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HomeMy WebLinkAboutWPO201400059 Application 2014-06-12 1.7irginia Stormwater Management Program(VSMP) iiiiiiricz 21 Application for Albemarle County , � Project Name: BRIARWOOD COMMERCIAL LOTS-GAS STATION WPO PiAN jI (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes❑ No Is this a revision or resubmission for review? Yes® No❑ i Pounty File Number; WPO-2014-59 (to be provided by the County for new applications) The following are required elements of new applications[from code section 17-401]• For revisions or amendments,please indicate which items are being amended. Signatures must be provided for any Submission, A. Signature of the Property Owner for each parcel: (Required with every submission or revision,NOT igl 1 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. 032G0-00-00-000B0 WOODBRIAR ASSOCIATES _ 7ji�i�"z � "%' " 8/8/2014 Map Tax M &Parcel Print Name of Property Owner Signature of Owner Date Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Contact Information for the Owner(s)to receive correspondence: Print Name WOODBRIAR ASSOCIATES Address P.D.BOX 5548 City CHARLOTTESVILLE State VA Zip 22905 Daytime Phone(434) 975-3334 E-mail ulcwww@embargmail.com 7/1/14,Revised:7/10/14 Page 1 of 2 ,rye ❑13. All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed Acres to be Total Fee Fee Due with this Fee with Transfer or disturbed Application modification of permit Less than 1 $290 $145 $20 1 and less than 5 $2,700 $1,350 $200 5 and less than 10 $3,400 $1,700 $250 10 and less than 50 $4,500 $2,250 $300 50 and less than $6,100 $3,050 $450 100 100 and more $9,600 $4,800 $700 For(minor)amendments to an approved plan;$200 per review Variances;$150 Mitigation Plan;$150 ❑ C. Registration Statement on the official DEQ form.. l D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. Ili] E. Stormwater Management Plan satisfying the requirements of code section 17-403. ❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404. ❑ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. O H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ J. Construction Record Drawings(as-builts)for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans.and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name SCOTT COLLINS-COLLINS ENGINEERING Address 200 GARRETT STREET,SUITE K City CHARLOTTESVILLE State VA Zip 22902 Daytime Phone(434)293-3719 E-mail scott(collins-enRineering.mm *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFF[CF.USE ONLY WPOf Fan Amount$-.. .. Data Paid,....._._ . _By who? 711114,Revised:7/10/14 Page 2 of 2 Virginia Stormwater Management Program (VSMP) Alts Application for Albemarle County 1"211". �'�ACINIP Project Name: BRIARWOOD COMMERCIAL LOTS -GAS STATION WPO PLAN (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes ❑ No NI Is this a revision or resubmission for review? Yes VCI No ❑ County File Number: WPO-2014-59 (to be provided by the County for 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 Property 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. 32G-B WOODBRIAR ASSOCIATES, L ��.