HomeMy WebLinkAboutWPO201500097 Application 2015-11-24 Community Development Departa
Albemarle Lunty 401 McIntire Road Charlottesville.VA 22902-4f
Voice:(434)296-5832 Fax:(434)972-4
.•1/ Planning Application
PARCEL / OWNER INFORMATION
TMP 04400-00-00-033G7 Owner(s): MCGILL, CHARLES M OR MARJORIE CATHERINE HIRSCHI
Application # WP0201500097
PROPERTY INFORMATION
Legal Description 1SOUTH IVY PH 2
Magisterial Dist. Jack Jouett Land Use Primary Forest
Current AFD Not in A/F District Current Zoning Primary Rural Areas
[APPLICATION INFORMATION
Entered
Street Address
Judy Martin
Application Type Water Protection Ordinances
111/24/2015
Project McGill Residence- VSMP
Received Date 11/23/15 Received Date Final Submittal Date 11/23/15Total Fees 2
Closing File Date Submittal Date Final Total Paid 2
Revision Number
Comments
Legal Ad
SUB APPLICATION(s)
Type Sub Application Comment
Erosion and Sediment Control Plan 11/23/15
Stormwater Management/BMP Plan 11/23/15
APPLICANT/ CONTACT INFORMATION
ContactType Name Address CityState Zip Phone PhoneCt
OwrieriAptitiont- Ci.4,Ft4S t4 OR MARJORIE CATHE.3633 VICTORIA LANE KESWICK VA 22947
Primary Contact CHARLES MCGILL 3633 VICTORIA LANE KESWICK, VIRGIN 22947 4349874693
Signature of Contractor or Authorized Agent Date
Virginia Stormwater Management Program (VSMP) ® N
Application for Albemarle County l
AA RES
s\ls
Project Name: M` G L L ES I DE(v(.,�
(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,.
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 upo the property as required to ensure
compliance with the a rved plans and permits.
0041d'G '. CC-G0' L C4164£ r I / 1 (- / 8- 15
Tax Map&Parcel Print Name of Property Owner Signa s C4 '1 er Date
nn , 11 i /— (8-6
6°4460-00-0,____2:=Q33_0-1-1 ,,,,;4 „,,,e N . )laclAA \ r ri_
Tax Map&Parcel Print me of Property Owner Sign:19e • 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 Informatiio} ►4n�for the Owner(s)to receive correspondence:
/T
Print Name t 0 /I C 61 C /✓ _
Address 3(23 3 V tC�'PZ- A- Li4 it/t
City i<eS t J VA-(G["'� • v•v `1r7 State VA— Zip v 2 ?1-7
Daytime Phone(13t 7 U l 4--(4 1 3 E-mail e'• • AG I I f t�/ ( f- ‘4941v
7/1/14,Revised: 7/10/14 Page 1 of 2
El B. 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 $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;$150
V:(C. Registration Statement on the official DEQ form.
VD. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
'E. Stormwater Management Plan satisfying the requirements of code section 17-403.
sF. Pollution Prevention Plan satisfying the requirements of code section 17-404.
V G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405.
❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
stream buffers.
❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408.
❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Provide 2 copies of all plans and any supporting documents. Professional seals must have original
signatures.
Additional information if not provided on plans and documents:
Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent)
1 �
Print Name
Address 14 C: '`t.d
City t✓ !t,#1 ->Ir �!v State tit Zip
Daytime PhoneS �1 7 7 ° - 5 E-mail CAlte,‘ III et.,," z) r-...1/4(1,,bk.,ch cc, ✓Yl
*When applications and plans are.reviewad,but not approved,and a response to comments is not received within 6 months
from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's
signatures will not be considered valid.
FOR OFFICE USE ONLY WPO# –t
Fee Amount$ �.oo•`�Date Paid 10/ '3�/j By who? C1 (:�V� r )-.2 /4 Receipt# 1 63-3 _Ck# I3 1 I By:
MrG-JI
7/1/14,Revised: 7/10/14 Page 2 of 2
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:
Contact:
Mailing Address:
City: State: Zip: Phone:
Email address(if available):
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 Con truction Activity:ti
Name: Se OW- I V "" 7 0 /X. fZUIV (4-m67
Address(if available): /'
City:6, f-h '(.o77ESV/1, �;-��.: . .7' - — State: V Zip: _____
County(if not located within a City): A J►6/1/41211.-;
../l1/1 L(; l ir
Latitude(decimal degrees): 16 3( 1+ 1 r` W Longitude(decimal degrees): 3u V'S Q?-Z
Name and Location of all Off-site Support Activities to be covered under the general permit:
Name:
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 a
5. Na re of the Construction Activity(e.g.,commercial,industrial,residential,agricultural,oil and gas,etc.):
ES f t (t//4- L
6. Name of the Receiving Water(s)and Hydrologic Unit Code(HUC):
Name: Iv,/ C-e2e.k. — L a /r., ttij Crzek Name:
HUC: C HUC:
7. If the discharge is through a Municipal Separate Storm Sewer System(MS4),the name of the MS4 operator:
8. Estimated Project Start and Completion Date:
Start Date(mm/dd/yyyy): 0/,/ Z. /6 Completion Date(mm/dd/yyyy):/C/Q/Zo
16
9. Total Land Area of Development(to he nearest one-hundredth acre): I,I-1&
Estimated Area to be Disturbed(to the nearest one-hundredth acre): I .4 4c-C--
10.
-v10. Is the area to be disturbed part of a larger common plan of development or sale? Yes❑ NoiZ
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 Name: Title:
Signature: Date:
(Please sign in INK. This Certification must be signed by the appropriate person associated with the operator identified in
Item#1.)
