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Home My WebLink AboutWPO201400064 Application WPO VSMP 2015-04-13 Virginia Stormwater Management Program (VSMP) ""'i "-111 ilii�f Application for Albemarle County /10;IN\ Project Name: Hyland Ridge (The name should he the same as it appears on plans) Is this an amendment to an approved plan? Yes ❑ No C/ Is this a revision or resubmission for review? Yes CI No ❑ County File Number: WPO201400064 (to he provided ht the County for new applications) The following are required elements of new applications Prom code section 17-4011. For revisions or amendments, please indicate which items are being amended. Signatures must he provided.* 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 he 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. 78-57, 78-01-F Dr. Charles Hurt M.D. 11r L- dt<? 1 4/13/15 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 Pantops-Lakeridge, LLC Address PO Box 8147 City Charlottesville State VA zip 22906 Daytime Phone (434) 979-8181 _ - _ 1.-mail cahbuild @ntelos net 7/1/14, Revised: 7/10/14, 1/7/14 Pae.c I of2 • B. All Fees [Code section 17-208] For new or modified plans; Total acres proposed to be disturbed N/A 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 $2250 $300 50 and less than 100 $6,100 $3,050 $450 100 and more , $9,600 $4,800 S700 For(minor) amendments to an approved plan; $200 per review Variances; $150 (per request) Mitigation Plan; $150 LI C. Registration Statement on the official DEQ form. ❑ D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ❑ E. Stormwater Management Plan satisfying the requirements of code section 17-403. ❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404. LI G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. C1 1-1. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence (usually the plan preparer, consultant or agent) Print Name Micheal Myers Address 172 South Pantops Dr. City Charlottesville State VA Zip 22911 Daytime Phone(434) 979-8121 Email mmyers @dominioneng.com *When applications and plans are reviewed,but not approved, and a response to comments is not received within 6 months from the date of county comments,the application will he deemed withdrawn. Applications without valid owner's signatures will not be considered valid.. FOR OFFICE USE ONLY WPO to Fee Amount$ Date Paid BN who' Receipt it C'L# BN 7/1/14, Revised: 7/10/14, 1/7/14 Page 2 or 2 w.r .rw, ,oY`�--,s Virginia Stormwater Management Program (VSMP) rc r -, Application for Albemarle County .►, ®— A PP t3' :� ,107: Project Name: I1� P g.L D6a� (The nam 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,❑ County File Number:1&Pt? (701 2-—0009/ (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. •K' 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 ereby grant the County of Albemarle the right to enter upon the property as required to ensure complianc ith the approved plans and permits. Ycht / (74.4 Tax Ma &Parcel Prmt�ame of Pro e Owner Si natu of Owner Date Map Property Signatu 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 /,C ia1-jes 141. K�- Address 1'7 s 2Ive,-13.07 d LT 1O City ar4-(0 e,5 v/lie State VA- ZipZZ. / Daytime Phone(43)f `Z 71 0 /8I E-mail 1� �r$ C► do'4//?' "1�n , (0'1 y � co 4 6,(iiel ( r) fe/(2.& . r7- .7.--- 7/1/14,Revised: 7/10/14, 1/7/14 Page 1 oft 1,6. 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 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;$150 ❑ C. Registration Statement on the official DEQ form. ❑ D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ❑ E. Stormwater Management Plan satisfying the requirements of code section 17-403. ❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404. ❑ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. , H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) / p Print Name I 'n ri t' 4 /? Address L 7 2. J- Po/t F n S L(iI - City OA W�U 4'SV t I k State VA Zip ft Daytime Phone( 7% vi 71 -e l i j E-mail Millie lr5 6 d o/h l v n(y fref j, (JM *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. s7 FOR OFFICE USE ONLY WPO# 2V 1 --' 9 ellOU{-LS Fee Amount$ Date Paid z-f 13 By who? B y t-1,,(�- Receipt# 8 7 21 ek# 1�� By: 7/1/14,Revised: 7/10/14, 1/7/14 Page 2 oft w✓ 'ore Virginia Stormwater Management Program (VSMP) /'alt ► Application for Albemarle County f (� � tj Project Name: �.yt�+hlA I7-.tda�'i G{bd i- : ! iC,-j name should should be 1heyeane as it appears on plans) Is this an amendment to an approved plan? Yes f No [1 Is this a revision or resubmission for review? Yes K No ❑ 1-." Pe z-Gici oocioq r r County File Number: (to be provided by the County fir 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. — 541. Tax Map&Parcel Print? ame of Propertyi)wner Signature of Owner Datc 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 a c_._ Zs.