorized to discharge Item 3: Name and Location of the Construction Activityunderthisgeneralpermitimmediatelyuponthegeneralpermit's information. effective date of July 1,2014. Provide the official name,street address(if available),city or county(ifC.To Apply for Permit Coverage. not located within a City)of the construction activity. Also,provide the latitude and longitude in decimal degrees of the approximate center of1. New Construction Activities. Any operator proposing a new the construction activity(e.g.,N 37.5000,W 77.5000). stormwater discharge from construction activities shall submit a complete Registration Statement to the Department prior to the Name and Location of Off-site Support Activity Information. commencement of land disturbance,unless exempted by Section B above. Any operator proposing a new stormwater discharge from This general permit also authorizes stormwater discharges from construction activities in response to a public emergency where the support activities (e.g., concrete or asphalt batch plants, equipment related work requires immediate authorization to avoid imminent staging yards, material storage areas, excavated material disposal endangerment to human health or the environment is immediately areas, borrow areas) located on-site or off-site provided that (i) theauthorizedtodischargeunderthisgeneralpermitandmustsubmitasupportactivityisdirectlyrelatedtoaconstrictionactivitythatiscompleteRegistrationStatementtotheDepartmentnolaterthan30requiredtohavegeneralpermitcoverage;(ii)the support activity is notdaysaftercommencinglanddisturbance; documentation to a commercial operation, nor does ft serve multiple unrelated substantiate the occurrence of the public emergency must construction activities by different operators; (Ili) the support activityaccompanytheRegistrationStatement. does not operate beyond the completion of the construction activity it supports; (iv) the support activity Is identified In the registration2. Existing Construction Activities. Any operator that was statement at the time of general permit coverage; (v) appropriateauthorizedtodischargeunderthegeneralpermitIssuedin2009, control measures are identified in a SWPPP and implemented toandwhointendstocontinuecoverageunderthisgeneralpermit, address the discharges from the support activity areas; and (vi) allshallsubmitacompleteRegistrationStatementtotheDepartmentapplicablestate, federal, and local approvals are obtained for theonorbeforeJune1,2014,unless exempted by Section B above. support activity. D.Where to Submit Registration Statements. Provide the official name,street address(if available),City and County if not located within a City) of all off-site support activities to beAllRegistrationStatementsshouldbesubmittedto: covered under this general permit. Also, provide the latitude and longitude in decimal degrees of the approximate center of the off-siteDepartmentofEnvironmentalQuality n support activities (e.g., N 37.5000, W 77.5000). Also, if an off-siteOfficeofStormwaterManagement,10 Floor support activity is going to be covered under this general permit theP.O.Box 1105 total land area of the off-site support activity and the estimated area toRichmond,VA 23218 be disturbed by the off-site support activity need to be included in Item 9. LINE-BY-LINE INSTRUCTIONS Item 4:Status of the Construction Activity.Item 1:Construction Activity Operator information. Indicate the appropriate status (Federal, State, Public, or Private) ofOperator" means the owner or operator of any facility or activity the construction activity. subject to the Stormwater Management Act and regulations. In the context of stormwater associated with a large or small construction item 5:Nature of the Construction Activity.activity, operator means any person associated with a construction project that meets either of the following two criteria:(i)the person has Provide a brief description of the construction activity, such asdirectoperationalcontroloverconstructionplansandspecifications, commercial,residential,agricultural,oil and gas,etc.This list is not allincludingtheabilitytomakemodificationstothoseplansandInclusive. specifications or(ii)the person has day-to-day operational control of those activities at a project that are necessary to ensure compliance item 6:Receiving Waters(s)and HUC Information. with a stormwater pollution prevention plan for the site or other state permit or VSMP authority permit conditions(I.e.,they are authorized to Provide the name of the receiving water(s)and corresponding HUC fordirectworkersatasitetocarryoutactivitiesrequiredbytheallstormwaterdischargesincludinganystormwaterdischargesfrom off-site support activities to be covered under this general permit. 