HomeMy WebLinkAboutWPO202100050 Bond 2023-01-20Internal Use Only
dl
Dare ReceiveJ:
Fee Paid: R =
Reeeived by:
Mwkc Fonimdfo Program Admfrdmnmr fy,�lVkb
BOND INSPECTION REQUEST
APPROVED PLAN #: VAR1ON007
PROJECT NAME (including Phase #): CHO-Albemarle Airport Elevator & Stairs Replacement CWP02021-00050)
(As listed on the approved plan)
This form is used to request a reduction or release of a bond. A fee is required for each inspection. Please
check the appropriate box below for the requested inspection(s). Fees includes 4% Technology Fee.
Inspections for the purposes of bond reduction or release will require a separate fee for each bond.
0 VSMP/VESCP Erosion Control, Stormwater Management and/or Mitigation per
Water Protection Ordinance sections 17-207 & 17-208 $294.32
❑ Reduction o Release
❑ Subdivision (roads, drainage, etc.) per Subdivision Ordinance sections 14-435 & 14-438 $307.84
❑ Reduction ❑ Release
❑ Water & Sewer bond per Subdivision Ordinance section 14-435 $307.84
❑ Reduction ❑ Release
❑ Site Development Performance bond (Incomplete Site Work & Landscaping) $344.24
❑ Reduction (site work only) ❑ Release
TOTAL FEES $294.32
Submit requests to: Department of Community Development, 401 McIntire Road, North Wing, Charlottesville,
VA 22902, Attention: Management Analyst — Phone 434-296-5832; Fax 434-972-4126. All roads and
stonnwater facilities will require construction record drawings, inspection reports, videos/photos, plats/esmts,
certifications, and completion processes through VDOT or DEQ (refer to County acceptance procedures).
Bonds will not be reduced or released without record drawings and inspection documentation pet the state
requirements and County's published procedures. A minimum 20% of the original posting is held until
acceptance of all bonded improvements. For Site Development Performance bonds, if landscape installation is
part of the bonded site work, a request for reduction should only be made once all landscaping is complete.
If all required documentation is not received within 30 days of receipt of this request, this application shall be
deemed incomplete and shall be rejected. If rejected, a new application, supporting documentation and fee will
be required. Applications may be withdrawn for a full refund within 30 days of receipt.
If this is a reduction request, the revised estimate will be prepared by the plan reviewer and sent to the owner.
Please provide contact information.
EMAIL: terrl@kenbridge.com; mflood@kenbridge.com; brandon@kenbridge.com
OR REGULAR MAIL ADDRESS: P.O. Box 480
Kenbridge, Virginia 23944
'ignatm ' of Owner/Developer
errs F. Newcomb, Corp Secretary, Kenbridge Construction Co., Inc. 01/09/23
Print Name Date
Revised 7/15/2014, 7/20/2015, 11/32015, 8/14/2017, 1/28/2020, 7/1/2021
VIRGINIA DEPARTMENT OF ENVIRONMENTAL QUALITY
GENERAL VPDES PERMIT FOR DISCHARGES OF STORMWATER FROM CONSTRUCTION ACTIVITIES (VAR10)
NOTICE OF TERMINATION 2019
Permit Coverage Number(VARSO####): VAR10N007
Section I. Operator/Permittee Information. The person or entity that has active permit coverage approval and operational control
over construction activities to ensure compliance with the general permit. A person with signatory authority for this operator must
sign the certification in Section VII (per Part III. K. of the VAR10 Permit).
Construction Activity Kenbridge Construction Co.. Inc.
Operator Name:
Mike Flood or Brandon Spence
Contact Person:
r
Address: 1101 East Fifth Avenue, P.O. Box 480
City, State, Zip Code: Kenbridge. VA 23944
Phone Number: 434-676-8221
Primary Email: mflood@kenbridge.com
CC Email: terri@kenbridge.com
brandon@kenb(idge.com
Section II. Construction Activity Location Information. Project site information.
CHO-Albemarle Airport Elevator & Stairs Replacement
Construction Activity Name:
Address: 100 Bowen Loop, Suite 200
City and/or County and Zip Code: Charlottesville. VA 22921
Latitude and Longitude 38.1417N78.4474W
(6-digit, decimal degrees format):
Section III: Reason for Terminating Coverage under the General Permit. The operator shall submit a Notice of Termination within
30 days after meeting one or more of the following conditions (select one or more):
® A. Necessary permanent control measures included in the SWPPP for the site are in place and functioning effectively and final
stabilization has been achieved on all portions of the site for which the operator is responsible. When applicable, long-term
responsibility and maintenance requirements for permanent control measures shall be recorded in the local land records
prior to the submission of a Notice of Termination;
❑ B. Another operator has assumed control over all areas of the site that have not been finally stabilized and obtained coverage for
the ongoing discharge;
❑ C. Coverage under an alternative VPDES or state permit has been obtained; or
❑ D. For residential construction only, temporary soil stabilization has been completed, the operator has provided written
notification to the homeowner about the importance of final stabilization and incorporating a copy of the notification and
signed certification statement into the SWPPP, and the residence has been transferred to the homeowner.
Rev 04/2019 PAGE 1 16
CONSTRUCTION GENERAL PERMIT (VAR10) NOTICE OF TERMINATION 2019
Section IV. Participation in a Regional Stormwater Management Plan. If your site discharges to a regional stormwater
management facility, provide information related to the regional stormwater management plan. Attach a separate list if discharging
to multiple regional facilities.
