HomeMy WebLinkAboutWPO202000036 Application 2020-06-29Virginia Stormwater Management Program (VSMP) }
7 /.
Application for Albemarle County a r}
Project Name: Afton Stables
(The name should be the same as it appears on plans)
Is this an amendment to an approved plan? Yes ❑ No ED
Is this a revision or resubmission for review? Yes ❑ No ED
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.
91A. 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.
n
3a 70-37C1 Peter and Angela Doolan
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
Tax Map & Parcel Print Name of Owner Signature of Owner Date
Contact Information for the Owner(s) to receive correspondence:
Print Name Peter and Angela Doolan
Address S o Ir �rRo,cD
J
City )P-roGj t VA t 12g2o State V6 Zip .2 %fig
Daytime Phone o3 D;Z7" Z E-mail peel r- Jarl `A'e 'Go'n
Revised p7/24/18 Page I of2
® B. All Fees [Code section 17-208]
For new or modified plans; Total acres proposed to be disturbed < 5 ac.
Acres to be
disturbed
Total Fee
Fee Due with this
Application
Fee with Transfer or
modification ofpermit
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, I00
$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.
® D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
® E. Stormwater Management Plan satisfying the requirements of code section 17403.
® F. Pollution Prevention Plan satisfying the requirements of code section 17404.
® 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.
n/a ❑ 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 Michael Myers, PE, CFM c/o 30 Scale, LLC
Address 871 Justin Drive
City Palmyra State VA Zip 22963
Daytime Phone (434) 242-2866
E-mail mike@30scale.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 p
Fee Amount $ Date Paid By who? Receipt q Ckp By:
Revised 07/24/18 Page 2 of 2