HomeMy WebLinkAboutWPO202100058 Application 2021-10-12Virginia Stormwater Management Program (VSMP) <
Application for Albemarle County - �r
Project Name: RST Residencies
(The name should be the same as it appears on plans)
Is this an amendment, modification, or transfer of an approved plan? Yes ❑ No RO
Is this a resubmission for review? Yes ❑ No 129
County File Number: WPO- (to be provided by the Countyfor new applications)
The following are required elements of new applications [code section 17-4011. 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. 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.
Tax Map & Parcel Print Name of Owner
Tax Map & Parcel
Tax Map & Parcel
Print Name of Owner
Name of Owner
of Owner
Signature of Owner
l�
Date
Tax Map & Parcel Print Name of Owner Signature of Owner Date
Contact Information for the Owner(s) to receive correspondence:
Print Name: Seminole Trail LLC C/O RST Development LLC
Address:168 Business Park Dr. Suite 200
City: Virginia Beach State:VA Zip: 23462
Daytime Phone: C922 49"317 E-mail: alex@mtdevelopmentcom
Revised 07/1/21; 7/26/2021
® B. All Fees [Code section 17-208]
For new or modified plans: Total acres proposed to be disturbed 19.51 AC
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 Iacre
($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 I 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
3340+$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 + $31.72)
® C. Registration Statement on the official DEQ form.
® D. Erosion and Sediment Control Plan satisfying the requirements of code section 17402.
® E. Stormwater Management Plan satisfying the requirements of code section 17403.
® F. Pollution Prevention Plan satisfying the requirements of code section 17-404.
® G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405.
U H. Mitigation Plan satisfying the requirements of code section 17406 for any proposed disturbance
of stream buffers. $176.80 ($170 fee +$6.80 technology surcharge)
U I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. $176.80 ($170 fee +
$6.80 technology surcharge)
Provide 2 copies 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
Address: 9100 Arboretum Parkway. Suite 360
City: Richmond State: VA Zip: 23236
Daytime Phone: 804 893-8200 E-mail: ryaugerfabohleren9.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. Active permits are subject to annual maintenance fees [17-2081.
FOR OFFICE USE ONLY WPO#
Fee Amount $ Date Paid By who? Receipt # Cld! By:
Revised 07/l/21: 7/26/2021