�r�L � �'��- !h` Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Contact Information for the Owner(s)to receive correspondence: Print Name WOODBRIAR ASSOCIATES-WENDELL WOOD Address P.O. BOX 5548 City CHARLOTTESVILLE State VA Zip 22905 Daytime Phone(434) 975-3334 E-mail uicwwwc embargmail.com 7/1/14,Revised:7/10/14 Page 1 of 2 Awe ® B. All Fees [Code section 17-208] For new or modified plans; Total acres proposed to be disturbed 2.29 AC Acres to be Total Fee Fee Due with this Fee with Transfer or disturbed Application modification of permit Less than 1 $290 $145 $20 1 and less than 5 $2,700 $1,350 $200 5 and less than 10 $3,400 $1,700 $250 10 and less than 50 $4,500 $2,250 $300 50 and less than $6,100 $3,050 $450 100 100 and more $9,600 $4,800 $700 For(minor)amendments to an approved plan;$200 per review Variances;$150 Mitigation Plan;$150 DKI C. Registration Statement on the official DEQ form. K1 D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ® E. Stormwater Management Plan satisfying the requirements of code section 17-403. ® F. Pollution Prevention Plan satisfying the requirements of code section 17-404. ® G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. N/-11 H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. NM 1. Requested Variations or Exceptions as provided in code sections 17-407 and 408. N/® J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name COLLINS ENGINEERING -SCOTT COLLINS Address 200 GARRETT STREET, SUITE K City CHARLOTTESVILLE State VA Zip 22902 Daytime Phone(434) 293-3719 E-mail scottPcollins-engineering.com *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# Fee Amount$ Date Paid By who? Receipt# Ck# By 7/1/14,Revised:7/10/14 Page 2 of 2 COLLINS `' *wool 200 GARR Via.SUITE K CHARLOTTESVILLE VA 22902 434.293.3719 PH 434.293.2813 FX www.col lins-engi n eering.com TRANSMITTAL ❑ FAX ❑ MAIL II DELIVERY TO: FROM: JOHN ANDERSON SCOTT COLLINS COMPANY: DATE: ALBEMARLE COUNTY 7/22/2014 FAX: TOTAL NO.OF PAGES INCLUDING COVER: PHONE NUMBER: SENDER'S PHONE NUMBER: 434.293.3719 PROJECT/SUBJECT: BRIARWOOD COMMERCIAL LOTS-GAS STATION WPO-2014-00059 PLEASE FIND ENCLOSED: NO.COPIES DATE DESCRIPTION 2 PLANS 1 APPLICATION 1 LETTER 1 COPY OF DEG FORMS&CHECK 1 SWM MAINTENANCE AGREEMENT NOTES/COMMENTS: RECEIVED BY: SIGNATURE DATE Registration Statement General VPDES Permit for Discharges of Stormwater from Construction Activities (VAR10) (Please Type or Print All Information) 1. Construction Activity Operator: (General permit coverage will be issued to this operator. The Certification in Item #12 must be signed by the appropriate person associated with this operator.) Name: WOODBRIAR ASSOCIATES Contact: WENDALL WOOD Mailing Address: P.O. BOX 5548 City: CHARLOTTESVILLE State: VA Zip: 22905 Phone: Email address(if available): Indicate if DEQ may transmit general permit correspondence electronically: Yes n No X 2. Existing General Permit Registration Number(for renewals only): VP1IZic- iL toi 2.7 3. Name and Location of the Construction Activity: Name: BRIARWOOD Address(if available): BRIARWOOD DRIVE City: CHARLOTTESVILLE State: VA Zip: 22911 County(if not located within a City): ALBEMARLE COUNTY Latitude(decimal degrees): 38.15944 Longitude(decimal degrees): -78.41833 Name and Location of all Off-site Support Activities to be covered under the general permit: Name: Address(if available): City: State: Zip: County(if not located within a City): Latitude (decimal degrees): Longitude(decimal degrees): 4. Status of the Construction Activity(check only one): Federal❑ Staten Public © Private E 5. Nature of the Construction Activity(e.g.,commercial, industrial, residential,agricultural,oil and gas,etc.): RESIDENTIAL&COMMERCIAL 6. Name of the Receiving Water(s)and