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Planning Application
PARCEL/OWNER INFORMATION
TMP 060E2-OO-00-00100 Owner(s): FARMINGTON COUNTRY CLUB
Application# WPO20I400100
PROPERTY INFORMATION
Legal Description FARMINGTON
Magisterial Dist, Jack Jouett Land Use Primary Semi—public
Current b.FD Not in A/F District v Current Zoning Primary Rural Areas
APPLICATION INFORMATION
Street Address 1946 OLD MILL RD CHARLOTTESVILLE,22901 Entered By
anielle Roth ED
Application Type Water Protection Ordinances E 112,•'2;2014
Project Farmington Regrading — VSMP
Received Date 11/25/14 Received Date Final Submittal Date Total Fees
Closing File Date Submittal Date Final Total Paid
Revision Number
Comments
Legal Ad
3 SUB APPLICATION(s)
Type Sub Applicatio Comment
Erosion and Sediment Control Plan
Stormwater Management/BMP Plan
Stream Buffer Development Request •
APPLICANT / CONTACT INFORMATION
ContactType I Name Address CityState Zip I Phone PhoneCell
Signature of Contractor or Authorized Agent Date
Virginia Stormwater Ma„..4gement Program (VSMP)
Application for Albemarle County
Project Name: Farmington Regrading
(The name should be the same as it appears on plans)
Is this an amendment to an approved plan? Yes ❑ No IE
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
antendments,please indicate which items are being amended. Signatures must be provided.f or 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.
TMP 60E1-0C-10 Scott Kinnan javt. 11/20/2014
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 Scott Kinnan
Address 1625 Country Club Circle
City Charlottesville State VA Zip 22901
Daytime Phone(434) 245-5370 E-mail SKinnan@fccva.com
7/1/14,Revised: 7/10/14 Page 1 of2
`wMr✓
El B. All Fees [Code section 17-208]
For new or modified plans; Total acres proposed to be disturbed 1.63 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 $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;$150
❑ C. Registration Statement on the official DEQ form.
El D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
❑ E. Stormwater Management Plan satisfying the requirements of code section 17-403.
❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404.
❑ C. Stormwater Pollution Prevention Plan satisfying,: the requirements of code section 17-405.
❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
stream buffers.
❑ 1. Requested Variations or Exceptions as provided in code sections 17-407 and 408.
❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Provide 2 copies of all plans and any supporting documents. Professional seals must have original
signatures.
Additional information if not provided on plans and documents:
Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent)
Print Name Christopher Mantle
Address 201 East High St.
City Charlottesville State VA Zip 22902
Daytime Phone(434) 979-7522 E-mail cmantle@mckeecarson.com
*When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months
from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's
signatures will not be considered valid.
FOR OFFICE USE ONLY WPO#
Fee Amount$ Date Paid By who? Receipt# Ck# By:
7/1/14, Revised: 7/10/14 Page 2 of 2
DARTMENT OF ENVIRONMENTAL QCLITY
we
CONSTRUCTION ACTIVITY OPERATOR PERMIT FEE FORM
(Please Type or Print All Information)
Instructions: Applicants for a Construction Activity Individual Permit are required to pay permit application fees. Fees are
also required for registration for coverage under a Construction Activity General Permit. Fees must be paid when
applications for state permit issuance, reissuance, modification or transfer are submitted. Applications will be considered
incomplete if the proper fee is not paid and will not be processed until the fee is received.
The fee schedule for state permits is included with this form. Fees for state permit issuance, reissuance, maintenance,
modification and transfer are included. Once you have determined the fee for the type of application you are submitting,
complete this form. The original copy of the form and your check or money order payable to "Treasurer of Virginia"
should be mailed to:
Department of Environmental Quality
Receipts Control
P.O. Box 1104
Richmond, VA 23218
A copy of this form and a copy of your check or money order should accompany the permit application (or registration
statement). You should retain a copy for your records.
Construction Activity Operator:
Name: Sc. 14-
Contact:
Mailing Address: i4 7.S C'o„)... C.146 e4rc,1t
City: A,‘tu •t4. State: N# Zip: Lego( Phone: Y;(4-1%(S• S s7 0
/
Email address (if available): S ��.•�.,. a Cc c✓q.c e•v.
