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Home My WebLink AboutWPO201600068 Application 2016-10-31 /t Community Development Departn `_: u ,`=` Albemarle C �n�y 401 McIntire Road Charlottesville,VA 22902-4! Voice:(434)296-5832 Fax:(434)972-4 +'�•.• r Planning Application PARCEL] OWNER INFORMATION TMP 05700-00-00-029B0 Owner(s): ALBEMARLE COUNTY SERVICE AUTHORITY Application # WP0201600068 PROPERTY INFORMATION Legal Description I ACREAGE CROZET FILTER PLANT Magisterial Dist. j White Hall -1 Land Use Primary Public Current AFD Not in A/F District ] Current Zoning Primary Light Industry [APPLICATION INFORMATION Street Address 4673 THREE NOTCH'D RD CHARLOTTESVILLE, 22901 Entered Judy Martin l Application Type Water Protection Ordinances _ 10/31/2016 Project Crozet WTP Finished Water Pump Station-VSMP (Amendment) Received Date 10/31/16 Received Date Final Submittal Date 11/07/16 Total Fees 1 Closing File Date Submittal Date Final Total Paid Revision Number Comments Legal Ad SUB APPLICATION(s) Type Sub Application Comment Stormwater Management/BMP Plan 11/07/16 Erosion and Sediment Control Plan 11/07/16 APPLICANT / CONTACT INFORMATION ContactType Name I .mess _ CityState Zip Phone PhoneC( Owner/Applicant ALBEMARLE COUNTY SERVICE AUTHORITY 168 SPOTNAP ROAD CHARLOTTESVILL 22911 Primary Contact MILES JENSEN 3535 VADNAIS CENTER DRIVE ST PAUL, MN 55110 6514902020 Signature of Contractor or Authorized Agent Date �•P ry Virginia Stormwater Management Program (VSMP) � Application for Albemarle County 11St• Project Name: Crozet WTP Finished Water Pump Station (Existing Plan Name: Crozet WTP GAC Building Upgrades) (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 WI County File Number: WPO20140008 (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 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. 57-29B Rivanna Water& Sewer Authority "�/\ /0—ZS—/‘ Tax Map&Parcel Print Name of Property Owner Signinure of Owner Date P riy 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 Rivanna Water and Sewer Authority-do Doug March Address 695 Moores Creek Lane City Charlottesville State VA Zip 22902 Daytime Phone(434) 977.2970 ext. 201 E-mail dmarch@rivanna.org 7/1/14,Revised:7/10/14, 1/7/14 Page 1 of 2 I I • B. All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed 0.27 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 100 $6,100 $3,050 $450 100 and more $9,600 $4,800 $700 For(minor)amendments to an approved plan;$200 per review Variances;$150(per request) Mitigation Plan;$150 ❑ C. Registration Statement on the official DEQ form. O D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. • E. Stormwater Management Plan satisfying the requirements of code section 17-403. ® F. Pollution Prevention Plan satisfying the requirements of code section 17-404. ® G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. ❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. O J. Construction Record Drawings(as-builts)for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Miles Jensen Address 3535 Vadnais Center Dr City St Paul State MN Zip 5510 Daytime Phone(651) 490.2020 E-mail mjensen@sehinc.com *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# r� /l� (, I Fee Amount$ 1 o Date Paid 1,*(1)6By who? 40 Q Receipt# bul /7 Ck# £ lS�By J-P 7/1/14,Revised:7/10/14, 1/7/14 Page 2 of 2