Regional Stormwater Management
N/A
Facility Type:
Address:
L
city and/or County and Zip Code:
Latitude and Longitude
N/A
(6-di it, decimal degrees format):
Total Acres Treated by Regional Facility
N/A
(report to one -hundredth of an acre):
Impervious Acres Treated by Regional Facility
NIA
(report to one -hundredth of an acre):
Section V. Perpetual Nutrient Credits. If your site is utilizing nutrient credits, provide information related to the perpetual nutrient
credits that were acquired in accordance with 4 62.1-44.15:35 of the Code of Virginia. Attach a separate list if needed.
Nonpoint Nutrient Credit Generating Entity
(Bank Name):
N/A
Perpetual Nutrient Credits Acquired
(pounds/acres/year):
N/A
Include the affidavit of sale for all nutrient credits acquired. Is the affidavit of sale of nutrient credits attached? ❑YES ONO
Section VI. Permanent Control Measures. If applicable, list the post -development stormwater management facilities or best
management practices (BMPs) that were constructed and installed as part of this activity to comply with the stormwater
management technical criteria (structural and nonstructural, on -site and off -site). Attach a separate list if needed.
If you have permanent control measures, the following items are required to be included with this form in order to complete your
Notice of Termination submittal:
❑ A. Engineer's Certification Statement
❑ B. As -built plans (construction record drawings) —digital
❑ C. As -built plans (construction record drawings) —full-sized, paper
❑D. StormwaterManagementPlans— digital
❑ E. BMP Maintenance Agreement— notarized original, for public and private projects under DEQ's VSMP Authority
Stormwater Management Facility Types (please choose from the followina 6mp types):
Bioretention 1
Bioretention 2
Bioretention basin
Bioretention filter
Constructed Wetland i
Constructed Wetland 2
Constructed wetlands
Dry Swale 1
Dry Swale 2
Extended detention (2x WQVoI)
Extended Detention Pond 1
Extended Detention Pond 2
Extended detention -enhanced
Filtering Practice 1
Filtering Practice 2
Grass Channel
Grassed swale
Infiltration (1 x WQ Vol)
Infiltration (2 x WQ Vol)
Infiltration 1
Infiltration 2
Other IIB (manufactured
treatment device, etc.)
Other IIC (manufactured
treatment device, etc.)
Permeable Pavement 1
Permeable Pavement 2
Rainwater Harvesting
Retention basin 1 (3 x WC. Vol)
Retention basin II (4x WQVoI)
Retention basin 111 (4x WQVoI
with aquatic bench)
Sand filter
Sheetflow to Vegetated Filter or
Conserved Open Space 2
Soil Amendments
Urban Bioretention
Vegetated filter strip
Vegetated Roof 1
Vegetated Roof 2
Wet Pond 1
Wet Pond 2
Wet Swale 1
Wet Swale 2
Rev 04/2019
PAGE 2 (6
CONSTRUCTION GENERAL PERMIT (VAR10) NOTICE OF TERMINATION 2019
Stormwater Management Facility #1
BMPType:
N/A
Date BMP Became Functional:
WP02021-00050; VAR10N007
Address (if available):
City and/or County and Zip Code:
Latitude and Longitude
(6-digit, decimal degrees format):
38.1417N78.4474W
Receiving Water(s)
(outfall discharge):
Total Acres Treated
(report to one -hundredth of an acre):
Impervious Acres Treated
(report to one -hundredth of an acre):
Stormwater Management Facility #2
BMP Type:
Date BMP Became Functional:
Address (if available):
City and/or County and Zip Code:
Latitude and Longitude
(6-digit, decimal degrees format):
Receiving Water(s)
(outfall discharge):
Total Acres Treated
(report to one -hundredth of an acre):
Impervious Acres Treated
(report to one -hundredth of an acre):
Stormwater Management Facility #3
BMP Type:
Date BMP Became Functional:
Address (if available):
City and/or County and Zip Code:
Latitude and Longitude
(6-digit, decimal degrees format):
Receiving Water(s)
(outfall discharge):
Total Acres Treated
(report to one -hundredth of an acre):
Impervious Acres Treated
(report to one -hundredth of an acre):
Rev 04/2019 PAGE 3 16
CONSTRUCTION GENERAL PERMIT (VAR10) NOTICE OF TERMINATION 2019
Section VII. Certification. This Certification must be signed by a person representing the operator identified in Section I. and
meeting the requirements of 9VAC25-880-70 Part III K.
Certification: "I certify under penalty of law that I have read and understand this Notice of Termination 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. 1 am aware that there are significant penalties for submitting false information including the possibility of
fine and imprisonment for knowing violations."
Printed Name:
Signature (signed in ink)
Date:
Section Vill. Submittal Instructions. Please submit this form to the Virginia Stormwater Management Program (VSMP) Authority
that has jurisdiction for your construction activity. If the locality is the VSMP Authority, please submit your form directly to the
locality; do NOT send this form to DEQ. A list of local VSMP Authorities is available here: VSMP Authorities.
If DEQ is the VSMP Authority, please send to:
Department of Environmental Quality
Office of Stormwater Management Suite 1400
PO Box 1105
Richmond VA 23218
co nstruct io nxaCdd eg.vi rgi n ia.xov
If the locality is the VSMP Authority, please send to:
'he Local VSMP Authority (insert aaaress
Permit terminations may be delayed if there are
outstanding annual permit maintenance fee balances due.
Rev 04/2019 PAGE 4 16