HomeMy WebLinkAboutWPO201600072 Application 2021-04-26Virginia Stormwater Management Program (VSIVIP)
Application for Albemarle County
Project Name: Woolen Mills industrial Park
(The name should he the same asit appears on plans)
Is this an amendment to an approved plan? Yes ® No ❑
Is this a revision or resubmission for review? Yes ❑ No 93
County File Number: 201600072 - Amendment #4 (to be provided by the County for ne- ayflicat;oars)
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.
O 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 activitiesand 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. J
77-40B Elemental Ecotech, LLC
Tax Map & Parcel print Name of Owner
Tax Map & Parcel. Print Name of Owner
Signature
Sigt,a.turc. of Owner
Date
I
Tax Map & Parcel Print Name of Owner Signature of Owner Date .
Tax Map & Parcel Print Name of Owner Sagntittire of owner - Date
Contact information for the Owtaer(s) toreceive correspondence:
Print Name Kevin O'Brian
Address 809 Bolling. Ave, unit C
ri, Charlottesville
to VA "Lip 22902
703 966-2438 E-ruai7 kaob@fpcinc.Nz
a;•aytiAne Phone (—._) -
Revised 07!24/18 Page I of 2
® B. All Fees [Code section 17-208]
For new or modified plans; Total acres proposed to be disturbed 6,33 acres
1 Acres to he
disturbed
Total Fee Fee Dlte with this
I Application
Fee with Transfer or
modification ofpermit
Less than 1
I and less than 5
S290 $145
$2,700 j $1,350
$20 _
$200
5 and less dean. 10
$3,400 S 1.700
5250
10 and less than 50
$4.,500 S2.250
$300
5(� ) and less than.
100
$6,1.00 _- 050 —
$450
100 and more
$9,600 $4,800
$700
Por (minor) amendments to an approved plan; $200 per review
Variances; $150
Mitigation flan; S150
0 C. Registration Statement on the official DEQ form.
fA D. Erosion. and Sediment Control PIan satisfying the requirements of code section 17-402.
0 E. Stormwater Management Plan satisfying the requirements of code section 17-403.
® F. Pollution Prevention Plan satisfying the requirements of code section 17-404,
® G. Stonnwater Pollution Prevention Plan satisfying the requirements of code section 17-405.
❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
stream buffers.
❑ 1. Requested Variations or Exceptions as provided in code sections 17-407 and 408.
O J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Provide 2 copies of all -plans and any .supporting documents. Professional seals must have original
signatures.
Additional information ifnotprovided on plans and documents:
Name of a Contact Person for correspondence (usually the plan preparer, comoltan. t or agent)
PrhltNaineMeridian Planning Group, LLC
Address 440 Premier Circle, Ste 200
City Charlottesville StatcVA Tip 22901
Daytime Phone (434) 882-0121 E-mail tmiller@meridianwbe.com
*When applications and plans are reviewed, but not approved, and a response to comments is not received within 6 months
from the date of county comments, the application will be deemed withdrawn. Applications without valid owner's
Signatures will not he considered valid.
FOR OFFIC$ USE ONLY
WPO #
Fee Ainount bDaLC Paid
t}v who?
i,eeciP li
U4
Bv;.
Revised 07/24/18 Page 2 of 2