Name and Location of the Construction Activity:
Name: Farmington Country Club
City: Charlottesville State: VA Zip: 22911
County: Albemarle
Type of State Permit: ❑ Construction Activity Individual Permit ❑x Construction Activity General Permit
(from Fee Schedule)
Type of Action: x❑ New Issuance ❑ Reissuance ❑ Maintenance
❑ Modification ❑ Transfer
Amount of Fee Submitted (from Fee Schedule): $1,350
Existing General Permit Registration Number(if applicable):
FOR DEQ USE ONLY
Date: DC#:
01/2014 Page 1 of 1
COI ZUCTION ACTIVITY PERMIT FEE StwEDULE
A. Individual Permits. The fee for filing a state permit application for a Construction Activity Individual Permit issued by the Board is as
follows: (NOTE: Individual permittees pay an annual permit maintenance fee instead of a reapplication fee. The permittee is billed
separately by DEQ for the annual permit maintenance fee.)
TYPE OF STATE PERMIT ISSUANCE
Individual Permit for Discharges from Construction Activities $15,000
B. Registration Statements. The fee for filing a state permit application (registration statement) for coverage under a Construction
Activity General Permit issued by the Board, including a state or federal agency that does not administer a project in accordance with
approved annual standards and specifications, is as follows:
TYPE OF STATE PERMIT ISSUANCE
General/Stormwater Management-Small Construction Activity/Land Clearing (Areas within common plans $290
of development or sale with land-disturbance acreage less than one acre)
General/Stormwater Management-Small Construction Activity/Land Clearing (Sites or areas within
common plans of development or sale with land-disturbance acreage equal to or greater than one acre and $2,700
less than five acres)
General/Stormwater Management-Large Construction Activity/Land Clearing (Sites or areas within
common plans of development or sale with land-disturbance acreage equal to or greater than five acres and $3,400
less than 10 acres)
General/Stormwater Management- Large Construction Activity/Land Clearing (Sites or areas within
common plans of development or sale with land-disturbance acreage equal to or greater than 10 acres and $4,500
less than 50 acres)
General/Stormwater Management- Large Construction Activity/Land Clearing (Sites or areas within
common plans of development or sale with land-disturbance acreage equal to or greater than 50 acres and $6,100
less than 100 acres)
General/Stormwater Management-Large Construction Activity/Land Clearing (Sites or areas within $9 600
common plans of development or sale with land-disturbance acreage equal to or greater than 100 acres)
The fee for filing a state permit application (registration statement) for coverage under a Construction Activity General Permit issued by
the Board for a state or federal agency that administers a project in accordance with approved annual standards and specifications is as
follows:
TYPE OF STATE PERMIT ISSUANCE
Construction General/Stormwater Management—Phase I Land Clearing("Large"Construction Activity— $750
Sites or common plans of development or sale equal to or greater than 5 acres)
Construction General/Stormwater Management—Phase II Land Clearing ("Small"Construction Activity— $450
Sites or common plans of development or sale equal to or greater than 1 acre and less than 5 acres)
01/2014 Page 1 of 2
C. State Permit Modification or Transees. The following fees apply to the modi n or transfer of a Construction Activity
Individual Permit or a Construction Activity General Permit issued by the Board. The fee assrssed shall be based on the total disturbed
acreage of the construction activity. In addition to the state permit modification fee, modifications resulting in an increase in total
disturbed acreage shall pay the difference in the initial Construction Activity General Permit fee paid and the Construction Activity
General Permit fee that would have applied for the total disturbed acreage in Section B above.
TYPE OF STATE PERMIT MODIFICATION
General/Stormwater Management—Small Construction Activity/Land Clearing (Areas within common $20
plans of development or sale with land disturbance acreage less than one acre)
General/Stormwater Management—Small Construction Activity/Land Clearing (Sites or areas within
common plans of development or sale with land-disturbance acreage equal to or greater than one and less $200
than five acres)
General/Stormwater Management—Large Construction Activity/Land Clearing (Sites or areas within
common plans of development or sale with land-disturbance acreage equal to or greater than five acres and $250
less than 10 acres)
General/Stormwater Management—Large Construction Activity/Land Clearing (Sites or areas within
common plans of development or sale with land-disturbance acreage equal to or greater than 10 acres and $300
less than 50 acres)
General/Stormwater Management—Large Construction Activity/Land Clearing (Sites or areas within
common plans of development or sale with land-disturbance acreage equal to or greater than 50 acres and $450
less than 100 acres)
General/Stormwater Management—Large Construction Activity/Land Clearing (Sites or areas within $SCO
common plans of development or sale with land-disturbance acreage equal to or greater than 100 acres)
Individual Permit for Discharges from Construction Activities $5,000
D. State Permit Maintenance Fees. The following annual state permit maintenance fees apply to each state permit identified below,
including expired permits that have been administratively continued. No annual state permit maintenance fee is required for coverage
under a Construction Activity General Permit for a state or federal agency that administers a project in accordance with approved annual
standards and specifications.
