HomeMy WebLinkAboutWPO202100056 Application 2022-01-31Virginia Stormwater Management Program (VSMP) a c
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 f2f
Is this a resubmission for review? Yes if No ❑
County File Number: WPO- 2021-00056 (lobe provided bvthe Countyfornew 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.
VA. 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 N ith, and 1 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 pro ty aslrequired to ensure
compliance eith the approved plans and permits. � s s , vw w �// I t
85-1 D
Tar Map & Parcel
Tax Map & Parcel
S
Print Name of Owner
Print Name of Owner
Signature of Owner
1/31/2022
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: Cyrena Sparkman
Address: 41 Wicket Way; POB 2304
City Cashiers
Daytime Phone: 1U 200-1947 E-mail: cy@sparkman.net
NC 7.in 28717
Revised 07/l/21; 7/26/2021
® B. All Fees [Code §17-208]
For new or modified plans: Total acres proposed to be disturbed 3.26 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 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 + 59.08)
Uss 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
$340+$13.60
50 and less than 100 acres
$3,596.32
5530.40
($3,458 + $138.32)
($510 + $20.40)
100 acres or more
$5,657.60
$824.72
($5,440 + $217.60)
($793 + $31-72)
fit C. Registration Statement on the official DEQ form.
&! D. Erosion and Sediment Control Plan satisfying the requirements of Code § 17-402.
12 E. Stormwater Management Plan satisfying the requirements of Code § 17-403.
® F. Pollution Prevention Plan satisfying the requirements of Code §17404.
® 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)
❑ L Requested Variations or Exceptions as provided in Code §17407 and §17408. $176.80 ($170 fee +$6.90
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 (Print): Daniel Hver
Address: 113 4th St NE, STE 100
City: Charlottesville
VA Tin- 22902
Daytime Phone: (434t962-2430 E-mail: dhver(aline-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
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