HomeMy WebLinkAboutWPO202100056 Application 2021-10-01Virginia Stormwater Management Program (VSMP)
Application for Albemarle County ,
Project Name: Waverly Residence
(The name should be the same as it appears on plans)
Is this an amendment, modification, or transfer of an approved plan? Yes ❑ No V
Is this a resubmission for review? Yes ❑ No V
County File Number: WPO-
be provided by the County for new applications,)
The following are required elements of new applications [§]7-401 J. For amendments and resubmission,
please indicate which items are being amended. Signatures must be provided for any submission.
V 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 activitie and de elopment on the subject
property. I hereby grant the County of Albemarle the right to enter upon the pro ry as�required to ensure
compliance with the approved plans and permits. � „ a. , s\ s �// ��
85-1 D
an
Tax Map & Parcel Print Name 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 Owncr(s) to receive correspondence:
Print Name: Cyrena Sparkman
Address: 41 Wicket Way; POB 2304
City: Cashiers
Daytime Phone: 7( 03) 200-1947 E-mail: cyCsparkman.net
NC 7in 28717
Revised 07/1/21; 7/26/2021
® B. All Fees [Code §17-208]
For new or modified plans: Total acres proposed to be disturbed 3.05 acres
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
$2392
Less than 1 acre
($165 + $6.60)
($23 + $0.92)
Single Family Dwelling only
S171AO
$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
($1530+$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
($2,550+$102)
($340+$13.60
50 and less than 100 acres
$3,596.32
$530.40
($3,458 + $13832)
($510 + $20.40)
100 acres or more
$5,657.60
$824.72
($5,440 + $217.60)
($793 + $31.72)
HB C. Registration Statement on the official DEQ form.
50D. Erosion and Sediment Control Plan satisfying the requirements of Code § 17-402.
® E. Stormwater Management Plan satisfying the requirements of Code §17-403.
OF. Pollution Prevention Plan satisfying the requirements of Code § 17-404,
56G. 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)
❑ I. Requested Variations or Exceptions as provided in Code § 17407 and §17408, $176.80 ($no fee + $6.80
technology surcharge)
Provide 2 co ies of all 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): Daniel Hver
Address: 113 4th St NE, STE 100
City: Charlottesville State: VA Zip: 22902
Daytime Phone: ( 4341962-2430 E-mail: dhyer&line-grade.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 wm not be considered valid. Active permits are subject to annual maintenance fees [§ 17-208].
FOR OFFICE USE ONLY WPO #
Fee Amour $ bate Paid By whop Receipt # Ck# By:
Revised 07/1/2I: 7/26/2021