HomeMy WebLinkAboutWPO201700019 Permit WPO VSMP 2018-03-30 General Permit for Discharges of Stormwater from Construction Activities(VARIO)
Registration Statement
(Please Type or Print Ali Information)
1. Construction Activity Operator(The permit will be issued to this operator, and the Certification in Item#13 must be signed by the
appropriate person associated with this operator[see the instructions)):
Name:Albemarle County School Board Contact: Joe P. Letteri
Mailing Address: 401 McIntire Road
City:Charlottesville State: VA zip: 22902 Phone: (434) 975-9340
Email address(if available): jletteri@k12albemarle.org
Indicate if DEQ may transmit the permit electronically: Yes X No
2. (Must be included for renewals of coverage only)Existing Permit Coverage#:
3. Location of Construction Activity:
Name: Scottsville Elementary School
Address:7868 Scottsville Road
City: Scottsville state:VA Zip: 24590
County: Albemarle
DMS to the nearest 15 seconds: Latitude 37.8187 Longitude -78.5106
Location of all Offsite Support Activities to be Covered Under the Permit:
Name:
Address:
City: State: Zip:
County:
if street address unavailable: Latitude Longitude
4. Status of Activity:Federal❑ State® Public❑ Private❑ (Check one only)
5. The Nature of the Construction Activity(e.g.,commercial,industrial,residential,agricultural,oil and gas,etc.):
Public
6. Name of the Receiving Water(s): Totier Creek- James River
Hydrologic Unit Code(HUC): 020802031103
(Receiving waters identified as impaired on the 2008 305(b)/303(d)Water Quality Assessment Integrated Report or for which a
TMDL WLA has been established for stormwater discharges from a construction site shall be noted in an attached list)
7. If the discharge is through a Municipal Separate Storm Sewer System(MS4),the name of the municipal operator of the
storm sewer: Albemarle County
8. Estimated Project Start Date(mm/dd/yyyy): 05/2018
Estimated Project Completion Date(mmtdd/yyyy): 08/2018
9. Total Land Area of Development(to the nearest one-tenth acre): 14.7
Estimated Area to be Disturbed(to the nearest one-tenth acre): 0.61
10. Is the area to be disturbed by the construction activity part of a larger common plan of development or sale?Yes❑ No®
11. Are nutrient offsets intended to be acquired for this activity?Yes❑ No® Under consideration❑
12. A stormwater pollution prevention plan (SWPPP)must be prepared in accordance with the requirements of the General
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.
13. 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."
Print Name: Mr Joseph P i
Title:1),-r4,,>, p,,..t�-, .,„L4,..
Signature: \t. ..A\ P Date: 3-30 1 P..,n
(Please sign `` I .The person signing this form must be associated with the operator identified in Item#1 above.)
Mail to: Deoartine t of Environmental Quality.Office of Stormwater Management. 10th Floor, P.O. Box 1105, Richmond,VA 23218
(DEQ 199-146)(08/13)
INSTRUCTIONS for FORM DEQ 199-146
General Permit Registration Statement - Construction Activity Stormwater Discharges
General Hydrologic Unit Code(HUC)is a watershed unit established in the most recent
A Registration Statement must be submitted to the Department of Environmental version of Virginia's 64,order national watershed boundary dataset
Quaky to register for coverage under the General Permit for Stormwater Section 7 Name of MS4 Operator
Discharges from Construction Activities. if the stomiwater is discharged through a menial separate storm sewer
Section 1 Construction Activity Operator information system(MS4),enter the name of the operator of the MS4.The name of the
"Operator means the owner or operator of any facility or activity subject to the MS4 operator is usually the Town, City, County, Institute or Federal facility
Stormstormwater the ac vity islocated.
associated with a large or small construction activity, operator means any Section 8 Estimated Project Start Date
person associated with a construction project that meets either of the following Enter the date(Month/Day/Year)the projected is expected to start
two criteria:(i)the person has direct operational control over constnxxion plans Estimated Project Completion Date
and specifications, including the ability to make modifications to those plans Enter the date(Month/Day/Year)the project is expected to be complete.
