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Home My WebLink AboutWPO201800039 Application WPO VSMP 2018-08-29 Virginia Stormwater Management Program (VSMP) q� Application for Albemarle County 1E0W Project Name: Hollymead Dam Spillway Improvements (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes ❑ No d Is this a revision or resubmission for review? Yes IX No 0 County File Number: w Pam gODD 31 (to be provided by the County for new applications) The following are required elements of new applications[from code section 17-401]. For revisions or amendments,please indicate which items are being amended Signatures must be provided for any submission. 0 A. Signature of the Property Owner for each parcel: (Required with every submission or revision, NOT TO BE SIGNED BY AN AGENT OR CONSULTANT) By signing this application as the owner,I hereby certify that all requirements of these plans and permits will be complied with,and I have the authority to authorize the land disturbing activities and development on the subject property. I hereby grant the County of Albemarle the right to enter upon the property as required to ensure compliance with the approved plans and permits. 1946B3-A County of Albemarle,VA ,f/7W(OP Tax Map&Parcel Print Name of Property Owner ignat of Owner Date 46B3-A2 County of Albemarle,VA F/2 Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Contact Information for the Owner(s)to receive correspondence: Print Name Trevor K. Henry,Assistant County Executive Address 401 McIntire Rd City Charlottesville State VA Zip 22902 Daytime Phone(434) 296-5841 E-mail thenry@albemarle.org 7/1/14,Revised: 7/10/14, 1/7/14 Page 1 of 2 0 B. All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed Acres to be Total Fee Fee Due with this Fee with Transfer or disturbed Application modification of permit Less than 1 $290 $145 $20 1 and less than 5 $2,700 $1,350 $200 5 and less than 10 $3,400 $1,700 $250 10 and less than 50 $4,500 $2,250 $300 50 and less than 100 $6,100 $3,050 $450 100 and more $9,600 $4,800 $700 For(minor)amendments to an approved plan;$200 per review Variances;$150(per request) Mitigation Plan;$150 0 C. Registration Statement on the official DEQ form. ❑ D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ❑ E. Stormwater Management Plan satisfying the requirements of code section 17-403. ❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404. ❑ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. ❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ J. Construction Record Drawings(as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Jeremy Young Address 1380 Wilmington Pike, Suite 100 City West Chester State PA Zip 19382 Daytime Phone(610) 696-6066 E-mail jyoung@schnabel-eng.com *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# Fee Amount$ Date Paid By who? Receipt# Ck# By: 7/1/14,Revised: 7/10/14, 1/7/14 Page 2 of 2 til Albemarle Coie#4. k ly Community Development Department 46‘441ntire Road Charlottesville,VA 22902-4596 .-i rVoi ce:1.434i 296-5832 Fax:1434)972-4126 Planning Application PARCEL I OWNER INFORMATION TMP 046B3-00-00-000A0 Owner(s): FOREST LAKES COMMUNITY ASSOCIATION Application# WP0201800039 PROPERTY INFORMATION - - Legal Description FOREST LAKES OPEN SPACE PMI ,.. Magisterial Dist. Rivanna `r I Land Use Primary Residential -- Single-family (incl. modular homes E , Current AFD Not in A/F Districtw I Current Zoning Primary R4 Residential r:1 I APPLICATION INFORMATION Street Address I Entered By , 11 Jennifer Smith Application Type Water Protection Ordinances i vl 15/22/2018 Project HOLLYMEAD DAM SPILLWAY IMPROVEMENTS- VSMP Received Date 05/21/18 I Received Date Final Submittal Date Total Fees' I Closing File Date Submittal Date Final Total Paid Revision Number Comments 1--- A Legal Ad SUB APPLICATION(s) Type Sub Applicatio I Comment Stormwater Management/BMP Plan 05/21/18 Erosion and Sediment Control Plan 05/21/18 • I IAPPLICANT /CONTACT INFORliATION ContactT .- Name i Address CityState Zip Phone PhoneCell Ow reriAppicaunt FOREST LAKES CO M hi U MIT Y P 0 BOX 8084 CHARLOTTESVILL Signature of Contractor or Authorized Agent Date Sae *tilt'` 4,0c AL Virginia Stormwater Management Program (VSMP) Application for Albemarle County ..wit ��AG1N�A Project Name: Hollymead Dam Spillway Improvements (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes ❑ No Is this a revision or resubmission for review? Yes 0 No E County File Number: (to be provided by the County for new applications) The following are required elements of new applications[from code section 17-401]. For revisions or amendments,please indicate which items are being amended. Signatures must be provided for any submission. E A. Signature of the Property Owner for each parcel: (Required with every submission or revision, NOT TO BE SIGNED BY AN AGENT OR CONSULTANT) By signing this application as the owner,I hereby certify that all requirements of these plans and permits will be complied with,and I have the authority to authorize the land disturbing activities and development on the subject property. I hereby grant the County of Albemarle the right to enter upon the property as required to ensure compliance with the approved plans and permits. 04663-000-00-00A0 Forest Lake Community Association U,1 //------ Tax Map&Parcel Print Name of Property Owner Signature of Owner Date 04683-000-00-00A2 Forest Lake Community Association Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Contact Information for the Owner(s)to receive correspondence: Print Name 1/�1 C?\ a' S \\/ Address T� mc��j' .e 'PGr City eintkiieS V: (iC State Y Zip Daytime Phone(437) 0(2 1 ( N E-mail ializeZts 0_42/44144_4 . 7/1/14,Revised: 7/10/14, 1/7/14 Page 1 oft Sore sure 0 B. All Fees [Code section 17-208] For new or modified plans; Total acres proposed to be disturbed 4.291 acres Acres to be Total Fee Fee Due with this Fee with Transfer or disturbed Application modification of permit Less than 1 $290 $145 $20 1 and less than 5 $2,700 $1,350 $200 5 and less than 10 $3,400 $1,700 $250 10 and less than 50 $4,500 $2,250 $300 50 and less than 100 $6,100 $3,050 $450 100 and more $9,600 $4,800 $700 For(minor)amendments to an approved plan;$200 per review Variances;$150(per request) Mitigation Plan;$150 Pi C. Registration Statement on the official DEQ form. El D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. E E. Stormwater Management Plan satisfying the requirements of code section 17-403. O F. Pollution Prevention Plan satisfying the requirements of code section 17-404. O G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. El H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. D I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ J. Construction Record Drawings (as-builts)for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Address City State Zip Daytime Phone( ) E-mail *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# Fee Amount$ Date Paid By who? Receipt# Ck# By: 7/1/14,Revised: 7/10/14, 1/7/14 Page 2 of 2