HomeMy WebLinkAboutWPO201800028 Inspection Bond Inspection 2019-04-25 Internal Use Only•
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/ BOND INSPECTION REQUEST
APPROVED PLAN # lAJ?0 LC.) I K 0 0 0 2 S
PROJECT NAME: Sc,-\ 0(Lk V t�t:�61-
(As listed on the approved plan)
This is to request that an inspection be performed by the County. Where fees are assessed,a fee is required for
each inspection. Please check the inspections requested.
VSMP/VESCP Erosion Control,Stormwater Management and/or Mitigation per
Water Protection Ordinance section 17-207& 208 $250
❑ Subdivision(roads,drainage,etc.)per Subdivision Ordinance section 14-435 and 14-438; $269
❑ Water& Sewer per Subdivision Ordinance section 14-435 $269
❑ Site Development Performance bond(Incomplete Site Work& Landscape Maintenance) $301
TOTAL FEES 02--SO
Inspections for the purposes of bond reduction or release will require a separate fee for each bond.
Submit requests to: Department of Community Development,401 McIntire Road,North Wing,Charlottesville,
VA 22902, Attention: Management Analyst- Phone 434-296-5832; Fax 434-972-4126. All roads and
stormwater facilities will require construction record drawings, inspection reports,and completion processes
through VDOT or DEQ. Bonds will not be reduced or released without record drawings and inspection
documentation per the state requirements and county's published procedures. A minimum 20%of the original
posting is held until acceptance of all bonded improvements. For Site Development Performance bonds, if
landscape installation is part of the bonded incomplete site work,a request for reduction should only be made
once all site work is complete.
The revised estimate should be sent to;i _
EMAIL: ±Oct �' fit?vi�.✓�.4a-l_},c�r•v\ Vc& , (l e y"
rn
OR REGULAR MAIL ADDRESS: ;Z DO .e,,te,N 0c--L,S l c.jw-
Grr.cJ)oc,c UA 2_2.1 Lk.3
:nature of Owner/Developer
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Go lc&ems V,� A lLek. LLL Ly o tl (2251 1"
Print Name t Date
710.A vtkc r^tick,\
Revised 7/15/2014,7/20/2015. 11'3/2015
Notice of Termination
General VPDES Permit for Discharges of Stormwater from Construction Activities (VAR10)
(Please Type or Print All Information)
1. Construction Activity Operator:at
Name 60 Lke vA I t.Ci cS •O t i c. (-LC
Contact: TAct Z\yn v '_'.cti
Mailing Address:' /CC) Se vL,^ Ocz.VS a I�clr.-vim
City- (3 rce u�W VA State- A Zip 'ZG L—( 1) Phone. a t i-i- Gi v ) 7
Email address(if available): 'tbot-4 L-1 v cA, , COw1
2. Name and Location of the Construction Activity:(As listed on the Registration Statement.)
Name. ScJ c A C a-L., (-611/41(rvk
Address(if available) )-1C� Se_VC C -s {—ctr0V\
City' C r rV1 Gs-q-)Ock State. V A.. Zip �-� 1LA
``
County(if not located within a City): (\i be.rv\cic (�
Latitude(decimal degrees): . Q Li ((o 3(o 1 Longitude(decimal degrees): g _ 1L{ (o .3 C)
3. General Permit Registration Number: V A IZ (C)f' 2 g
4. Reason for Terminating Coverage Under the General Permit: (The operator shall submit a Notice of Termination after one or
more of the following conditions have been met.)
A. Necessary permanent control measures included in the SWPPP for the site are in place and functioning effectively and final
stabilization has been achieved on all portions of the site for which the operator is responsible When applicable, long-term
responsibility and maintenance requirements for permanent control measures shall be recorded in the local land records prior
to the submission of a notice of termination,
❑ B Another operator has assumed control over all areas of the site that have not been finally stabilized and obtained coverage
for the ongoing discharge,
❑ C Coverage under an alternative VPDES or state permit has been obtained; or
❑ D For residential construction only,temporary soil stabilization has been completed and the residence has been transferred to
the homeowner
The notice of termination should be submitted no later than 30 days after one of the above conditions being met. Authorization to
discharge terminates at midnight on the date that the notice of termination is submitted for the conditions set forth in subsections B
through D above, unless otherwise notified by the VSMP authority or the Department. Termination of authorizations to discharge
for the conditions set forth in subsection A above shall be effective upon notification from the Department that the provisions of
subsection A have been met or 60 days after submittal of the notice of terminations, whichever occurs first.