and specifications or(ii)the person has day-to-day operational control of those
activities at a project that are necessary to ensure compliance with a Section 9 Total Land Area of the Development
stormwater pollution prevention plan for the site or other state permit conditions Enter total area(to the nearest one tenth acre)of the development(meaning
(i.e., they are authorized to direct workers at a site to carry out activities the total acreage of the larger common plan of development or sale).Include
required by the stormwater pollution prevention plan or comply with other the total acreage of any offsite support activities to be covered under the general
permit conditions). permit
The entities IMio are considered operators will commonly consist of the owner or Estimated Area to be Disturbed
developer of a project(the party with control of project specifications)and the Enter an estimate of the total number of acres(to the nearest one tenth acre)to
general contractor(the party with day to day operational ward of the activities at be disturbed. Include in the Estimated Area to be Disturbed the area of
the project site which are necessary to ensure compliance with the state disturbance that will was at off-site support activities to be covered under the
permit). Contractors and subcontractors who are under the general permit
supervision of the general contractor are not considered operators and would Section 10 Larger Common Plan of Development or Sale
not need to submit a registration statement. Give the legal name of the Incicate if the area to be disturbed by the construction activity is part of a lager
operator,do not use a colloquial name.Enter the complete address and phone common plan of development or sale.Larger common plan of development or
number of the operator.The permit will be issued to this operator. sale defines a contiguous are where separate and distinct construction may be
Section 2 Existing General Permit Coverage Number haling place at different times on different schedules.Plan is broadly defined as
For reappicatiors only,indicate the existing general permit coverage number for any announcement or documentation,inducting a sign,pubic notice or hearing,
the project.This section does not need to be completed for new projects applying poles pitch,advertisement,such drawing,permits,lot soon,zoning request,etc.,ri g r
for state permit coverage. physical demarcation as boundary signs,lot stake,and surveyor markings
indicating that construction activities may coax.
Section 3 Location of Construction Activity Information Section 11 Nutrient Offsets
Enter the activitys official name and complete street address.including city(or
town),county(if not located within a City),state and ZIP code. Indicate if rxinert offsets are intended to be acquired in accordance with§62.1-
If the site lades a street address,enter the city(or fawn},county(if not located 44.15:35 of the Code ofllrgiria.If the acquisition of offsets is being considered but
within a City) and the latitude and longitude in degrees, minutes, seconds s not certain,select"order consideration."
(DMS)to the nearest 15 seconds of the approximate center of the site(example Section 12 A stormwater pollution prevention plan(SWPPP)must be prepared
37°30'15"N 77°20'15"W). in accordance with the requirements of the General Permit for Discharges of
Location of Offsite Support Activities Stormwater from Construction Activitiesprior to submitting this Registration
This general permit also authorizes stormwater discharges from support activities Statement By signing this Registration Statement the operator is certifying that
the SWPPP has been prepared.
(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 Section 13 Certification
provided that (a)The support activity is directly related to the construction site The operator identified in Section 1 of this Registration Statement is
that is required to have general permit coverage for discharges of stormwater responsible for certifying and submitting this Registration
associated with construction activity(b)The support activity is not a corrvmercial Statement Please sign the form in INK. State statutes provide for
operation serving multiple unrelated construction projects by different operators, severe penalties for submitting false information.State regulations require
and does not operate beyond the completion of the construction ion activity at the this Registration Statement to be signed as follows:
last construction project it supports; and (c)Appropriate control measures are For a corporation:by a responsible corporate officer.For the purpose of this
identified in a stormwater pollution prevention plan and implemented to address part,a responsible corporate
ry,
the discharges iron the support activity areas. treasurer,or vi the corporation means: in a chprarge of, principal
vice-president of the charge of a principal business
Provide the information required for each off-site support activity seeking function,or any other person who performs similar policy-making or decision-
coverage.If an off-site support activity is going to be covered by this permit the making functions for the corporation;or(ii)the manager of one ix more
total laid area of the off-site support activity and area to be distubed by the off, manufacturing,production,or operating facilities,provided the manager is
site support activity need to be included in the Estimated Area to be Disturbed authorized to make management decisions that govern the operation of the
(Section 8). regulated facility including having the explicit or implicit duty of making major
Section 4 Status of Activity capital investment recommendations,and initiating and directing other
environmental the appropriateusof status(Federal,State, Public, or Private) of the comprehensive measures to assure long-term compliance with envirorental
laws and regulations;the manager can ensure that the necessary systems are
activity. established or actions taken tor
Bathe complete and accurate information for
Section 5 Nature of the Construction Project permit application requirements;and where authority to sign documents has
Indicate the nature of the construction project (commercial, residential. been assigned or delegated to the manager in accordance with corporate
agricultural,oil and gas,etc).This list is not all indusive. procedures.
