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HomeMy WebLinkAboutWPO201400068 Application WPO VSMP 2014-08-11 dtl iiir,; Albemarle Co ty Community Development Department 4(- _lntire Road Charlottesville,VA 22902-4596 © ' ` Voice: (434)296-5832 Fax: (434)972-4126 .�...':�' Planning Application GIN% PARCEL/ OWNER INFORMATION TMP 060E2-00-00-00100 Owner(s): FARMINGTON COUNTRY CLUB Application # WP0201400068 PROPERTY INFORMATION Legal Description FARMINGTON Magisterial Dist. Jack Jouett Land Use Primary Semi-public Current AFD Not in A/F District Current Zoning Primary Rural Areas APPLICATION INFORMATION Street Address 1625 COUNTRY CLUB CIR CHARLOTTESVILLE, 22901 Entered By Todd Shifflett Application Type Water Protection Ordinances 08/11/2014 Project Farmington Country Club South Side Improvements Received Date 08/11/14 Received Date Final Submittal Date Total Fees 1350 Closing File Date Submittal Date Final Total Paid 1350 Revision Number Comments Legal Ad SUB APPLICATION(s) Type Sub Applicati Comment APPLICANT/ CONTACT INFORMATION ContactType Name Address I CityState Zip Phone PhoneCell Owner/Applicant FARMINGTON COUNTRY CLUB 1625 COUNTRY CLUB CIRCLE CHARLOTTESVILL '22901 Primary Contact JOSEPH KRENN, COO/GENERAL MANAGE 11625 COUNTRY CLUB CIRCLE CHARLOTTESVILL 22901 4342450699 Signature of Contractor or Authorized Agent Date r fui Virginia Stormwater Management Program (VSMP) Application for Albemarle County Project Name: Farmington Country Club South Side Improvements (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes lit No 0 Is this a revision or resubmission for review? Yes.l No 0 County File Number: (to be 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. 0 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. , TM 60E, Parcel 2-1 Farmington Country Club-Shiela Tate,President 4. t ' / I, 5 . 4- ' Tax Map&Parcel Print Name of Property Owner _n.ture 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 Farmington Country Club - Attn: Joseph Krenn, COO/General Manager Address 1625 Country Club Circle City Charlottesville State VA Zip 22901 245-0699 jkrenn@fccva.com Daytime Phone(434) E-mail 7/1/14,Revised:7/10/14 Page 1 of 2 ❑ B. All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed 2.5 Acres to be I 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;$150 ❑ C. Registration Statement on the official DEQ form. o D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. IN E. Stormwater Management Plan satisfying the requirements of code section 17-403. ❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404. ❑ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. ❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. O J. Construction Record Drawings(as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) PrintNameWW Associates, Inc. - Attn: John D. Beirne, P.E. Address 3040 Avemore Square Place City Charlottesville State VA Zip 22911 Daytime Phone(434) 984-2700 E-mail jbeirne@wwassociates.net *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# _ (� Fee Amount$ )3n Alb Date Paid �11t�'IV By who', �a(M 1(j]�O V) Receipt#q Cp723Ck# 191/1 5 y 1) 600►74'( j c1 v�j 7/1/14,Revised: 7/10/14 Page 2 of 2 ,d tt rk, Virginia Stormwater Management Program (VSMP) `� SJi 'Ik Application for Albemarle County 4111itlir Project Name: Farmington Country Club South Side Improvements (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes El No El Is this a revision or resubmission for review? Yes ❑ No ❑ County File Number: (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. TM 60E, Parcel 2-1 Farmington Country Club-Joseph Krenn,COO/GM /f/ g( Tax Map&Parcel Print Name of Property Owner Signature I Owner Dat 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 Farmington Country Club - Attn: Joseph Krenn, COO/General Manager Address 1625 Country Club Circle City Charlottesville State VA Zip 22901 245-0699 jkrenn@fccva.com Daytime Phone(434)_ E-mail 7/1/14,Revised: 7/10/14 Page 1 of 2 ❑ B. All Fees [Code section 17-208] For new or modified plans; Total acres proposed to be disturbed 2.-5 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 ll C. Registration Statement on the official DEQ form. IN 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. N/A LI F. Pollution Prevention Plan satisfying the requirements of code section 17-404. IN G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. N/A ❑ 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) PrintNameWW Associates, Inc. - Attn: John D. Beirne, P.E. Address 3040 Avemore Square Place City Charlottesville State VA Zip 22911 _ .._._.... 