TYPE OF STATE PERMIT MAINTENANCE
General/Stormwater Management—Small Construction Activity/Land Clearing (Areas within common $50
plans of development or sale with land disturbance acreage less than one acre)
General/Stormwater Management—Small Construction Activity/Land Clearing(Sites or areas within
common plans of development or sale with land-disturbance acreage equal to or greater than one and less $400
than five acres)
General/Stormwater Management—Large Construction Activity/Land Clearing (Sites or areas within
common plans of development or sale with land-disturbance acreage equal to or greater than five acres and $500
less than 10 acres)
General/Stormwater Management—Large Construction Activity/Land Clearing (Sites or areas within
common plans of development or sale with land-disturbance acreage equal to or greater than 10 acres and $650
less than 50 acres)
General/Stormwater Management—Large Construction Activity/Land Clearing(Sites or areas within
common plans of development or sale with land-disturbance acreage equal to or greater than 50 acres and $900
less than 100 acres)
General/Stormwater Management—Large Construction Activity/Land Clearing (Sites or areas within $1,400
common plans of development or sale with land-disturbance acreage equal to or greater than 100 acres)
Individual Permit for Discharges from Construction Activities $3,000
01/2014 Page 2 of 2
Registration Statement —
i 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: Scott Kinnan
Contact:
Mailing Address: 1625 Country Club Circle
City: Charlottesville State: VA Zip: 22901 Phone: 434-245-5370
Email address (if available):
Indicate if DEQ may transmit general permit correspondence electronically: Yes ❑ No n
2. Existing General Permit Registration Number(for renewals only):
3. Name and Location of the Construction Activity:
Name: Farmington Regrading
Address(if available): 1625 Country Club Circle
City: Charlottesville State: Virginia Zip: 22901
County(if not located within a City): Albemarle
Latitude (decimal degrees): 38.051846 Longitude (decimal degrees): -78.543105
Name and Location of all Off-site Support Activities to be covered under the general permit:
Name: Not Applicable
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 n State n Public❑ Private x
5. Nature of the Construction Activity (e.g., commercial, industrial, residential, agricultural, oil and gas, etc.):
Grading
6. Name of the Receiving Water(s)and Hydrologic Unit Code (HUC):
Name: Rivanna River Name:
HUC: 02080204 HUC:
7. If the discharge is through a Municipal Separate Storm Sewer System (MS4),the name of the MS4 operator:
Albemarle County
8. Estimated Project Start and Completion Date: •
Start Date(mm/dd/yyyy): Completion Date(mm/dd/yyyy):
9. Total Land Area of Development(to the nearest one-hundredth acre): 271.29 acre
Estimated Area to be Disturbed(to the nearest one-hundredth acre): 1.63 acres
10. Is the area to be disturbed part of a larger common plan of development or sale? Yes❑ No n
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: Cott Kinnan Title: Cwt4 Cvkir,
Signature: Date: I I•z s' "1'
(Please sign in INK. This Certification must be signed by the appropriate person associated with the operator identified in
Item#1.)
07/2014 Page 1 of 1
Instruns for Completing the Registration•o[atement
General VPDES Permit for Discharges of Stormwater from Construction Activities (VAR10)
GENERAL The entities that are considered operators will commonly consist of the
owner or developer of a project (the party with control of project plans
A.Coverage Under this General Permit. and specifications)or the general contractor(the party with day to day
operational control of the activities at the project site which are
Any operator applying for coverage under this general permit who is necessary to ensure compliance with the general permit).
required to submit a Registration Statement (see Section B below)
must submit a complete Registration Statement to the Department. Provide the legal name(do not use a colloquial name),contact,mailing
The Registration Statement serves as a Notice of Intent for coverage address, telephone number, and email address (if available) of the
under the General VPDES Permit for Discharges of Stormwater from construction activity operator;general permit coverage will be issued to
Construction Activities(VAR10). this operator. Indicate if the Department may transmit general permit
correspondence electronically.
B.Single-family Detached Residential Structures.
Item 2:Existing General Permit Registration Number.
Operators with an existing stormwater discharge or proposing a new
stormwater discharge associated with the construction of a single- For reapplications only, provide the existing general permit registration
family detached residential structure are not required to submit a number for the construction activity. This item does not need to be
Registration Statement or the Department of Environmental Quality completed for new construction activities applying for general permit
(DEQ)portion of the general permit fee. coverage.
Operators of these types of discharges are authorized to discharge Item 3: Name and Location of the Construction Activity
under this general permit immediately upon the general permit's Information.
effective date of July 1,2014.