Section 6 Name of Receiving Water(s) For a partnership or sole proprietorship:by a general partner or the
Enter the name of the receiving water(s) for ail stormwater discharge(s), proprietor,respectively.
including any stormwater discharges from off-site support activities to be For a municipality,state,federal,or other public agency:by either a principal
covered under the permit. Receiving waters identified as impaired on the executive officer or ranking elected official.For purposes of this part,a
2008 305(b)/303(d)Water Quality Assessment Integrated Report or for which principal executive officer of a public agency includes:(i)the chief executive
a Total Maximum Daily Load(TMDL)Waste Load Allocation(WLA)has been officer of the agency or(i)a senior executive officer having responsibility for
established for stormwater discharges from construction activities shall be the overall operations of a principal geographic unit of the agency.
noted.
The Department of Environmental Quality reserves the richt to request additional information not directly addressed by the
Registration Statement if in its discretion.a facility or operation poses a potential impact on water quality.
(DEQ 199-146)(08/13)
COUNTY OF ALBEMARLE
Community Development
401 McIntire Road
Charlottesville, Vriginia 22902-4596
(434)296-5832
EROSION CONTROL PERMIT
Date of Application: 02/21/2017
Permit Effective Date: 10/17/2017 Number:
LANDOWNER: COUNTY OF ALBEMARLE SCHOOL BOARD ATTN: Phone:
SUPERINTENDENT OF SCHOOLS
401 MCINTIRE ROAD
CHARLOTTESVILLE VA22901
CONTRACTOR: CS CUSTOM STRUCTURES - DANIEL CYRUS Phone:
1934 GRAVES MILL RD
LYNCHBURG, VA24502
REPONSIBLE LAND JASON WRIGHT - WRIGHT CONTRACTING Phone:
DISTURBER: 1036 LEIGH MOUNTAIN ROAD
GREEN BAY, VA23942
Ccrtification/License #: RLD05964 Type:
Plans Prepared By.-
Plans
y:
Plans Dated:
Plans Entitled:
Tax Map:
Timmons Group
04/03/2017
WPO -2017-00019
(434) 610-3719
(434) 315-1770
Responsible Land Disturber
Last Revised: 09/06/2017
SCOTTSVILLE ELEMENTARY SCHOOL SECURITY Location:
ADDITION AND IMPROVEMENTS
13000-00-00-025PO
Dist. 0.58
Acreage:
Hydrological JM44
Unit:
Additional Information: Annual Maintenance Fees [Sections 17-Zo7 & 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 BQZ:4�e�l17-
Title: Erosion Control Officer
iT
Signature Date
General Permit for Discharges of Stormwater from Construction Activities(VAR10)
Registration Statement
(Please Type or Print All Information)
1. Construction Activity Operator(The permit will be issued to this operator,and the Certification in Item#13 must be signed by the
appropriate person associated with this operator(see the instruction&):
Name:Albemarle County School Board Contact: Joe P. Letteri
Mailing Address: 401 McIntire Road
City:Charlottesville State: VA zip: 22902 Phone: (434) 975-9340
Email address(if available): jletteri@k12albemarle.org
Indicate if DEQ may transmit the permit electronically: Yes X No
2. (Must be included for renewals of coverage only)Existing Permit Coverage#:
3. Location of Construction Activity:
Name: Scottsville Elementary School
Address: 7868 Scottsville Road
City: Scottsville state:VA Zip:• 24590
County: Albemarle
DMS to the nearest 15 seconds: Latitude 37.8187 Longitude -78.5106
Location of all Offsite Support Activities to be Covered Under the Permit:
Name:
Address:
City: State: Zip:
County:
If street address unavailable: Latitude Longitude
4. Status of Activity:Federal❑ Stats® Public❑ Private 0 (Check one only)
5. The Nature of the Construction Activity(e.g.,commercial,industrial,residential,agricultural,oil and gate,etc.):
Public
a. Name of the Receiving Water(s): Totier Creek-James River
Hydrologic Unit Cods(HUC): 020802031103
(Receiving waters identified as impaired on the 2008 305(b)1303(d)Water Quality Assessment integrated Report or for which a
TMDL WLA has been established for stormwater discharges from a construction site shall be noted In an attached list)
7. If the discharge is through a Municipal Separate Storm Sewer System(MS4),the name of the municipal operator of the
storm sewer: Albemarle County
8. Estimated Project Start Date(mmiddlyyyy): 05/2018
Estimated Project Completion Date(mmiddlyyyy): 08/2018
9. Total Land Area of Development(to the nearest one-tenth acre): 14.7
Estimated Area to be Disturbed(to the nearest one-tenth acre): 0.58
10. Is the area to be disturbed by the construction activity part of a larger common plan of development or sale?Yes❑ No®
11. Are nutrient offsets Intended to be acquired for this activity?Yes❑ No® Under consideration❑
12. A stormwater pollution prevention plan (SWPPP)must be prepared in accordance with the requirements of the General
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.
