HomeMy WebLinkAboutWPO202200009 Application 2022-03-17Virginia Stormwater Management Program (VSMP)it
Application for Albemarle County
Project Name: Mountain View Elementary School
(The name should be the same as it appears on plans)
Is this an amendment, modification, or transfer of an approved plan? Yes ® No ❑
Is this a resubmission for review? Yes ❑ No 19
County File Number: WPO- (to be provided by the County for new applications)
The following are required elements of new applications [§17-4011. For amendments and resubmissions,
please indicate which items are being amended. Signatures must be provided for any submission.
[EA. 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 pr perty as required to ensure
compliance with the approved plans and permits. �I
09100-00-00-01300 Sheila Hoo mann
Tax Map & Parcel Print Name of Owner giglfatuFe o wner y 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: Albemarle County School Board - Sheila Hoopmann
Address: 401 McIntire Road
Charlottesville
Daytime Phone: 4.3-4}975-9340 E-mail: sh000mannOkl2albemarle org
22902
Revised 07/1121; 7/26/2021
❑ B. All Fees [Code §17-2081
For new or modified plans: Total acres proposed to be disturbed 4.7
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 l 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
I$2550+$102
($340+$13.60
50 and less than 100 acres
$3,596.32
$530.40
(S3,458 + $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 § 17-402.
® E. Stormwater Management Plan satisfying the requirements of Code § 17-403.
❑ F. Pollution Prevention Plan satisfying the requirements of Code § 17-404.
19 G. Stormwater Pollution Prevention Plan satisfying the requirements of Code § 17-405.
❑ I L Mitigation Plan satisfying the requirements of Code § 17-406 for any proposed disturbance of
stream buffers. $176.80 ($170 fee + $6.80 technology surcharge)
❑ 1. Requested Variations or Exceptions as provided in Code § 17407 and § 17408. $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 (Print): Craig Kotarski
Address: 608 Preston Ave, Suite 200
City: Charlottesville
VA ziu. 22903
Daytime Phone:4M)327-1688 E-mail: Craig. Kotarski@timmons.eom
" 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 subiect to annual maintenanee f ac IS r 7-Ina]
FOR OFFICE USE ONLY WPO of
Fee Anwunt $ Date Paid By who? Receipt # Ck# By:
Revised 07/1/21; 7/26/2021