984-2700 jbeirne @wwassociates.net Daytime Phone(434) E-mail *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 S._ Date Paid By who? Receipt# Ck# By 7/1/14,Revised: 7/10/14 Page 2 of 2 Albemarle COQ,,,,.tv Community Development Department M1 4014iftIntire Road Charlottesville,VA 22902-4596 �'` # Planning Application Voice:(434)296-5832 Fax:(434)972-4126 PARCEL/ OWNER INFORMATION TMP 060E2-00-00-00100 Owner(s): Application # WP0201400068 FARMINGTON COUNTRY CLUB PROPERTY INFORMATION Legal Description FARMINGTON Magisterial Dist. Jack Jouett Land Use Primary Semi-public Current AFD Not in A/F District Current Zoning Primary Rural Areas APPLICATION INFORMATION Street Address 1625 COUNTRY CLUB CIR CHARLOTTESVILLE, 22901 Entered By Todd Shifflett Application Type Water Protection Ordinances 08/11/2014 Project Farmington Country Club South Side Improvements Received Date 08/11/14 Received Date Final Submittal Date Total Fees 1350 Closing File Date Submittal Date Final Total Paid 1350 Revision Number Comments Legal Ad SUB APPLICATION(s) Type I Sub Applicati I Comment 'APPLICANT/ CONTACT INFORMATION ContactType Name 1 Address I CityState 1 Zip Phone PhoneCell Owner/Applicant 2290... .. .�. ........_..;.....,...�................_sFARM1INGTONCOUNTRYCLUB � . . =1625;COUNTRY CLUBCIRCLE;,ACtiF1Rt(7iTTESVtCL_;22941 Primary Contact JOSEPH KRENN, COO/GENERAL MANAGE 1625 COUNTRY CLUB CIRCLE CHARLOTTESVILL 22901 4342450699 Signature of Contractor or Authorized Agent Date Virginia Stormwater Management Program (VSMP) t 'lots Application for Albemarle County � um,a�a Project Name: Farmington Country Club South Side Improvements (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes 1St No ❑ Is this a revision or resubmission for review? Yes. No ❑ County File Number: (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. I i c TM 60E, Parcel 2-1 Farmington Country Club-Shiela Tate,President A. / - ' J( , . Z.1/ i �i VVV �i(J ) Tax Map&Parcel Print Name of Property Owner .n.ture 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 Farmington Country Club - Attn: Joseph Krenn, COO/General Manager Address 1625 Country Club Circle City Charlottesville State VA Zip 22901 Daytime Phone(434) 245-0699 E-mail jkrenn @fccva.com 7/1/14,Revised: 7/10/14 Page 1 of2 ❑ B. All Fees [Code section 17-208] For new or modified plans; Total acres proposed to be disturbed 2.5 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;$150 ❑ C. Registration Statement on the official DEQ form. IN D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. IN E. Stormwater Management Plan satisfying the requirements of code section 17-403. ❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404. ❑ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. El H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name WW Associates, Inc. - Attn: John D. Beirne, P.E. Address 3040 Avemore Square Place City Charlottesville State VA Zip 22911 Daytime Phone(434) 984-2700 E-mail jbeirne@wwassociates.net *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# CC � Fee Amount$ )no.� % Date Paid '11''1 By who? (4((1654-0 V) Receipt#q 1.723Ck# 19 1 5 "F3 y: ,E c...04-/-1 7/1/14,Revised: 7/10/14 Page 2 of2 Virginia Stormwater Management Program (VSMP) ® ; Application for Albemarle County Project Name: Farmington Country Club South Side Improvements (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes El No ❑ Is this a revision or resubmission for review? Yes ❑ No El County File Number: (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. TM 60E, Parcel 2-1 Farmington Country Club-Joseph Krenn,COO/GM f /�/ Jrzji_ct Tax Map&Parcel Print Name of Property Owner Signature Owner I)at Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Tax Map&Parcel Print Name of Propel ty 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 Farmington Country Club - Attn: Joseph Krenn, COO/General Manager Address 1625 Country Club Circle City Charlottesville _ State VA Zip 22901 Daytime Phone(4 ) 245-0699 E-mail jkrenn@fccva.com 7/1/14,Revised. 7/10/14 Page 1 of 2 • ❑ B. All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed 2.5 Acres to be Total Fee Fee Due with this Fee with Transfer or disturbed Application modification of permit Less than 1 $290 $145 $20 ] 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;$150 ® C. Registration Statement on the official DEQ form. IN D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ICJ E. Stormwater Management Plan satisfying the requirements of code section 17-403. N/A D F. Pollution Prevention Plan satisfying the requirements of code section 17-404. M G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. N/A 0 H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. N/A ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. N/A ❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print NameWW Associates, Inc. - Attn: John D. Beirne, P.E. Address 3040 Avemore Square Place City Charlottesville State VA zip 22911 DaytimePhone(434) 984-2700 E-mail jbeirne@wwassociates.net *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# Fee Amount$ Date Paid By who9 Receipt# _ Ck# _ _ By._.__ 7/1/14,Revised. 7/10/14 Page 2 of 2