13. 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 aresignificant penalties for submitting false information including the possibility of
fine and imprisonment for knowing viola ions."
..L _
Print Name: MrJoseph P. Title: Director
Signature:
Date: e ' 2 ' 11
(Please sign iIN .The person signing this form must be associated with the operator identified in Item#1 above.)
Mail to: Deoartm t of Environmental Quality. Office of Stormwater Management, 10th Floor,P.O. Box 1105, Richmond,VA 23218
(DEQ 199.146)(08113)
E
E
•
INSTRUCTIONS for FORM DEQ 199-146
General Permit Registration Statement-Construction Activity Stormwater Discharges
General Hydrologic Unit Code(HUC)is a watershed unt established in the most recent
A Registration Statement must be submit ed to the Departnert of Endenrrental version of Virginia's 6"order national watershed boundary dataset.
Quality to register for coverage under tie General Penult for Stornuaata Section 7 Name of MS4 Operator
Discharges from Construction Aq . If the starnwater is discharged through a municipal separate stone sewer
Section 1 Construction Activity Operator Information system(MS4),enter the name of the operator of the MS4.The name of the
"Operator"means the owner or operator of any fac sty or activity subject to the MS4 operator is usually the Town, City, County, institute or Federal facility
Stormwater Management Act and regulations. In the context of stormwaier where the conitru ion activity is located.
associated with a large or small construction activity, operator means any Section 8 Estimated Project Start Date
person associated with a construction project that meets either of the following Enter the date(Month/Day/Year)the projected is expected to start.
two asteria:(I)the person has died operational control over construction plans Estimated Project Completion Date
and specifications, including the abfiity to make,modifications to those plans Eraer the date(Month/Day/Year)the project is expected to be campke.
and specifications or(b)the person has day-today operational control ofthose Suction 9 Total Land Area of the Development
activities at a tprojecton that n are neon theersi to ensure compliance ppiartce wlth a Enter the total area(to the nearest one tenth acre)of the development(meaning
stamwey pollution authorized
toon plan wfaters
site or etrer state carry
outf tadMtles the total acreage of the carrion ion p�of development or sale).Include(i.e., they are authod direct workers ti a siteaorto cony activities r the acreageof any offate support activities to be covered under the general
required by the stormwater pollution prevention plan comply with �'
permit conditions). permit.
Estimated Ares to be Disturbed
The entities who are considered o °ra will canna* �of the uvea,a Enter an estimate of the total number of acres(to the nearest one tenth acre)to
general contractor d a project(are party ayl d yd d project sped 0tme )and the be daubed. Inckrde in the Estimmatad Area to be Disturthed the area of
general ctsiteh c party necessaryeday to day operational Control d the eddies hi ctehrrbaoe that v ooar at off-site support activities to be covered under the
the project site which are to ensue compliance with the stats
permit). Contractors and subcor>tmdors who we under the general Per
supervision of the general contractor are not considered operators and would ',action 10 Larger Common Plan of Development or Sale
not need to submit a registration statement. Give the legd name of the in icate if the area to be disturbed by the construction activity is part of a larger
operator,do not use a colloquial name.Enter the co nplete address and phone cannon plan of development a sale.lager common plan of development or
number of the operator.The permit oil be issued to this operator. sale deines a canfguaus are where separate and distinct constnidbn may be
Section 2 Existing General Permit Coverage Number ung pace at(Hferent times on dilfeet schedules.Plan is broadly defined as
any anounoernent or daarrrentatlon,including a sign,public notice a hearing,
For reappicoions only,iodate the exising general pelt°overage reader for sales etch,adverise ant,drawing,pent appicadon,zoning request,etc.,or
the project.This seduce does not need to be completed for new projects applying physical demarcatlon such as boundary signs,lot stake,and surveyor markings
far state permit coverage. Indicating that corstnx ion activities may occur.