Provide the official name, street address (if available), city or county(if
C.To Apply for Permit Coverage. not located within a City) of the construction activity. Also, provide the
latitude and longitude in decimal degrees of the approximate center of
1. New Construction Activities. Any operator proposing a new the construction activity(e.g., N 37.5000,W 77.5000).
stormwater discharge from construction activities shall submit a
complete Registration Statement to the Department prior to the Name and Location of Off-site Support Activity Information.
commencement of land disturbance, unless exempted by Section B
above. Any operator proposing a new stormwater discharge from This general permit also authorizes stormwater discharges from
construction activities in response to a public emergency where the support activities (e.g., concrete or asphalt batch plants, equipment
related work requires immediate authorization to avoid imminent staging yards, material storage areas, excavated material disposal
endangerment to human health or the environment is immediately areas, borrow areas) located on-site or off-site provided that (i) the
authorized to discharge under this general permit and must submit a support activity is directly related to a construction activity that is
complete Registration Statement to the Department no later than 30 required to have general permit coverage; (ii)the support activity is not
days after commencing land disturbance; documentation to a commercial operation, nor does it serve multiple unrelated
substantiate the occurrence of the public emergency must construction activities by different operators; (iii) the support activity
accompany the Registration Statement. does not operate beyond the completion of the construction activity it
supports; (iv) the support activity is identified in the registration
2. Existing Construction Activities. Any operator that was statement at the time of general permit coverage; (v) appropriate
authorized to discharge under the general permit issued in 2009, control measures are identified in a SWPPP and implemented to
and who intends to continue coverage under this general permit, address the discharges from the support activity areas; and (vi) all
shall submit a complete Registration Statement to the Department applicable state, federal, and local approvals are obtained for the
on or before June 1,2014, unless exempted by Section B above. support activity.
D.Where to Submit Registration Statements. Provide the official name, street address(if available), City and County
(if not located within a City) of all off-site support activities to be
All Registration Statements should be submitted to: covered under this general permit. Also, provide the latitude and
longitude in decimal degrees of the approximate center of the off-site
Department of Environmental Quality support activities (e.g., N 37.5000, W 77.5000). Also, if an off-site
Office of Stormwater Management,10th Floor support activity is going to be covered under this general permit the
P.O.Box 1105 total land area of the off-site support activity and the estimated area to
Richmond,VA 23218 be disturbed by the off-site support activity need to be included in Item
#9.
LINE-BY-LINE INSTRUCTIONS
Item 4:Status of the Construction Activity.
Item 1:Construction Activity Operator Information.
Indicate the appropriate status (Federal, State, Public, or Private) of
"Operator" means the owner or operator of any facility or activity the construction activity.
subject to the Stormwater Management Act and regulations. In the
context of stormwater associated with a large or small construction Item 5:Nature of the Construction Activity.
activity, operator means any person associated with a construction
project that meets either of the following two criteria: (i)the person has Provide a brief description of the construction activity, such as
direct operational control over construction plans and specifications, commercial, residential, agricultural, oil and gas, etc. This list is not all
including the ability to make modifications to those plans and inclusive.
specifications or (ii) the person has day-to-day operational control of
those activities at a project that are necessary to ensure compliance Item 6:Receiving Waters(s)and HUC Information.
with a stormwater pollution prevention plan for the site or other state
permit or VSMP authority permit conditions(i.e., they are authorized to Provide the name of the receiving water(s)and corresponding HUC for
direct workers at a site to carry out activities required by the all stormwater discharges including any stormwater discharges from
stormwater pollution prevention plan or comply with other permit off-site support activities to be covered under this general permit.
conditions). Hydrologic Unit Code or HUC is a watershed unit established in the
most recent version of Virginia's 6`h order national watershed boundary
dataset.
07/2014 Page 1 of 2
assigned or dere.d to the manager in accordance with
Item 7:MS4 Information. corporate proced
If stormwater is discharged through a municipal separate storm sewer b. For a partnership or sole proprietorship: by a general partner or
system(MS4), provide the name of the MS4 operator.The name of the the proprietor, respectively.
MS4 operator is generally the Town, City, County, Institute or Federal
facility where the construction activity is located. c. For a municipality, state, federal, or other public agency: by either
a principal executive officer or ranking elected official. For purposes
Item 8: Construction Activity Start and Completion Date of this part,a principal executive officer of a public agency includes:
Information.
(i)The chief executive officer of the agency,or
Provide the estimated start date (month/day/year) of the construction
activity. Provide the estimated completion date (month/day/year) of (ii) A senior executive officer having responsibility for the overall
the construction activity. operations of a principal geographic unit of the agency.
