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WPO201800028 Application 2018-04-20
Albemarle Cot Ly Community Development Department �.r � 4,onrclntireRoad Charlottesville. vA22902-4598 Voice k434i 298-5832 Fax 1434)972-4120 Planning Application PARCEL/ OWNER INFORMATION TMP 05500-00-00-01500 Owner(s): GOLDEN MAGNOLIA LLC Application# rrP02OI 800028 PROPERTY INFORMATION _ J' Legal Description (ACREAGE SEVEN OAKS Magisterial Dist. White Hall Li Land Use Primary Residential -- Single-family(incl. modular homes[] Current AFD Yellow Mountain Current Zoning Primary Rural Areas APPLICATION INFORMATION Street Address 195 SEVEN OAKS FARM GREENWOOD,22943 j Entered By Jennifer Smith!.i Application Type Water Protection Ordinances 14,24,2018 Project SEVEN OAKS VINEYARD- VSMP Received Date 04/20/18 Received Date Final Submittal Date I Total Fees I 1350, Closing File Date Submittal Date Final j Total Paid l 1350 Revision Number Comments Legal Ad SUB APPLICATION(s) -I Type I Sub Applicatio i Conm-ert �^ Stormwater Management/BMP Plan 04/20/18 `Erosion and Sediment Control Plan 04/20/18 'APPLICANT /CONTACT INFORMATION ContactType Name Address 1 CityState _. Zip Phar,e PhoreCelll �vwrer+Aogs{.art GOLDEN MAGNOLIA LLC •9440 GOLDEN OA.K PL PARKER CO 80134 ° nay Lcrte== 'JUSTIN SHIh1P- SHIMP ENGINEERING. PC '201 E.MAIN ST., SUITE M CHARLOTTESOLL 22903 4342275140 Signature of Contractoror Authorized Agent Date Virginia Stormwater Management Program (VSMP) Application for Albemarle County VNF =' Project Name: Seven Oaks Vineyard (The name should be the same as it appears on plans) I3 this an amendment to an approved plan? Yes ❑ No 0 Is this a revision or resubmission for review? Yes ❑ No El County File Number: (to be provided by the Count y ty 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. El 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. 05500-00-00-01500 Golden Magnolia LLC tf1t- f' Tax Map&Parcel Print Name of Property Owner Si a e f 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 Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Contact Information for the Owner(s)to receive correspondence. Print Name Shimp Engineering PC Address 201 E.Main St, Suite M City Charllotesville State VA Zip 22903 Daytime Phone(434) 227-5140 E-mail Justin@shimp-engineering.com 7/1/14,Revised:7/10/14, 1/7/14 Page 1 of2 slaw B. All Fees [Code section 17-208] For new or modified plans; Total acres proposed to be disturbed 1.98 AC Acres to be Total Fee Fee Due with this Fee with Transfer or disturbed Application pp 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;$150 El C. Registration Statement on the official DEQ form. 0 D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ❑ E. Stormwater Management Plan satisfying the requirements of code section 17-403. ® F. Pollution Prevention Plan satisfying the requirements of code section 17-404. El G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. ❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Shimp Engineering PC, Address 201 E.Main St, Suite M City Charlotesville State VA Zip 22903 Daytime Phone(434) 227-5140 E-mail Justin@shimp-engineering.com *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY /� WPO#�C 1?-._ Fee Amount$f`�JV U Date Paid4 �l y who?Col fl �nCj�l D(X./ 1,� C eipJrl#� C� C- i By:W -Ka(71 c c�a q C 7/1/14,Revised:7/10/14, 1/7/14 Page 2 of 2 Statement General VPDES Permit for Discharges Registration of Stormwater from Construction Activities(VARIQ (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: (Colder, Ma,noiio t.( C Contact: Mailing Address: at* seven ©c F.tyy\ Cam: C're`v‘'"roo1 State: U ft Zap: aa.1043 Phone: Email address(if available): Indicate if DEQ may transmit general permit correspondence electronically: Yes❑ No❑ 2. Existing General Permit Registration Number(for renewals only): 3. Name and Location of the Construction Activity: Name: Sevh Oulu urn Address(if available): aoo Sa-ve n ncaK.o Fur m City: Crs2tnwood State: Vttgir<iu (\j ) Zip: 2143—}9i2 County(if not located within a City): Latitude(decimal degrees): 3S.04 U,3 to Longitude(decimal degrees): —T6.14 to% Name and Location of all Off-site Support Activities to be covered under the general permit: Name: Address(if available): City: State: County(if not located within a City): Zip: Latitude(decimal degrees): Longitude(decimal degrees): 4. Status of the Construction Activity(check only one): Federal❑ State❑ Public❑ Private Rt 5. Nature of the Construction Activity(e.g.,commercial,industrial,residential,agricultural,oil and gas,etc.): A rice t}urca 6. Name of the Receiving Water(s)and Hydrologic Unit Code(HUC): Name: M<<hums P+ivef— S)oc V jy Crec1F+ Name: HUC: oa0$O. 0totot HUC: 7. if the discharge Is through a Municipal Separate Storm Sewer System(MS4),the name of the MS4 operator: N/i°t 8. Estimated Project Start and Completion Date: Start Date(mm/dd/yyyy): C)T I°11 a 0(a Completion Date(mm/dd! 9. Total Land Area of Development(to the nearest one-hundredth acre): I.c1$ ) 1 0 oil Estimated Area to be Disturbed(to the nearest one-hundredth acre): i- 10. Is the area to be disturbed part of a larger common plan of development or sale? Yes❑ No l y 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,and complete. i am aware that there are signi `t penalties or submitting false information including the possibility of fine and imprisonment for kn... ng vko ont; _ Printed Name: �;IW G-t�tw1c/Ar.-• M Title: Get . Signature: I (Please sign in I Is Certification must a signed b the Date: Item#1.) Y a PProPdats parson associated with the operator identified in 07/2014 Page 1 of 1