Section 3 Location of Construction Activity Information Section 11 Nutrient Offsets
Enter the actvitys otidal name and complete street address,including city(a Mate if rmudbient offsets are intended to be acquired In accordance with§621-
town),county Of not located MI*a City),state and ZIP code 44.15:35 d the Code ofVtgimia.ff the emulation d ctbdi is being considered but
If the site lades a street address,enter the city(or bon),county(II not located is not Date%,midst"under corrdderdion"
within a City) and the latitude and imp*in degrees, minutes, seconds knoula A pow prevention ,p)must be prepared37'50 to the newest7°°2020'155" conds of the approximate tarifa,dire site(example(exampleinn accordance with the requ irenents of the General Permit for Discharges d
37°30 15"N 7 "W). geometer from Canstrumon Adlviies prkX to submlting this Registration
Location of Offsite Support Activities Statement By signing this Registration Statement the operator is certifying that
This general permit also authorizes slamweter discharges from euPPoit activities the SVVPPP has been prepared.
(e.g.,concrete or asphalt batch plants,equipment staging yards,nmaiafel storage Section 13 Certification
areas,excavated material disposal areas,borrow areas)located anode or off-site See operator Identified In Section 1 of this Registration Statement is
thprovided that(a)The support l pee Is coveractlyge
related r to atgesthe og tam stir responsible for certifying and submitting this Registration
associated
ied required construction have general permit heesupp for cii vi is ni d sbomcaraedetal Statement Please sign the form In INK. State statutes provide for
operoperdiond with mutatead ted(b)The support eaciwb+b not a different aper tors, severe penalties for adremiting false i formation.State regulations require
°^s r �� et norl Pry ctioncthis Registration Statement to be signed as follows:
and does not operate beyond the completion d the construction activity at bre last construction project it supports;art(c)Appropriate control measures we Fora corporation:by a respond*corporateofficer.For the purpose of this
identified in a sto rnwater pluton ton prevention pen and irplemeried to address part a responsible corporate officer means:(1)a president,secretary,
the discharges from the support activity areas. treasurer,or vice-president d the corporation in charge of a principal business
Provide the Information required for each cu-site support activity seeking on,or other person who performs simian policy-mating or decision
coverage.If an off-site support activity is going to be covered by this permit the making functions for the corporation;or®the manager of one or more
total laid area of the of-site support activity and area to be disturbed by the off- maxfaaurk►g,production,or operating facilities,provided the manager is
site support activity need to be included in the Estimated Area to be Disturbed
authorized to make rrherhsgerrhent decisions that govern tie operation of the
(Section 8) regulated facility including having the explicit or implidt duty of ma drg major
capital In restmernt reoommerh lations,and initiating and directing other
Section 4 Status of Activity comprehensive measures to assure long-term compliance with environmental
Indicate the appropriate status(Federal,State,Public,or Private)of the laws and regulations;the manager can ensure that the necessary systems are
activity. established a actions taken to gather complete and accurate information for
Section 5 Nature of the Construction Projecttonts;and where authority t°sigthe manager in accordance"
documents has
Indicate the nature d the construction project (camrnactal, residential. assigned
with corporate
agriculiral,of and gas,etc).This list is not all inclusive. procedures.
Section 6 Name of Receiving Water(s) For a partnership or sole proprietorship:by a general partner or the
Enter the name of the receiving water(s) for all stonnwater discharge(s), proprietor,respectively.
inducting any stonrnrater discharges from off-site support activities to be For a municipality,state,federal,or other pubic agency.by either a principal
covered under the permit Receiving waters identified as impaired on the
executive officer or ranking elected oificial.For purposes of this part,a
2008 305(b)1303(d)Water Quality Assessment Integrated Report or for which principal executive officer of a public agency includes:(I)the chief executive
a Total Maximum Daily Load(TMDL)Waste Load Allocation(1yVLA)has been officer of the agency or 1))a senior executive officer having responsibility for
established for stormwater discharges iron construction acliviies shall be the overall operations of a principal geographic tea of the agency.
noted.
The Department of Environmental Quality reserves the d aht to request additional information not directly addressed by the
Registration Statement if.in its discretion,a facility or operation poses a potential impact on water quality.
(DEQ 199-146)(08/13)