-_4). H uJ Address I J r-1 -sic bi.►?!Y'i ------- - - - - City t I/1 0+ $V p p State rI . .... Zip 22 11 Daytime Phone 4(1341) 111_' tl 0 I F.-mat! Ga l6(A ; lti5 ----- 7/1/14,Revised: 7/10/14 Page I of 2 ..v l� R. All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed Acres to he ; Total Fee Fee Due with this Fee with Transfer in disturbed Application modification of hermit Less than It $290 $145 $• 20 1 and less than 5 i $2,700 $1,350 $200 5 and less than 10 $3,400 1 $1,700 $250 10 and less than 50 $4,500 r $2,250 $• 300 50 and less than $6,100 $3,050 $450 100 100 and more $9,600 $4,800 4 $700 For(minor)amendments to an approved plan;$200 per review Variances;$150 Mitigation Plan;$150 ❑ 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. ❑ 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 proposal disturhan„e 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 t■�� 1 ^��1 '( Address 1 7Z 6:?�s L ei V r ... _ .... ._ .._......... .. . City � ��L��V i t `+tate \ /"1- Zip _2, (_CL Daytime Phone t�T39. 0 7j` tLI t•'d t mail / �(C".y j.. p L r�L£ f'r �GJ �-' *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# I cc Arnow S h,ic P ud Os who" Rc,e■pt ft c kN By 7/1714,Revised: 7;10/14 Page 2 of 2 is Albemarle Coui�y Community Development Department 401 ~fire Road Charlottesville,VA 22902-4596 ----- Planning Application Voice:(434)296-5832 Fax:(434)972-4126 PARCEL/ OWNER INFORMATION TMP 07800-00-00-05700 Owner(s): Application # WP0201400064 PANTOPS-LAKERIDGE LLC PROPERTY INFORMATION Legal Description ACREAGE Magisterial Dist. Rivanna 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 07/11/2014 Project Hyland Ridge Received Date 07/10/14 Received Date Final Submittal Date Total Fees 150 Closing File Date Submittal Date Final Total Paid 150 Revision Number Comments Legal Ad SUB APPLICATION(s) Type C Sub Applicati Comment Erosion and Sediment Control Plan (APPLICANT/ CONTACT INFORMATION ContactType l Name Address CityState l Zip Phone PhoneCell OwnertApplicant _ t PANTOPS-LAKERIDGE LLC P 0 BOX 8147 ICHARLOI 1'6'1411 122906 Primary Contact MICHAEL MYERS, P.E., DOMINION ENGI 172 S. PANTOPS DR. CHARLOTTESVILL 22911 4349798121 Signature of Contractor or Authorized Agent Date • Virginia Erosion and Sediment Control Program (VESCP) Application for Albemarle County Required Elements of this application [from code section 17-4021 Provide 2 copies of al/plans and any supporting documents. Professional seals must have original signatures. )`i 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. -78 -5 7 763 -01- F C4 , Tax Map&Parcel Signature of Owner Date Tax Map&Parcel Signature of Owner Date Tax Map&Parcel Signature of Owner Date Tax Map&Parcel Signature of Owner Date Contact Information for the Owner(s)to receive con espondence. Print Name tevit{U 5 ' L-ottLt" Address { (?DY. C/t 4 City Ck r(O1 ICSvdt 1t% State VA_ Zip 7.2- Ut . Daytime Phone(Vi 7°1® 0,1 t7 i E-mail C_ V( L{( c e -) n V1/:3". All Fees [Code section 17-207] Total acres proposed to be disturbed ÷ 0.7' • Acres to be disturbed Total Fee — Less than I $150 pra review ifs--e? More than 1 $300 per review — — l C. Registration Statement on the official DEQ form (attached). 7/1/2014 Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name ^�14l t'iIr fe't t l'f y i'`�.,, ��e ' D0/77 Al Address 172-2- S . 17617C-rs (/.,/ City Ch /Gr-fr't t State VA .. .. zap 2 11 Daytime Phone ' 7c, 1. f E-mail yvilviy-ev5 ac*'•7'7! 1 /)'2 *When applications and plans are reviewed, but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owners signatures will not be considered valid. FOR OFFICE USE ONLY )WPO# awl -gilt 6"I �,,�aa//�� IJ Fee Amount$ ,746'e'�,Date Paid (7411/By who? GFUA- 0k C- t eceipt# '9 3 Cktl /g "2. By. 7/1/2014