Hydrologic Unit Code(HUC): Name: NORTH FORK RIVANNA RIVER-JACOB'S RUN Name: HUC: JR11(020802040303) HUC: 7. If the discharge is through a Municipal Separate Storm Sewer System(MS4),the name of the MS4 operator: 8. Estimated Project Start and Completion Date: Start Date(mm/dd/yyyy): 41 10 i 1.4.0 lt:' Completion Date(mm/dd/yyyy): ')IOI 19LC I I, 9. Total Land Area of Development(to the nearest one-hundredth acre): 47 AG Estimated Area to be Disturbed(to the nearest one-hundredth acre): 47 AC 10. Is the area to be disturbed part of a larger common plan of development or sale? Yes ❑ No ❑ 11. A stormwater pollution prevention plan (SWPPP) must be prepared in accordance with the requirements of the General VPDES Permit for Discharges of Stormwater from Construction Activities prior to submitting this Registration Statement. By signing this Registration Statement the operator is certifying that the SWPPP has been prepared. 12. Certification: "I certify under penalty of law that I have read and understand this Registration Statement and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system or those persons directly responsible for gathering the information, the information submitted is to the best of my knowledge and belief true, accurate, and complete. I am aware that there are significant penalties for submitting false information including the possibility of fine and imprisonment for knowing violations." Printed Name: („11/".0 ele L i'� &ye/ � ,2 V i t 4t�c` At°a Title: G°: I'et tk r C".t A" c.r", Signature: F- ( Date: S.-2Y— /4" (Please sign in INK. This Certification must be signed by the appropriate person associated with the operator identified in Item#1.) 01/2014 Page 1 of 1 Registration Statement General VPDES Permit for Discharges of Stormwater from Construction Activities (VAR10) (Please Type or Print All Information) 1. Construction Activity Operator: (General permit coverage will be issued to this operator. The Certification in Item #12 must be signed by the appropriate person associated with this operator.) Name: WOODBRIAR ASSOCIATES Contact: WENDALL WOOD Mailing Address: P.O. BOX 5548 City: CHARLOTTESVILLE State: VA Zip: 22905 Phone: Email address(if available): Indicate if DEQ may transmit general permit correspondence electronically: Yes No 2. Existing General Permit Registration Number(for renewals only): VAV i0- iC- (0t227 3. Name and Location of the Construction Activity: Name: BRIARWOOD Address (if available): BRIARWOOD DRIVE City: CHARLOTTESVILLE State: VA Zip: 22911 County(if not located within a City): ALBEMARLE COUNTY Latitude(decimal degrees): 38.15944 Longitude(decimal degrees): -78.41833 Name and Location of all Off-site Support Activities to be covered under the general permit: Name: Address(if available): City: State: Zip: County(if not located within a City): Latitude (decimal degrees): Longitude (decimal degrees): 4. Status of the Construction Activity(check only one): Federal❑ State❑ Public n Private n 5. Nature of the Construction Activity(e.g.,commercial, industrial, residential,agricultural,oil and gas,etc.): RESIDENTIAL&COMMERCIAL 6. Name of the Receiving Water(s)and Hydrologic Unit Code(HUC): Name: NORTH FORK RIVANNA RIVER-JACOB'S RUN Name: HUC: JR11(020802040303) HUC: 7. If the discharge is through a Municipal Separate Storm Sewer System(MS4),the name of the MS4 operator: 8. Estimated Project Start and Completion Date: Start