HomeMy WebLinkAboutWPO201900050 Application 2019-09-06Virginia Stormwater Management Program (VSMP)
Application for Albemarle County
Project Name: BERKMAR OVERLOOK
(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 ❑ No la
County File Number: (to be provided by the Countyfor 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.
® 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.
45-85
BERKMAR DEVELOPMENT, LLC
9 g
Tax Map & Parcel
Print Name of Owner Signatur of er
Date
45-85A
BERKMAR DEVELOPMENT, LLC
�, 9
Tax Map & Parcel
Print Name of Owner i atur of O or
Date
45-112F1
BERKMAR DEVELOPMENT, LLC
9/ 1.9
Tax Map & Parcel
Print Name of Owner Signatu of O ner
Date
45-112F2
BERKMAR DEVELOPMENT, LLC
914. h9
Contact Information for the Owner(s) to receive correspondence:
Print Name BERKMAR DEVELOPMENT, LLC
Address 2496 OLD IVY ROAD
City. CHARLOTTESVILLE State VA Zip 22903
Daytime Phone cu 34) 295 -0033 E-mail e { FAULOOweot tads�uC-np� CQ A
Revised 07/24/18 Page 1 of 2
L m
cm
R1 B. All Fees [Code section 17-208]
For new or modified plans; Total acres proposed to be disturbed 9.27 AC
Acres to be
disturbed
Less than 1
Total Fee
$290
Fee Due with this
Application
$145
Fee with Transfer or
modification of permit
$20
1 and less than 5
$2,700
$1,350
$200
5 and less than 10
$3,400
$ ,7
$250
10 and Iess 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
Mitigation Plan; $150
® C. Registration Statement on the official DEQ form.
10 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 SCOTT COLLINS - COLLINS ENGINEERING
Address 200 GARRETT STREET, SUITE K
City CHARLOTTESVILLE State VA Zip 22902
Daytime Phone (434� 293-3719 E-mail scott@collins-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 he deemed withdrawn. Applications without valid owner's
signatures will not be considered valid.
FOR OFFICE USE ONLY hypo # OCL ew
Fee Amount $Date Pai B who? �-' �� • 1
d���� Y ry < ,�T i"/��ceipt # � Y� Ck#2/�_By:%�c•�•'L�
Revised 07/24/18 Page 2 of 2