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HomeMy WebLinkAboutWPO201600013 Application 2016-03-01 �t Albermarle Co' ' w/ Planning Application PARCEL . ........................................... j OWNER INFORMATI©N TM"' 02900-00-00-00800 O+vner(S : MILLER, EARL H OR KATE Application# WP0201600013 PROPERTY INFORMATION Le;ai Dea:rept on riiCREAGE Ma; >ter'a Drit. White Hall ` '. •( Lani u=e Pr,rnar, Residential -- Single-family (incl. modular home! "- Moorman's River r;11 Current'nnln a.r rna-, Rural Areas 'APPLICATION INFORMATION Strr'et.-��res> 912 FREE UNION RD CHARLOTTESVILLE. 22901_ Entire:F, :.Pphcatnon Tape Water Protection Ordinances --} arne_Ile Roth Y.J -a!! 3': «':i6 c-o)e,t Miller Residence - VSMP =ece,.e1 Dve 62/29/16 F.e:e,,ed Date Final --___ . ' Su.n�tta) Cate T-� I ` � i .ta! Fees( 209 Clc,sing F:ie :ate ! 1 i >�bmitta= Cate =malt 1 Total P5.7 266 Re4+S n ilumber �-•;•,err• .. ,_ ...-..._.......... tl SUB APPLICATION(s) ' t ...._.._......__.___.._....._.—_f Y:P�_ _._ Sub IlcaUov_. ___._.._...._.._.. s_ornrrent __.___.__...............i Erosion and Sediment Control Plan Stream Buffer Development Request Stormwater Management/BMP Plan APPLICANT / CONTACT INFORMATION =c-ntactT;pe ..,.. Name. .." Address '.. Cit}5tate Zip T Pone PhoneCell FIILLEF.E�RL ,R n.= E 1a`C4 HIDDEN 4:_r1.C.r, -r $E<tICh.LE+ C 1514. --5-. ••:'-i :: CHRISTOPHER C htULLIG:4. • 914 MONTICELLO ROLD, CH=RLQTTES'rILL 2291.7,2 4:457?42,;5 lr itL :.f Centractar or Authc ,,.ed Agent C.� ` **r .r or Virginia Stormwater Management Program (VSMP) Application for Albemarle County Pref Project Name: Miller Residence-IMP 29-8 (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes 0 No 0 Is this a revision or resubmission for review? Yes 0 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 17-401 J. 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. 02900-00-00-00800 Earl H. or Kate Miller — i2o'�(o//b 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 Christopher C. Mulligan Address 914 Monticello Road City Charlottesville State Virginia Zip 22902 Daytime Phone(434) 977-0205 E-mail cmulligan@roudabush.com 7/1/14,Revised: 7110/14, 1/7/14 Page 1 of 2 Nue r.r • B. All Fees [Code section 17-208] For new or modified plans; Total acres proposed to be disturbed 4.3 Acres 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 v $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;$150 ® C. Registration Statement on the official DEQ form. LI D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ® E. Stormwater Management Plan satisfying the requirements of code section 17-403. ® F. Pollution Prevention Plan satisfying the requirements of code section 17-404. ▪ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. El H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. O J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Christopher C. Mulligan Address 914 Monticello Road City Charlottesville State Virginia Zip 22902 Daytime Phone(434) 977-0205 E-mail cmulligan@roudabush.com *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# Fee Amount$ `' Date Paid)"/25-14, By who? /6 LI /rte, Receipt# LP 3 sy Ck# ,2/6 3 By:_ „,4 z PIA) -roe.; 7/1/14,Revised: 7/10/14, 1/7/14 Page 2 of 2 low wv 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: +D$ort.11'rICcSe�-�-i e /�P f^c�2fD. Contact: -St rn a 5 e le--r'c I t Mailing Address: 7-0. o X 3 7) City: CACI 21 o es U i If-e State: VC'. Zip:o�01�1 oZ Phone: i/ 3 T—5"3/— 51/ Email address(if available): rI 4_5 e Desi e!J e;-$-L het2g hi a r /, Co 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: Miller residence TMP 29-08 Address(if available):3912 Free Union Road City: Charlottesville State:Virginia Zip:22901 County(if not located within a City): Albemarle County Latitude(decimal degrees): 38.1444 Longitude(decimal degrees): '78.5589 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 51( 5. Nature of the Construction Activity(e.g.,commercial,industrial,residential,agricultural,oil and gas,etc.): Residential Dwelling,including driveway 6. Name of the Receiving Water(s)and Hydrologic Unit Code(HUC): Name: Mechums River-Beaver Creek Name: HUC: JR02 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): 04/01/2016 Completion Date(mm/dd/yyyy): 04/01/2016 9. Total Land Area of Development(to the nearest one-hundredth acre): 4.28 Acres Estimated Area to be Disturbed(to the nearest one-hundredth acre): 4.28 Acres 10. Is the area to be disturbed part of a larger common plan of development or sale? Yes❑ No U 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: T4 w•• es 1-1-\0. c 2�� c t„Q U - t�Q e S Title: S , Signature: ?-Y1 - ..40111r. Date: e -f a. t/ /J(p (Please sign t!INK. This Certification ust a signed by the appropriate person associated with the operator identified in Item#1.) 01/2014 • Page 1 of 1 Armor ,60V ALkt, Virginia Stormwater Management Program (VSMP) Application for Albemarle County 4" 4,11,440, Project Name: Miller Residence-TMP 29-8 (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes 0 No 10 Is this a revision or resubmission for review? Yes ® No 0 County File Number: WPO201600013 (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. 02900-00-00-00800 Earl H. or Kate Miller ' �"'r ,R/2w 4 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 Jeremy L. Fox Address 914 Monticello Road City Charlottesville State Virginia Zip 22902 Daytime Phone(434) 977-0205 E-mail jfox@roudabush.com 7/1/14,Revised: 7/10/14, 1/7/14 Page 1 of2 WI B. All Fees [Code section 17-208] For new or modified plans; Total acres proposed to be disturbed 4.6 Acres 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;$150 ® C. Registration Statement on the official DEQ form. D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ® E. Stormwater Management Plan satisfying the requirements of code section 17-403. ® F. Pollution Prevention Plan satisfying the requirements of code section 17-404. ▪ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. ❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Jeremy L. Fox Address 914 Monticello Road City Charlottesville State Virginia Zip 22902 Daytime Phone(434) 977-0205 E-mail jfox@roudabush.com *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE E ONLY WPO# f'/ '> 6:2'0'/ 3 Fee Amount$ ` Date Paid 3' P&ger,By who? "/1 _ /C. tl" •eceipt# /63(03 Ck# •��� . By: 406:411416. 7/1/14,Revised: 7/10/14, 1/7/14 Page 2 of2