5. Permanent Control Measures Installed: (When applicable, a list of the on-site and off-site permanent control measures (both
structural and nonstructural)that were installed to comply with the stormwater management technical criteria. Attach a separate list
if additional space is needed.)
Permanent Control Measure#1 N I i\
Type of Permanent Control Measure
Date Functional:
Address(if available).
City. State. Zip
County(if not located within a City):
Latitude(decimal degrees): Longitude(decimal degrees):
Receiving Water
Total Acres Treated: Impervious Acres Treated:
012014 Page 1 of 2
•
•
Permanent Control Measure#2
Type of Permanent Control Measure
Date Functional:
Address(if available):
City. State. Zip
County(if not located within a City):
Latitude(decimal degrees): Longitude(decimal degrees):
Receiving Water
Total Acres Treated: Impervious Acres Treated:
Permanent Control Measure#3
Type of Permanent Control Measure.
Date Functional:
Address(if available):
City. State: Zip
County(if not located within a City):
Latitude(decimal degrees): Longitude(decimal degrees):
Receiving Water
Total Acres Treated: Impervious Acres Treated:
6. Participation in a Regional Stormwater Management Plan: (When applicable, information related to the participation in a
regional stormwater management plan Attach a separate list if additional space is needed.)
Regional Stormwater Manaaement Facility ('
Type of Regional Stormwater Management Facility. Ft)rt 'e et'..zt C E;A Ne_v .
Address(if available). �()(j c �� a 5 t—exrev\ -1
City. T+' i/lW �
nlek State: �A Zip d- `V(
County(if not located within a City): t �.,-a ( I Q
Latitude(decimal degrees): 3��>#(��L'(el G( Longitude(decimal degrees): — -7 2. Z 1'(/ 3 t 6
Total Site Acres Treated: ��i) 2. t' Impervious Site Acres Treated.
7. Perpetual Nutrient Credits: (When applicable, information related to perpetual nutrient credits that were acquired in accordance
with§62.1-44 15 35 of the Code of Virginia.Attach a separate list if additional space is needed.)
Nonooint Nutrient Credit Generating Entity
Name.
Perpetual Nutrient Credits Acquired(lbs/acre/year):
8. Certification:"I certify under penalty of law that I have read and understand this Notice of Termination 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." ij pp I r \ G(/�F4w... It.4 vie+`,tci. L(_ ( ls.� /"f• UJ' —
Printed Name �J�� w t \vr�t n r J Title. 0 "C Le
Signature. Date. Li/13/ PI
(Please sign in I is Certification must be signed by the appropriate person associated with the operator identified in
Item#1.)
012014 Page 2 of 2
•
Notice of Termination
General VPDES Permit for Discharges of Stormwater from Construction Activities(VAR10)
(Please Type or Print All Information)
1. Construction Activity Operator:
Name: Ge tottV n
-7 ct011a
Contact: "Tact Lkvv\w.c rtia ^�-
c '
Mailing Address: �CDC) Se✓C.. O <-S `l(-.�r
City: (4/'c e rn wood State. v A-� Zip:)z'(.1-(' Phone a 14- (13-41Q 1
Email address(if available): 1-back St`Jcv�da -cR,..c M V o , Cow
2. Name and Location of the Construction Activity:(As listed on the Registration Statement)
Name. SCJeA 00-ks t—a{,\
Address(if available). o)-tO S C vC AOA--S l .0 w�
City C(-Le✓1 GJDCA State: V k Zip: )-2G t4
County(if not located within a City): A M (f'_
Latitude(decimal degrees): . Q y(iv (o Longitude(decimal degrees): 1 g . M Co k 3 O
3. General Permit Registration Number: VAR t 0 L. K 2 g
4. Reason for Terminating Coverage Under the General Permit: (The operator shall submit a Notice of Termination after one or
more of the following conditions have been met.)
