HomeMy WebLinkAboutWPO202100033 Application WPO VSMP 2021-05-26Virginia Stormwater Management Program (VSMP) p alr:
Application for Albemarle County s`
4ircay�r
Project Name: Troxell Poultry House
(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 0
County File Number:
be provided by the County for 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.
0 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. 1 /7
#129 5 Broc Troxell .21
Tax Map & Parcel Print Name of Owner Gignatureof Own r Date
Tax Map & Parcel Print Name of Owner Signature of Owner Date
Tax Map & Parcel
Print Name
Signature of Owner Date
Tax Map & Parcel Print Name of Owner Signature of Owner Date
Contact Information for the Owner(s) to receive correspondence:
Address vcoa vyaia rv1111 �a
City Scottsville
State VA Zip 24590
Daytime Phone (5 ) 412-0364 E-mail Troxellfarms@
...,. ,10 o,.,.o I of 7
Virginia Stormwater Management Program (VSMP)
Application for Albemarle County
�IACAN�P
Project Name: Troxell Poultry House
(The name should be the same as it appears on plans)
Is this an amendment to an approved plan? Yes ❑ No 10
Is this a revision or resubmission for review? Yes ❑ No 17
County File Number: (to be provided by the Counryfor 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.
10A. 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.
#129-5
Broc Troxell
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 Broc Troxell
Address 4369 Dyers Mill Lane
City Scottsville
Daytime Phone (570 ) 412-0364
Troxelifarms@gmaii.com
VA 7in 24590
Revised 07/24/18 Page 1 of 2
10 B. All Fees [Code section 17-208]
For new or modified plans; Total acres proposed to be disturbed 7.65
Acres to be
disturbed
Total Fee
Fee Due with this
Application
Fee with Transfer or
modification of permit
Less than 1
$290
$145
S20
1 and less than 5
$2,700
$1,350
S200
5 and less than 10
$3,400
$1,700
S250
10 and less than 50
S4,500
$2,250
S300
50 and less than
100
$6,100
$3,050
S450
100 and more
$9,600
$4,800
$700
For (minor) amendments to an approved plan, $200 per review
Variances, $150
Mitigation Plan, $150
10 C. Registration Statement on the official DEQ form.
10 D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
10 E. Stormwater Management Plan satisfying the requirements of code section 17-403.
10 F. Pollution Prevention Plan satisfying the requirements of code section 17-404.
10 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 Brian Kinzie
Address 566 East Market St.
City Harrisonburg State VA Zip 22801
Daytime Phone (5401 432-9555 E-mail Brian(a�BlackwellEngineering.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 #
Fee Amowt $ Date Paid
By who?
Receipt #
Ck# By:
Revised 07/24/18 Page 2 of