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HomeMy WebLinkAboutWPO201800069 Application 2018-09-05 t77`,�1"' Community Development Department l! � yy AlbemarleQ j? 11 4011"--`:re Road Charlottesville,VA22902-4595 :(434)296-5E32 Fax:(434)972-4.120 Planning Application PARCEL/ OWNER INFORMATION TMP 061W1-00-00-000A0 Owner(s): ALBEMARLE COUNTY SERVICE AUTHORITY Application# WP02OI 800069 PROPERTY INFORMATION • Legal Description PARCEL Y OAK FOREST / /SEWAGE PUMP STATION / ,/ I. Magisterial Dist.(Jack Jouett �., Land Use Primary,PUblic .__h.f! Current AFD INot in A/F District Current Zoning Primary R4 Residential APPLICATION INFORMATION Street Address A 112 OAK FOREST CIR CHARLOTTESVILLE,22901 Entered By Application Type IWater Protection Ordinances Jennifer Pritcl- ® 9;'iD,t201s Project Oak Forest Pump Station Abandonment Project—VSMP Received Date 09/05/18 Received Date Final Submittal Date Total Fees 145 Closing File Date Submittal Date Final • Total Paid 145 Revision Number Comments Legal Ad • SUB APPLICATION(s) Type Sub.4pplicatio Comment Erosion and Sediment Control Plan 09/10/18 • Stnrinwater Management/BMP Plan . 09/10/18 APPLICANT / CONTACT INFORMATION ContactType Name Address CityState Zip Phone PhoneCell cF,.r-r,appt3_-rt" ALBEMARLE COUNTY.SERVICE AUTHORiTY 165"SPOTNAPROAD " : CHARLOTTESVILL 22911 4349774511 Prim_:y C•_rt:_t i SUSAN STALNAKER 4435 WATERFRONT DR,STE GLEN ALLEN,VA 23060 8049224227 Signature of Contractor or Authorized Agent Date Virginia Stormwater Management Program (VSMP) Application for Albemarle County V ® ' ' Project Name: Oak Forest Pump Station Abandonment Project (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes 0 No IRI Is this a revision or resubmission for review? Yes © No 0 County File Number: wh t- [co (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. 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. Cal A 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 Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Contact Information for the Owner(s)to receive correspondence: Print NameJeremy Lynn, P.E. -Albemarle County Service Authority Address 168 Spotnap Road City Charlottesville State VA Zip 22911 Daytime Phone(434) 977-4511 E-mail jlynn@serviceauthority.org 7/1/14,Revised:7/10/14, 1/7/14 Page 1 of 2 ❑ B. All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed 0.83 Acres to be Total Fee ' Fee Due with this Fee with Transfer or disturbed Application modification of permit Less than 1 $290 $145 $20 l 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;$150 ❑ C. Registration Statement on the official DEQ form. ❑ D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ❑ E. Stormwater Management Plan satisfying the requirements of code section 17-403. ❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404. ❑ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. ❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Susan Stalnaker Address 4435 Waterfront Drive, Suite 205 ;ty Glen Allen State VA Zip 23060 Daytime Phone(804) 822-4227 E-mail susan.stalnaker@obg.com *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY �j WPO#c90 — �A 1 �j Fee Amount$ I`'�,� Date Paid "I 51!'By who?_ ,�S `Receipt# 11 ` Ck#%-�/ By: S 7/1/14,Revised:7/10/14, 1/7/14 Page 2 of 2