01/2014 Page 1 of 2 t Hydrologic Unit Code or HUC is a watershed unit established in the gather complete and accurate information for permit application most recent version of Virginia's 6"order national watershed boundary requirements; and where authority to sign documents has been dataset. assigned or delegated to the manager in accordance with corporate procedures. Item 7:MS4 Information. b. For a partnership or sole proprietorship: by a general partner or If stormwater is discharged through a municipal separate storm sewer the proprietor,respectively. system(MS4),provide the name of the MS4 operator.The name of the MS4 operator Is generally the Town,City,County, Institute or Federal c.For a municipality,state,federal,or other public agency:by either facility where the construction activity is located.a principal executive officer or ranking elected official.For purposes of this part,a principal executive officer of a public agency includes: Item 8: Construction Activity Start and Completion Date Information. I)The chief executive officer of the agency,or Provide the estimated start date(month/day/year) of the construction ii)A senior executive officer having responsibility for the overall activity. Provide the estimated completion date (month/day/year) of operations of a principal geographic unit of the agency. the construction activity. Item 9:Construction Activity Area Information. Provide the total area (to the nearest one-hundredth acre) of the development (i.e.., 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 ii) 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 measures to assure long-tern compliance with environmental laws and regulations;the manager can ensure that the necessary systems are established or actions taken to 01/2014` Page 2 of 2 COMMONWEALTH of VIRGINIA DEPARTMENT OF ENVIRONMENTAL QUALITY Street address: 1111 E. Main Street, Suite 1400, Richmond, Virginia 23219 Mailing address: P.O. Box 1105, Richmond, Virginia 23218 www.deq.virginia.gov Matthew J. Strickler Secretary of Natural Resources David K. Paylor Director 804) 698-4000 1-800-592-5482May24, 2018 Ben Wilson 19607 White Oak Rd Sutherland, VA 23885 wilsongrpac@rcn.com RE:Coverage under the VPDES Construction General Permit (VAR10) General Permit No. VAR10L129 WPO2017-00079 Blandemar Farms Lot 9 Wilson Residence Residential Albemarle Dear Permittee: DEQ has reviewed your Registration Statement received on December 07, 2017 and determined that the proposed land-disturbing activity is covered under the General VPDES Permit for Discharges of Stormwater from Construction Activities (VAR10). The effective date of your coverage under this general permit is July 1, 2014 or the date of this letter, whichever is later. A copy of the general permit can be obtained from DEQ’s webpage at the following location: http://www.deq.virginia.gov/Portals/0/DEQ/Water/Publications/CGP2014.pdf. The general permit contains the applicable Stormwater Pollution Prevention Plan (SWPPP) requirements and other conditions of coverage. Please print the general permit and read it carefully as you will be responsible for compliance with all permit conditions. Additionally, coverage under this construction general permit does not relieve the operator of complying with all other federal, state, or local laws and regulations. DEQ staff has determined that the proposed land-disturbing activity will discharge to a surface water identified as impaired or for which a TMDL wasteload allocation has been established and approved prior to the term of the general permit for (i) sediment or a sediment-related parameter or (ii) nutrients. Therefore, the following general permit (Part I.B.4) and SWPPP requirements (Part II.A.5) must be implemented for the land-disturbing activity: Permanent or temporary soil stabilization shall be applied to denuded areas within seven (7) days after final grade is reached on any portion of the site; Nutrients (e.g., fertilizers) shall be applied in accordance with manufacturer’s recommendations or an approved nutrient management plan and shall not be applied during rainfall events; Inspections shall be conducted at a frequency of (i) at least once every four (4) business days or (ii) at least once every (5) business days and no later than 48 hours following a measurable storm event. In the event that a measurable storm event occurs when there are more than 48 hours between business days, the inspection shall be conducted on the next business day; and Representative inspections used by utility line installation, pipeline construction, or other similar linear construction activities shall inspect all outfalls. In accordance with the Virginia Stormwater Management Program State Permit Fee Regulation 9 VAC 25-870-830), you may be required to pay an annual permit maintenance fee until coverage under this 2 general permit is terminated. If you are required to pay an annual permit maintenance fee, you will receive an invoice from the VSMP Authority including the amount and due date. The general permit will expire on June 30, 2019. The conditions of the general permit require that you submit a new registration statement at least 90 days prior to that date if you wish to continue coverage under the general permit, unless permission for a later date has been granted by the Board. Permission cannot be granted to submit the registration statement after the expiration date of the general permit. If you have any questions about this permit, please contact the DEQ Office of Stormwater Management at ConstructionGP@deq.virginia.gov. Sincerely, Jaime B. Robb, Manager Office of Stormwater Management