01/2014 Page 1 of 1
`fir ✓ �°t,�te��
Virginia Stormwater Management Program (VSMP) o •
Q Orel
Application for Albemarle County
(WV)
Project Name: M` G L`. ?%ES I DE tvC
(The name should be the same as it appears on plans)
Is this an amendment to an approved plan? Yes 0 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.
El 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 upo the property as required to ensure
compliance with the a r ved plans and permits. l 1
dO 0 - GG-GU' C ar t6 k (7,11 4 / IN
Tax Map&Parcel Print Name of Property Owner Signa • ��r er Date
6o4400-oo-00-033 v : r, ul„e ji.6r I__
Tax Map&Parcel Print me of Property Owner Sign 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 CflAR .�1E C
Address J(0 J V 3 cc1W (A ✓4/v t
City �S u/ G g J VA - Z- T'P7 State VA- ZipOZ ?I/7
7
Daytime Phone(l t 7 U ( 4-(/ 1 3 E-mail C . 04• /41C-. 1 i I l�ai�v eO�l'(,
V
7/1/14,Revised:7/10/14 Page 1 of 2
Now
❑ B. 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 $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;$150
fiC. Registration Statement on the official DEQ form.
VD. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
EYE. Stormwater Management Plan satisfying the requirements of code section 17-403.
G/F. Pollution Prevention Plan satisfying the requirements of code section 17-404.
fG. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405.
❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
stream buffers.
❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408.
❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Provide 2 copies of all plans and any supporting documents. Professional seals must have original
signatures.
Additional information if not provided on plans and documents:
Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent)
Print Name (--I Y'.S /'t r tII 1<�
Address 6114 /The 1i L ,1/1, r
City ��1.t✓/t 1/ �� Yr.) State Vim-- Zip 2.1.102.
Daytime Phone S 41 7 ' - '5 E-mail Ui40.II ipct,a, './1'l
*When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months
from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's
signatures will not be considered valid.
FOR OFFICE USE ONLY WPO#
Fee Amount$ Date Paid By who? Receipt# Ck# By:
7/1/14,Revised: 7/10/14 Page 2 of 2
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:
Contact:
Mailing Address:
City: State: Zip: Phone:
Email address(if available):
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 Con truction Activity:
Name: $O(,iW- I V — -Fox /zUAJ tiriv _
"
Address(if available): V.City:Gt-Mgto 7esV/L, , �:.,'.:mi• :' - State: V Zip: g0/
County(if not located within a City): 4 J 6M 4 QI 0 —�
Latitude(decimal degrees): 1) 31 94.1" W Longitude(decimal degrees): 3 a v'S c57-Z
Name and Location of all Off-site Support Activities to be covered under the general permit:
Name:
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 a
5. Nare of the Construction Activity(e.g.,commercial,industrial,residential,agricultural,oil and gas,etc.):
es/ flE& /.k L
6. Name of the Receiving Water(s)and Hydrologic Unit Code(HUC):
Name: IV,/ C. ,(C — Li III. till Cr-z,e—' Name:
HUC: 7 HUC:
7. If the discharge is through a Municipal Separate Storm Sewer System(MS4),the name of the MS4 operator:
8. Estimated Project Start and Completion Date: /
Start Date(mm/dd/yyyy): 0/ ' z/2.OI Completion Date(mm/dd/yyyy):/Oft V W I/iD
9. Total Land Area of Development(to the nearest one-hundredth acre): I,
Estimated Area to be Disturbed(to the nearest one-hundredth acre): I.4 4-Cr
10. Is the area to be disturbed part of a larger common plan of development or sale? Yes❑ No.0
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 Name: Title:
Signature: Date:
(Please sign in INK. This Certification must be signed by the appropriate person associated with the operator identified in
Item#1.)
01/2014 Page 1 of 1
pF AL$F
Virginia Stormwater 1Vranagement Program (VSMP) Lex
Application for Albemarle County rYY
An Rc,r,z
Project Name: I`1 G Q G L 1. Es I DE NC'
(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 X
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 upo the property as required to ensure
compliance with the air ve d,lplans and permits.G�G - GG-6Q' C UY ) C r I / IN I 88- 15
Tax Map&Parcel Print Name of Property Owner Signa • • ��r'er Date
re-IS
60400 00'00-033 cr, ale --{ i Ac r l�
Tax Map&Parcel Print ,me of Property Owner Sign:II 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:
MARCO
Print Name / C G/(,/V
Address 3(Q3 3 V t&'0J r A-- L,4 fiVt
City �S (G f v/ - - v v ` State VA ZiptZ ?"/-7
Daytime Phone(1t q U u 13 f I� Ma i t v
E-mail G• �• �Gq 1 � L
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
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;$150
VC. Registration Statement on the official DEQ form.
VD. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
l /E. Stormwater Management Plan satisfying the requirements of code section 17-403.
IF. Pollution Prevention Plan satisfying the requirements of code section 17-404.
Cr�G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405.
❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
stream buffers.
❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408.
❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Provide 2 copies of all plans and any supporting documents. Professional seals must have original
signatures.
Additional information if not provided on plans and documents:
Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent)
I •
Print Name Ci.i r 1.s Mall rA r,.1
Address 604 n i 6.147 4.d Ptj
City ���.t✓�c �l�s ire /(u/ State tics— Zip 22-`iC2.
Daytime Phone ON 41 7/
-1'11°5 E-mail C;-11 q„,?I i Gtr. z) r';,� a. ti,St\ ,Cc'v11
*When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months
from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's
signatures will not be considered valid.
FOR OFFICE USE ONLY WPO#
Fee Amount$ Date Paid By who? Receipt# Ck# By:
7/1/14,Revised: 7/10/14 Page 2 of 2