Date(mm/dd/yyyy): 44101 tilt IV Completion Date(mm/dd/yyyy): 4i/0l124Itr 9. Total Land Area of Development(to the nearest one-hundredth acre): 47 AC, Estimated Area to be Disturbed(to the nearest one-hundredth acre): 4.7 AC 10. Is the area to be disturbed part of a larger common plan of development or sale? Yes ❑ No❑ 11. A stormwater pollution prevention plan (SWPPP) must be prepared in accordance with the requirements of the General VPDES Permit for Discharges of Stormwater from Construction Activities prior to submitting this Registration Statement. By signing this Registration Statement the operator is certifying that the SWPPP has been prepared. 12. Certification: "I certify under penalty of law that I have read and understand this Registration Statement and that this document and all attachments were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system or those persons directly responsible for gathering the information, the information submitted is to the best of my knowledge and belief true, accurate, and complete. I am aware that there are significant penalties for submitting false information including the possibility of fine and imprisonment for knowing violations." Printed Name: (J,' ,,/"4,7 '/ )(.4.;4 e k rZ: e(°.‘a to Title: ' "k L Signature: Date: S 2 y— /�f (Please sign in INK. This Certification must be signed by the appropriate person associated with the operator identified in Item#1.) 01/2014 Page 1 of 1 Application for Review of PP = K''A Erosion & Sediment Control Plan & Stormwater Management/BMP Plan & '' 1O Stream Buffer Mitigation Plan W9o--2o4 - 00059 El Erosion& Sediment Control Plan ❑ Stormwater Management/BMP Plan ❑ Stream Buffer Mitigation Plan ❑ E&S Plan Amendment ❑ SWM Plan Amendment (Previous Plan# ) (Previous Plan# ) ❑ E&S Plan with Variance ❑Request for Exception #of Variances ❑SWM Plan Resubmittal ❑ E&S Plan Resubmittal WPO Application# WPO Application# Submit 2 copies each of applicable plans/narrative/computations *When a WPO plan is 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. Project Name: BRIARWOOD COMMERCIAL LOTS-GAS STATION WPO Tax map and parcel: 32G-B Zoning: Cl &EC Amount of Land Disturbance.'2 P9-- ,CJ Acres Location of property(landmarks,intersections,or other): BRIARWOOD DRIVE Contact Person(Who should we call/write concerning this project?): SCOTT COLLINS-COLLINS ENGINEERING Address 200 GARRETT STREET,SUITE K City CHARLOTTESVILLE State VA Zip 22902 Daytime Phone(434) 293-3719 Fax#( ) E-mail scott@collins-engineering.com Owner of Record WOODBRIAR ASSOCIATES Address PO BOX 5548 City CHARLOTTESVILLE State VA Zip 22905 Daytime Phone( ) Fax#( ) E-mail Contractor Address City State Zip Daytime Phone( ) Fax#( ) E-mail Plan Preparer COLLINS ENGINEERING Address City State Zip Daytime Phone( ) Fax#( ) E-mail Owner/Applicant Must Read and Sign By signing this application as owner,I hereby certify that all requirements of the approved Erosion Control Plan,Stormwater Management/BMP Plan,and/or Mitigation Plan 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 compl'ance with t approved lan. c.'t/.t� 5S�c t C1� .1)1 .3 <'t Si ure of Owner,Contract chaser Date Print me 29 � / �� Daytime phone number of Signatory �r1 FOR OFFICE USE ONLY WPO# Fee Amount$ Date Paid By who? Receipt# Ck# By: Revised November 14,2011 Page 1 of 3 me EROSION CONTROL PLAN: (SUBMIT 2 COPIES) Land disturbing activity pertaining to single family dwelling unit: 