HomeMy WebLinkAboutWPO202100049 Application 2021-09-16Virginia Stormwater Management Program (VSMP) it
Application for Albemarle County
Project Name: Wawa Route 29 and Greenbrier
(The name should be the same as it appears on plans)
Is this an amendment, modification, or transfer of an approved plan? Yes ❑ No 04
Is this a resubmission for review? Yes ❑ No D9
County File Number: WPO- (to be provided by the County for new applications)
The following are required elements of new applications [§17-401]. For amendments and resubmission,
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, 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. 1 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 �� n o,_O 2021
Map & Parcel
& Parcel Print
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
Address:
Daytime Phone: (_) E-mail:
Revised 07/1/21; 7/26/2021
❑ B. All Fees [Code §17-208]
For new or modified plans: Total acres proposed to be disturbed 2.60
Fee Due with this
Transfer or
Acres to be Disturbed
Application
Modification Fee
Total Fee = (Application Fee +4% Technology Surcharge)
Single Family Dwelling only
$171.60
$23.92
Less than 1 acre
($165 + $6.60)
$23 + $0,92
Single Family Dwelling only
$171.60
$236.08
1 and less than 5 acres
($165 + $6.60)
($227+$9.08)
Less than 1 acre
$171.60
$20.80
($165+$6.60)
($20+$0.80)
1 and less than 5 acres
$1,591.20
$236.08
($1,530+$61.20)
($227+$9.08)
5 and less than 10 acres
$2,004.08
$294.32
($1,927 + $77.08)
($283 + $11.32)
10 and less than 50 acres
$2,652.00
$353.60
$2550+$102
$340+$13.60
50 and less than 100 acres
$3,596.32
$530.40
($3,458+$138.32)
($510 + $20.40)
100 acres or more
$5,657.60
$824.72
($5,440 + $217.60)
($793 +$31.7n)
❑ C. Registration Statement on the official DEQ form.
❑ D. Erosion and Sediment Control Plan satisfying the requirements of Code § 17402.
❑ E. Stormwater Management Plan satisfying the requirements of Code § 17403.
❑ F. Pollution Prevention Plan satisfying the requirements of Code § 17-404.
❑ G. Stormwater Pollution Prevention Plan satisfying the requirements of Code § 17-405.
❑ H. Mitigation Plan satisfying the requirements of Code § 17-406 for any proposed disturbance of
stream buffers. $176.80 ($170 fee + $6.80 technology surcharge)
Ill. Requested Variations or Exceptions as provided in Code § 17-407 and § 17-408. $176.80 ($170 fee + $6.80
technology surcharge)
Provide 2 conies ofall plans and any supporting documents or submit all documents online. 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):
Name (Print): Stephen MCCray
Address: 1700 Willow Lawn Drive Suite 200
city: Richmond State: VA Zip: 23230
Daytime Phone: (804) 273-8379 E-mail: stephen.mccray@kimley-hom.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
&.gr ,.u,cs WHE uu. Ve CV„],UVFCU vano. Active permits are subject to annual maintenance fees 1§ 17-2081.
rFOR OFFICE I1SE ONLY wpo #
mount $ Date Paid By whop Receipt
Revised 07/1/21: 7/26/2021