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Home My WebLink AboutWPO201900004 Application 2019-02-04 401 M rt' rr�' • imunity Development Department #iela !11 Albemarle Coun� dCharlottesviIle.VA22902-4596 Voice. tY�Y;!296 5832 Fax:(434)972-4126 „ y Planning Application PARCEL OWNER INFORMATION TMP 04600-00-00-019A0 Owner(s): CROCKETT CORPORATION Application# WP0201900004 PROPERTY INFORMATION Legal Description I Parcel 8A A, Magisterial Dist. Rivanna Land Use Primary Unassigned El Current AFD Not in A/F Dist•rict (wr t Current Zoning Primary[Neighborhood Model District E [APPLICATION INFORMATION Street Address Entered By 'Jennifer SmithR Application Type Water Protection Ordinances D 2/4/2019 Project BROOKHILL - BLOCK 8A - SENIOR LIVING FACILITY - VSMP - DIGITAL Received Date 02/01/19 I Received Date Final f Submittal Date Total Fees 1700 i Closing File Date Submittal Date Final Total Paid 1700 Revision Number Comments �_ ., Legal Ad , R SUB APPLICATION(s) Type Sub Applicatio Comment Stormwater Management/BMP Plan 02/04/19 . Erosion and Sediment Control Plan 02/04/19 APPLICANT / CONTACT INFORMATION ContactType Name Address CityState Zip Phone PhoneCell 34,e =--• CROCKETT CORPORATION 435 PARK ST CHARLOTTESVILL 22901 ana Contact RYAN YAUGER-BOHLER ENGINEERING 28 BLACKWELL PARK LANE, WARRENTON,VA d n y 20186 5403494500 AWtcart MATT BOOMA-CA SENIOR LIVING 130 EAST RANDOLPH STREET, CHICAGO,IL 60601 3122391896 Signature of Contractor or Authorized Agent Date • .of AL*,, Virginia Stormwater Managetent Program (VSMP) �� 9A Application for Albemarle County ® ' Project Name: Brookhill - Block 8A-Senior Living Facility (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes ❑ No El Is this a revision or resubmission for review? Yes ❑ No IX] County File Number: (to be provided by the County,for new applications) The following are required elements of new applications[from code section 17-4011 For revisions or amendments,please indicate which items are being amended. Signatures must be provided for any submission. Pc1 A. Signature of the 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. 'lam 04600-00-00-019A0 Crockett CorporationL 1/24/19 Tax Map&Parcel Print Name of Owner Signature of Awner Contract Owner Date Tax Map&Parcel Print Name of Owner Signature of Owner Date Tax Map&Parcel Print Name of Owner Signature of Owner Date Tax Map&Parcel Print Name of Owner Signature of Owner Date Contact Information for the Owner(s)to receive correspondence: Print Name CA Senior Living HoldinQs,.LLC - Matt Booma,Authorized Signatory Address 130 East Randolph Street,Suite 2100 City Chicago State IL Zip 60601 Daytime Phone( 312)239-1896 E-mail mbooma@ca-ventures.com Revised 07/24/18 Page 1 of 2 IX) B. All Fees [Code section 17-208 For new or modified plans;Total acres proposed to be disturbed 5.17 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 $6,100 $3,050 $450 100 100 and more $9,600 $4,800 $700 For(minor)amendments to an approved plan;$200 per review Variances;$150 Mitigation Plan;$150 ❑ C. Registration Statement on the official DEQ form. ❑ D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ❑ E. Stormwater Management Plan satisfying the requirements of code section 17-403. ❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404. ❑ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. ❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Bohler Engineering VA, LLC- Ryan Yauger Address 28 Blackwell Park Lane,Suite 201 City Warrenton State VA Zip 20186 Daytime Phone(540) 349-4500 _E-mail rvauger@bohlereng.com *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn.Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO#01\19 A 'A/,,�R Fee Amount$ "rl A 1 Date Paic� I By who. eceipt if`llU(LW CkI1)p Q By: Revised 07/24/18 Page 2 of 2 • Fee Received 7 va Received Date RECEIVED 9-4lia FEB 0 1 Received By COMMUNITY DEVELOPMENT ill OV A L/34.i Virginia Stormwater Management Program (VSMP) 4 Application for Albemarle County ice;,,\- Project Name: Brookhill - Block 8A-Senior Living Facility (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes El No 1311 Is this a revision or resubmission for review? Yes ® No El County File Number: WPO2019000 (to be provided by the County for new applications) The following are required elements of new applications[from code section 17-4011 For revisions or amendments,please indicate which items are being amended. Signatures must be provided for any submission. I7 A. Signature of the 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. 