1. Plan Review $150 per review (TO BE PAID AT TIME OF APPLICATION AND EACH SUBMITTAL THEREAFTER UNTIL APPROVAL) 2 Permit and First Year Inspection Fees $150 (TO BE PAID PRIOR TO SCHEDULING PRECONSTRUCTION CONFERENCE FOR EROSION CONTROL PERMIT) 3. Annual Permit Renewal and Inspection Fees $150 (TO BE PAID ANNUALLY,STARTING WITH SECOND YEAR,UNTIL COMPLETION OF APPROVED PLAN REQUIREMENTS) 4. Each reinspection $150 (REINSPECTION FEES ARE INVOICED TO THE LANDOWNER) Land disturbing activity, pertaining to non-exempt agricultural land: 5. Plan Review $150 per review (TO BE PAID AT TIME OF APPLICATION AND EACH SUBMITTAL THEREAFTER UNTIL APPROVAL) 6. Permit and First Year Inspection Fees $150 (TO BE PAID PRIOR TO SCHEDULING PRECONSTRUCTION CONFERENCE FOR EROSION CONTROL PERMIT) 7. Annual Permit Renewal and Inspection Fees $150 (TO BE PAID ANNUALLY,STARTING WITH SECOND YEAR,UNTIL COMPLETION OF APPROVED PLAN REQUIREMENTS) 8. Each reinspection $150 (REINSPECTION FEES ARE INVOICED TO THE LANDOWNER) All other land disturbing activity: 9. Plan Review,Disturbed Area Less Than One Acre $150 per review (TO BE PAID AT TIME OF APPLICATION AND EACH SUBMITTAL THEREAFTER UNTIL APPROVAL) 10. Permit and First Year Inspection Fees, Disturbed Area Less Than One Acre $200 (TO BE PAID PRIOR TO SCHEDULING PRECONSTRUCTION CONFERENCE FOR EROSION CONTROL PERMIT) 11. Annual Permit Renewal and Inspection Fees,Disturbed Area Less Than One Acre $200 (TO BE PAID ANNUALLY,STARTING WITH SECOND YEAR,UNTIL COMPLETION OF APPROVED PLAN REQUIREMENTS) 12. Plan Review,Disturbed Area One Acre or Larger $300 per renew e (TO BE PAID AT TIME OF APPLICATION AND EACH SUBMITTAL THEREAFTER UNTIL APPROVAL) 13. Permit and First Year Inspection Fees, Disturbed Area One Acre or Larger $100/per disturbed acre (TO BE PAID PRIOR TO SCHEDULING PRECONSTRUCTION CONFERENCE FOR EROSION CONTROL PERMIT) 14. Annual Permit Renewal and Inspection Fees,Disturbed Area One Acre or Larger $100/per disturbed acre (TO BE PAID ANNUALLY,STARTING WITH SECOND YEAR,UNTIL COMPLETION OF APPROVED PLAN REQUIREMENTS) 15. Each reinspection $250 (REINSPECTION FEES ARE INVOICED TO THE LANDOWNER) 16. Amendment to Approved Plan $180/per plan review (TO BE PAID AT TIME OF APPLICATION AND EACH SUBMITTAL THEREAFTER UNTIL APPROVAL) 17. Variances $150/per request (TO BE PAID AT TIME OF APPLICATION) 18. SUBTOTAL EROSION CONTROL PLAN $300 Revised November 14,2011 Page 2 of 3 STORMWATER MANAGEMENT/BMP PLAN & MITIGATION PLAN: (SUBMIT 2 COPIES) 19. Stormwater Management/BMP Plan... C00/per plan review (TO BE PAID AT TIME OF APPLICATION AND EACH SUBMITTAL THEREAFTER UNTIL APPROVAL) 20. Major Amendment of Plan $180/per plan review (TO BE PAID AT TIME OF APPLICATION AND EACH SUBMITTAL THEREAFTER UNTIL APPROVAL) 21. Request for exception $240 (TO BE PAID AT TIME OF APPLICATION) 22. Request for development in a stream buffer or for reduction or modification of stream buffer and mitigation plan(if not part of another document)—Single family dwelling unit or accessory structure $85 (TO BE PAID AT TIME OF APPLICATION) 23. Each inspection or reinspection $60 (INSPECTION/REINSPECTION FEES ARE INVOICED TO THE LANDOWNER) 24. Mitigation Plan $150 (TO BE PAID AT TIME OF APPLICATION) 25. SUBTOTAL SWM/BMP PLAN $300 TOTAL APPLICATION FEE: (Add lines 18 and 25) $600 THE OWNER SHALL BE RESPONSIBLE FOR ALL REINSPECTION AND/OR ANNUAL RENEWAL FEES WHICH MAY BE CHARGED TO THIS PROJECT. Revised