gA. Necessary permanent control measures included in the SWPPP for the site are in place and functioning effectively and final
stabilization has been achieved on all portions of the site for which the operator is responsible. When applicable. Ion-term
resoonsibilitv and maintenance reauirernents for permanent control measures shall be recorded in the local land records odor
to the submission of a notice of termination,
❑ B Another operator has assumed control over all areas of the site that have not been finally stabilized and obtained coverage
for the ongoing discharge;
❑ C Coverage under an alternative VPDES or state permit has been obtained;or
❑ D For residential construction only,temporary soil stabilization has been completed and the residence has been transferred to
the homeowner.
The notice of termination should be submitted no later than 30 days after one of the above conditions being met. Authorization to
discharge terminates at midnight on the date that the notice of termination is submitted for the conditions set forth in subsections B
through D above, unless otherwise notified by the VSMP authority or the Department. Termination of authorizations to discharge
for the conditions set forth in subsection A above shall be effective upon notification from the Department that the provisions of
subsection A have been met or 60 days after submittal of the notice of terminations,whichever occurs first.
5. Permanent Control Measures Installed: (When applicable, a list of the on-site and off-site permanent control measures (both
structural and nonstructural)that were installed to comply with the stormwater management technical criteria.Attach a separate list
if additional space is needed.)
Permanent Control Measure#1 N I P
Type of Permanent Control Measure.
Date Functional:
Address(if available):
City. State. Zip-
County(if not located within a City):
Latitude(decimal degrees): Longitude(decimal degrees).
Receiving Water:
Total Acres Treated: Impervious Acres Treated:
012014 Page 1 of 2
1
Permanent Control Measure SZ
Type of Permanent Control Measure
Date Functional:
Address(if available):
City. State: Zip:
County(if not located within a City):
Latitude(decimal degrees): Longitude(decimal degrees):
Receiving Water
Total Acres Treated: Impervious Acres Treated:
Permanent Control Measure,k 1
Type of Permanent Control Measure: p
Date Functional: Ld/>4'jl fJ ( 71
Address(if available):
City. State: Zip:
County(if not located within a City):Latitude(decimal degrees): LonngituQ (decimal degrees):
Receiving Water dt411/1-4-.rv1.4 Atv -
Total Acres Treated: Impervious Acres Treated:
6. Participation in a Regional Storrmvater Management Plan: (When applicable, information related to the participation in a
regional stormwater management plan.Attach a separate list if additional space is needed.)
pea Iona l Stormwater Management Facility Type of Regional Stormwater Management Facility Fo rt Si
e�� c eft c. E to NC-wA t
Address(if available). boo C7r°�le.Y. Qo LS { rrv" A
City. (,(C C A W State: ( A Zip: D-)`1v L( 3
County(if not located within a City): At k a Q
Latitude(decimal degrees): 3 8,6 Li 41 0`l`( Longitude(decimal degrees): - 8. *1 11 3 6 d n
Total Site Acres Treated: tt 2. Z Impervious Site Acres Treated: 0 4 Z (q ,),
7. Perpetual Nutrient Credits:(When applicable, information related to perpetual nutrient credits that were acquired in accordance
with§62.1-44.15:35 of the Code of Virginia.Attach a separate list if additional space is needed.)
Nonooint Nutrient Credit Generating Entity
Name:
Perpetual Nutrient Credits Acquired(lbs/acre/year):
8. Certification:"I certify under penalty of law that I have read and understand this Notice of Termination 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."
Printed Name: aotet L t tnn vv•e r.nA.o 'f GaLL 114 •o�w, CL Title: 0 W�C� �Ch.- "-
Signature: Date: 1-11131 (1
(Please sign in I is Certification must be signed by the appropriate person associated with the operator identified in
Item S1.)
012014
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