HomeMy WebLinkAboutWPO202000037 Application 2022-04-29Virginia Stormwater Management Program (VSMP)
Application for Albemarle County
Project Name: GALAXIE FARM SUBDIVISION
(The name should be the same as it appears on plans)
Is this an amendment to an approved plan? Yes 0 No ❑
Is this a revision or resubmission for review? Yes ❑ No lia
County File Number: WP02020-00037 (to be provided by the Countyfor new applications)
The following are required elements of new applications (from code section 17-4011. For revisions or
amendments, 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 or revision, 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.
91-9 GALAXIE FARM INVESTMENTS 4-111- -- 4/28/2022
Tax Map & Parcel Print Name of Owner Signature of Owner Date
91-15 GALAXIE FARM INVESTMENTS �I�" 4/2812022
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 NameGALAXIE FARM INVESTMENTS, LLC
Address 600 WATER STREET, SUITE H
City CHARLOTTESVILLE
Daytime Phone
VA Tin 22902
Revised 07/24/18 Page 1 of
❑ B. All Fees [Code section 17-208]
For new or modified plans: Total acres proposed to be disturbed 12.72
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
$2,550+$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 + $31.72)
13 C. Registration Statement on the official DEQ form.
® D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
❑ E. Stormwater Management Plan satisfying the requirements of code section 17-403.
® F. Pollution Prevention Plan satisfying the requirements of code section 17-404.
N G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405.
❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance
of stream buffers. $176.80 ($170 fee + $6.80 technology surcharge)
❑ I. Request Exceptions as provided in code section 17-408. $282.88 ($272.00 fee + $10.88 technology surcharge)
Provide 2 copies 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): Scott Collins
Address: 200 Garrett Street, Suite K
City: Charlottesville —State:—VA Zip: 22902
Daytime Phone: (434) 293-3719 E-mail: scoff@collins-engineering.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 117-2081.
FOR OFFICE USE ONLY
WPO #
Fee Amount $ Date Paid
By who?
Receipt #
Ck# By:
Revised 07/l/21: 7/26/2021: 3/9/2022