November 14,2011 Page 3 of 3 Albemarle Co c tV Community Development Department 401 McIntire Road Charlottesville,VA 22902-4596 Planning Application : (434)296-5832 Fax:(434)972-4126 PARCEL/ OWNER INFORMATION 1 TMPI 032G0-00-00-000B0 I Owner(s): WOODBRIAR ASSOCIATES Application # WP0201400059 PROPERTY INFORMATION Legal Description TRACT B Magisterial Dist. Rio Land Use Primary Forest Current AFD Not in A/F District Current Zoning Primary Rural Areas APPLICATION INFORMATION Street Address Entered By Todd Shifflett Application Type Water Protection Ordinances 06/12/2014 Project IBriarwood Commercial Lots-Gas Station Received Date 06/12/14 Received Date Final Submittal Date Total Fees 600 Closing File Date Submittal Date Final Total Paid 600 Revision Number Comments Legal Ad SUB APPLICATION(s) Type Sub Applicati f Comment Erosion and Sediment Control Plan Storrr►water Managemen#/;BMP Ilan !APPLICANT/ CONTACT INFORMATION ContactType 1 Name I Address ( CityState I Zip Phone PhoneCell Owner/Applicant WOOL BRIAR ASSOCIATES P 0 BOX 5548 CHA RLOTTESVILL;22905,' y _ y................: .....:... ......::�:� ......,i., .......t Primary Contact SCOTT COLLINS - COLLINS ENGINEERIN 200 GARRETT STREET,SUITE CHARLOTTESVILL 22902 4342933719 Plan Preparer COLLINS ENGINEERING Signature of Contractor or Authorized Agent Date Iiiiraol Application for Review of Erosion & Sediment Control Plan & Stormwater ManagementBMP Plan & * " Stream Buffer Mitigation Plan O Erosion & Sediment Control Plan 0 Stormwater ManagementBMP Plan ❑ Stream Buffer Mitigation Plan ❑ E&S Plan Amendment ❑ SWM Plan Amendment (Previous Plan# ) (Previous Plan# ) ❑ E&S Plan with Variance ❑ Request for Exception #of Variances ❑ SWM Plan Resubmittal ❑ E&S Plan Resubmittal WPO Application # WPO Application# Submit 2 copies each of applicable plans/narrative/computations *When a WPO plan is 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. Project Name: BRIARWOOD COMMERCIAL LOTS-GAS STATION WPO Tax map and parcel: 32G-B Zoning: Cl &EC Amount of Land Disturbance: 2,29 Acres Location of property(landmarks,intersections,or other): BRIARWOOD DRIVE Contact Person(Who should we call/write concerning this project?): SCOTT COLLINS-COLLINS ENGINEERING Address 200 GARRETT STREET,SUITE K City CHARLOTTESVILLE State VA Zip 22902 Daytime Phone(434J 293-3719 Fax#( E-mail scottgcollins-engineering,com Owner of Record WOODBRIAR ASSOCIATES Address PO BOX 5548 City CHARLOTTESVILLE State VA Zip 22905 Daytime Phone( J Fax#( ) _.. E-mail Contractor Address_ City _State Zip Daytime Phone( ) Fax#(_ ) E-mail Plan Preparer COLLINS ENGINEERING Address m.� City State Zip___ u_ Daytime Phone( )_ Fax#(..._ .)_ E-mail Owner/Applicant Must Read and Sign By s tyling tleie - 4 f= no owner.r an y. e aPPrOved Erosion Cannel Plank lineranniter Man , Plien,apdine n,non wfdl be compiled wAil end Ihave the water*to wetieretto the land dheetrhing activities and development on theladtittatprOparrty, I hereby grant the County of Albemarle the right to enter upon the property intatOred to ensure compliance wiith the a p . Signature of Owner, a . Date aix,,,„4,v4.iii f aei ahro.or f ` 3 irigsiv Print Name Daytime phone number of Signatory FOR OFFICE USE ONLY WPO b Fee Amount S Date Paid By who? _ Receipt N Cka By: Revised N wi ether 14 XI 1 1 Pape I of 1 EROSION CONTROL PLAN: (SUBMIT 2 COPIES) Land disturbing activity pertaining to single family dwelling unit: 1. Plan Review $150 per review (TO BE PAID AT TIME OF APPLICATION AND EACH SUBMITTAL THEREAFTER UNTIL APPROVAL) 2 Permit and First Year Inspection Fees $150 (TO BE PAID PRIOR TO SCHEDULING PRECONSTRUCTION CONFERENCE FOR EROSION CONTROL PERMIT) 3. Annual Permit Renewal and Inspection Fees $150 (TO BE PAID ANNUALLY,STARTING WITH SECOND YEAR,UNTIL COMPLETION OF APPROVED PLAN REQUIREMENTS) 4. Each reinspection $150 (REINSPECTION FEES ARE INVOICED TO THE LANDOWNER) Land disturbing activity pertaining to non-exempt agricultural land: 5. Plan Review $150 per review (TO BE PAID AT TIME OF APPLICATION AND EACH SUBMITTAL THEREAFTER UNTIL APPROVAL) 6. Permit and First Year Inspection Fees $150 (TO BE PAID PRIOR TO SCHEDULING PRECONSTRUCTION CONFERENCE FOR EROSION CONTROL PERMIT) 7. Annual Permit Renewal and Inspection Fees $150 (TO BE PAID ANNUALLY,STARTING WITH SECOND YEAR,UNTIL COMPLETION OF APPROVED PLAN REQUIREMENTS) 8. Each reinspection $150 (REINSPECTION FEES ARE INVOICED TO THE LANDOWNER) All other land disturbing activity: 9. Plan Review,Disturbed Area Less Than One Acre $150 per review (TO BE PAID AT TIME OF APPLICATION AND EACH SUBMITTAL THEREAFTER UNTIL APPROVAL) 10. Permit and First Year Inspection Fees,Disturbed Area Less Than One Acre $200 (TO BE PAID PRIOR TO SCHEDULING PRECONSTRUCTION CONFERENCE FOR EROSION CONTROL PERMIT) 11. Annual Permit Renewal and Inspection Fees,Disturbed Area Less Than One Acre $200 (TO BE PAID ANNUALLY,STARTING WITH SECOND YEAR,UNTIL COMPLETION OF APPROVED PLAN REQUIREMENTS) 12. Plan Review,Disturbed Area One Acre or Larger 300 per review (TO BE PAID AT TIME OF APPLICATION AND EACH SUBMITTAL THEREAFTER UNTIL APPROVAL) 13. Permit and First Year Inspection Fees,Disturbed Area One Acre or Larger $100/per disturbed acre (TO BE PAID PRIOR TO SCHEDULING PRECONSTRUCTION CONFERENCE FOR EROSION CONTROL PERMIT) 14. Annual Permit Renewal and Inspection Fees,Disturbed Area One Acre or Larger $100/per disturbed acre (TO BE PAID ANNUALLY,STARTING WITH SECOND YEAR,UNTIL COMPLETION OF APPROVED PLAN REQUIREMENTS) 15. Each reinspection $250 (REINSPECTION FEES ARE INVOICED TO THE LANDOWNER) 16. Amendment to Approved Plan $180/per plan review (TO BE PAID AT TIME OF APPLICATION AND EACH SUBMITTAL THEREAFTER UNTIL APPROVAL) 17. Variances $150/per request (TO BE PAID AT TIME OF APPLICATION) 18. SUBTOTAL EROSION CONTROL PLAN $300 Revised November 14,2011 Page 2 of 3 STORMWATER MANAGEMENT/BMP PLAN & MITIGATION PLAN: (SUBMIT 2 COPIES) 19. Stormwater Management/BMP Plan $300/per plan review (TO BE PAID AT TIME OF APPLICATION AND EACH SUBMITTAL THEREAFTER UNTIL APPROVAL) 20. Major Amendment of Plan $180/per plan review (TO BE PAID AT TIME OF APPLICATION AND EACH SUBMITTAL THEREAFTER UNTIL APPROVAL) 21. Request for exception $240 (TO BE PAID AT TIME OF APPLICATION) 22. Request for development in a stream buffer or for reduction or modification of stream buffer and mitigation plan(if not part of another document)—Single family dwelling unit or accessory structure $85 (TO BE PAID AT TIME OF APPLICATION) 23. Each inspection or reinspection $60 (INSPECTION/REINSPECTION FEES ARE INVOICED TO THE LANDOWNER) 24. Mitigation Plan $150 (TO BE PAID AT TIME OF APPLICATION) 25.SUBTOTAL SWM/BMP PLAN $300 TOTAL APPLICATION FEE: (Add lines 18 and 25) $600 THE OWNER SHALL BE RESPONSIBLE FOR ALL REINSPECTION AND/OR ANNUAL RENEWAL FEES WHICH MAY BE CHARGED TO THIS PROJECT. Revised November 14,2011 Page 3 of 3