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Home My WebLink AboutWPO201900035 Application 2019-06-03 Community DevelopmentDepartmert talc. Albemarle Co ut7 401 h e Road Charlottesville,VA22902-4596 ; y1� ' .(434)296-5832 Fax:(434)972-4126 �,`� �/ Planning Application PARCEL OWNER INFORMATION — TPY1F' 04200-00-00-059RO Owner(s): JOHNSON, CRAIG A& LEIGH 0 JOHNSON Application# WPO201900035 PROPERTY INFORMATION ' Legal Description !ACREAGE Magisterial Dist. White Hall Land Use Primary Open u Current.AFD Not in A/F District Current Zoning Primary Rural Areas — «_ [-APPLICATION INFORMATION Street Address 2265 DECCA LN CHARLOTTESVILLE,22901 Entered By Y-----+ ]ennifer Pri--t ui Application Type Water Protection Ordinances „ 67471014 — Project 2265 Decca Lane - VSMP Received Date 06/03/19 R.ecei ed Date Final Submittal Date � Total Fees Closing File Date Submittal Date Final Total Paid Revision Number Comments N., Legal Ad SUB APPLICATION(s) Type Sub Applicatio Comment Stormwater Management/BMP Plan 06/03/19 Erosion and Sediment Control Plan 06/03/19 APPLICANT__ / CONTACT INFORMATION ContactType j Nan a : dress GityState Zip Phone PhoneCell Signature of Contractor or Authorized Agent Date Virginia Stormwater Management Program (VSMP) �^ t' v,J' Application for Albemarle County '1 Project Name: 2265 DECCA LANE (The name should he 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 El No El County File Number: (to he provided by the County for new applications) The following are required elements of new applications[from code section 17-401J. For revisions or amendments,please indicate which items are being amended. Signatures must be provided.for any submission. M 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. 42-59B CA - i oLt1cor1 L.tt�R dIn$ e^ (1'0 19-4l 5lCt Tax Map&Parcel Print Name of Owner Signature of ner 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 0_r' J O k-A n c a Address � R 0 5k., L d City State V4. . Zip o1�J7.o� (p Daytime Phone($6(1) Ze) O E-mail C..r teN` kck s o "j Q_ vv. Q. • C M Revised 07/24/18 Page 1 of 2 1 B. All Fees [Code section 1 8] For new or modified plans;Total acres proposed to be disturbed 3.20 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; $150 i C. Registration Statement on the official DEQ form. i D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. 1 F. Stormwater Management Plan satisfying the requirements of code section 17-403. i F. Pollution Prevention Plan satisfying the requirements of code section 17-404. l G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. N/A 0 H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. N/A ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. N/A ❑ J. Construction Record Drawings (as-builts)for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Kurt M. Gloeckner Address 1980 FOX RUN LANE City CHARLOTTESVILLE State VA Zip 22901 Daytime Phone(434) 971-1591 _E-mail kurtgloeckner@gmail.com *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn.Applications without valid owner's signatures will not be considered valid. /��,,�l� FOR OFFICE USE ONLY WPO#r '' (21)35 7 I I� Fee Amount$ I �Date Paid (O/ l By who? eceipt#_� I ra� Ck# "^" BY JP Revised 07/24/18 Page 2 of 2 Jp . do RECEIVED '� GI Received By JUN031n19 COMMUNITY DEVELOPMENT 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: LEIGH AND CRAIG JOHNSON Contact: o& oAn n s•n Mailing Address: Pi 2.S Li et City: 12 m.l.,M. r.eJ2 State: V a Zip:23 a.a.(Q Phone: Email address(if available): ,ol..n so w & . La tY\ Indicate if DEQ may transmit general permit correspondence electronically: Yes❑ No❑ 2. Existing General Permit Registration Number(for renewals only): 3. Name and Location of the Construction Activity: Name: 2265 DECCA LANE Address(if available): 2265 DECCA LANE City: CHARLOTTESVILLE State: VA Zip: 22901 County(if not located within a City): ALBEMARLE Latitude(decimal degrees): 38.09908 Longitude(decimal degrees): -78.59830 Name and Location of all Off-site Support Activities to be covered under the general permit: Name: N/A 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❑ Private❑X 5. Nature of the Construction Activity(e.g.,commercial, industrial,residential,agricultural,oil and gas,etc.): RESIDENTIAL 6. Name of the Receiving Water(s)and Hydrologic Unit Code(HUC): Name: MECHUMS RIVER Name: HUC: JR-02 HUC: 7. If the discharge is through a Municipal Separate Storm Sewer System(MS4),the name of the MS4 operator: N/A 8. Estimated Project Start and Completion Date: Start Date(mm/dd/yyyy): 07/01/2019 Completion Date(mm/dd/yyyy): 07/01/2020 9. Total Land Area of Development(to the nearest one-hundredth acre): 47.30 Estimated Area to be Disturbed(to the nearest one-hundredth acre): 3.20 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 Na .0 C o`a:72A n`'o(It LC \-. J c�n S •n Title: w Signature: � Date: Sl2.q f 19 (Please sign in INK This Certification must sign d by the appropriate person associated with the operator identified in Item#1.) 07/2014 Page 1 of 1