04600-00-00-019A0 Crockett Corporation 6/28/19 Tax Map&Parcel Print Name of Owner Signature ofvf Owner Contract Owner Date Tax Map&Parcel Print Name of Owner Signature of Owner Date Tax Map&Parcel Print Name of Owner Signature of Owner Date Tax Map&Parcel Print Name of Owner Signature of Owner Date Contact Information for the Owner(s)to receive correspondence: Print Name CA Senior Living Holdings,LLC - Matt Booma,Authorized Signatory Address 130 East Randolph Street, Suite 2100 City Chicago State IL Zip 60601 Daytime Phone( 312)239-1896 E-mail mbooma@ca-ventures.com Revised 07/24/18 Page 1 of 2 ® B. All Fees [Code section 17-208] For new or modified plans; Total acres proposed to be disturbed 5.17 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 $6,100 $3,050 $450 100 100 and more $9,600 $4,800 $700 For(minor)amendments to an approved plan;$200 per review Variances;$150 Mitigation Plan; $150 El C. Registration Statement on the official DEQ form. O D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ❑ E. Stormwater Management Plan satisfying the requirements of code section 17-403. ❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404. O G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. ❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Bohler Engineering VA, LLC- Ryan Yauger Address 28 Blackwell Park Lane,Suite 201 City Warrenton State VA Zip 20186 Daytime Phone(540) 349-4500 E-mail ryauger@bohlereng.com *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn.Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# Fee Amount$ Date Paid By who? Receipt# Ck# By: Revised 07/24/18 Page 2 of 2 -"1‘.Virginia Stormwater Management Program (VSIV[P) Application for Albemarle County Project Name: Brookhill -Block 8A-Senior Living Facility (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes 0 No 50 Is this a revision or resubmission for review? Yes ® No 0 County File Number: WPQ2019000 (to be provided by the County for new applications) The following are required elements of new applications[from code section 17-4011 For revisions or amendments,please indicate which items are being amended. Signatures must be provided for any submission. in A. Signature of the 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. 04600-00-00-019A0 Crockett Corporation "!"'"'- 8/30/19 Tax Map&Parcel Print Name of Owner Signature ;R Contract Owner Date Tax Map&Parcel Print Name of Owner Signature of Owner Date Tax Map&Parcel Print Name of Owner Signature of Owner Date Tax Map&Parcel Print Name of Owner Signature of Owner Date Contact Information for the Owner(s)to receive correspondence: Print Name CA Senior Living Holdings,LLC - Matt Booma,Authorized Sianatory Address 130 East Randolph Street,Suite 2100 City Chicago State IL Zip 60601 Daytime Phone`312)239-1896 E-mail mbooma@ca-ventures.com Revised 07/24/18 Page 1 of 2 ® B. All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed_5_07 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 $6,100 $3,050 $450 100 100 and more $9,600 $4,800 $700 For(minor)amendments to an approved plan;$200 per review Variances;$150 Mitigation Plan;$150 ❑ C. Registration Statement on the official DEQ form. ❑ D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ❑ E. Stormwater Management Plan satisfying the requirements of code section 17-403. ❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404. ❑ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. ❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Bohler Engineering VA, LLC-Ryan Yauger Address 28 Blackwell Park Lane,Suite 201 City Warrenton State VA Zip 20186 Daytime Phone(540 ) 349-4500 E-mail ryaugerCWbohlereng.com *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid o,s ncr's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# Fee Amount$ Date Paid By who9 Receipt# Ck# 13c: Revised 07/24/18 Page 2 of 2 B OHLER ENGINEERING 28 Blackwell Park Lane, Suite 201, Warrenton, VA 20186 Professional Engineering Services Telephone: (540) 349-4500 Fax: (540) 349-0321 VIA: Federal Express TO: Albemarle County Community Development 401 McIntire Road Charlottesville, VA (434) 296-5832 ATTN: Emily Cox, P.E. LETTER OF TRANSMITTAL RE: Virginia Stormwater Management Plan — I" Submission Brookhill — Block 8A- Senior Living Facility 2571 Seminole Trail Charlottesville, VA 22902 Albemarle County DATE: January 31, 2019 JOB NO: V182023 WE ARE SENDING YOU ❑ Shop drawings ❑ Copy of letter ®Attached ❑ Prints ❑ Change order COPIES JOB# DATE REVISION REVISION DATE 1 V182023 1/25/19 1 V182023 1/24/19 2 V182023 1/25/19 These Are Transmitted: ❑ For approval ® For review and comment ❑ Returned for corrections REMARKS: SHEET NO. Check #002848 1-2 of 2 1-19 of 19 ❑For your use []Approved as submitted DESCRIPTION Check in the amount of 1,700.00 made payable to Albemarle County Virginia Stormwater Management Program Application Virginia Stormwater Management Plan ❑As requested ❑Approved as noted Enclosed please find the above mentioned items for the Brookhill — Block 8A — Senior Living Facility project in Charlottesville, Virginia. Should you have any questions or require additional information, please do not hesitate to contact this office at (540) 3494500. COPY TO: File REGEIVEp' COMMUNITY DEVELOPMENT SIGNED: //- V , 6� r Ryan Yauger, P.E.