Item 9:Construction Activity Area Information.
Provide the total area (to the nearest one-hundredth acre) of the
development (i.e.., the total acreage of the larger common plan of
development or sale). Include the total acreage of any off-site support
activity to be covered under this general permit.
Provide the estimated area (to the nearest one-hundredth acre) to be
disturbed by the construction activity. Include the estimated area of
land disturbance that will occur at any off-site support activity to be
covered under this general permit.
Item 10: Common Plan of Development or Sale Information.
Indicate if the area to be disturbed by the construction activity is part of
a larger common plan of development or sale. Larger common plan of
development or sale is defined as a contiguous area where separate
and distinct construction may be taking place at different times on
different schedules. Plan is broadly defined as any announcement or
documentation, including a sign, public notice or hearing, sales pitch,
advertisement, drawing, permit application, zoning request, etc., or
physical demarcation such as boundary signs, lot stakes, or surveyor
markings indicating that construction activities may occur.
Item 11:Stormwater Pollution Prevention Plan(SWPPP).
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(VAR10)prior to
submitting this Registration Statement. By signing this Registration
Statement the operator is certifying that the SWPPP has been
prepared.
Item 12:Certification.
A properly authorized individual associated with the operator identified
in Item 1 of the Registration Statement is responsible for certifying and
signing the Registration Statement. Please sign the Registration
Statement in INK.
State statutes provide for severe penalties for submitting false
information on the Registration Statement. State regulations require
that the Registration Statement be signed as follows:
a. For a corporation: by a responsible corporate officer. For the
purpose of this part,a responsible corporate officer means:
(i) A president, secretary, treasurer, or vice-president of the
corporation in charge of a principal business function, or any other
person who performs similar policy-making or decision-making
functions for the corporation,or
(ii) the manager of one or more manufacturing, production, or
operating facilities, provided the manager is authorized to make
management decisions that govern the operation of the regulated
facility including having the explicit or implicit duty of making major
capital investment recommendations, and initiating and directing
other comprehensive measures to assure long-term compliance
with environmental laws and regulations; the manager can ensure
that the necessary systems are established or actions taken to
gather complete and accurate information for permit application
requirements; and where authority to sign documents has been
07/2014 Page 2 of 2
r.r
McKEECARSON
LANDSCAPE ARCHITECTS ■ CONSULTING ENGINEERS ■ LAND PLANNERS
TRANSMITTAL
PROJECT: Farmington Regrading PROJECT# 1405
TO: Albemarle County Community Development DATE: 11/25/14
PHONE: 296-5832
ATTN: Glenn Brooks, County Engineer
FROM: Christopher Mantle, LA
SUBJECT: Farmington Regrading ESC,SWM, SWPPP Application
IF CHECKED, PLEASE:
Return enclosures to us
Acknowledge receipt of enclosures
DATE COPIES DESCRIPTION WE TRANSMIT:
X Here with via Person
11/25/14 1 Registration Statement Under separate cover
11/20/14 1 SWPPP Certification Packet a Statement Via
1 DEQ Construction Activity Operator Permit Form & Fee As requested
11/20/14 1 VSMP Application FOR YOUR:
11/21/14 2 ESC/SWM Sheet Set Use
X Approval
Review and comment
Distribution
Records/information
REMARKS: THE FOLLOWING:
Glenn, Originals
Please find along with this transmittal the required documents for the SWPPP X Copies
ESC, and SWM for the Farmington Regrading. Reproducible
Correspondence
Shop drawings
Change order
Samples
Please contact me with any questions. Disk/CD
Computations
Other(Specify):
SIGNED: Christopher Mantle, LA
CC: RBM/File
if enclosures are not as stated, please notify us immediately
301 East High Street ■ Charlottesville,Virginia 22902 ■ TEL:434-979-7522 ■ FAX:434-977-1194 ■ www.mckeecarson.com
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COUNTY OF ALBEMARLE
Community Development
401 McIntire Road
Charlottesville,Vriginia 22902-4596
(434)296-5832
EROSION CONTROL PERMIT
Date of Application: 11/25/2014
Permit Effective Date: 07/15/2015 Number: WPO-2014-00100
LANDOWNER: FARMINGTON COUNTRY CLUB Phone: 4342455370
1625 COUNTRY CLUB CIRCLE
CHARLOTTESVILLE VA22901
CONTRACTOR: FARMINGTON COUNTRY CLUB(SCOTT KINNAN) Phone: (434)245-5370
1625 COUNTRY CLUB CIRCLE
CHARLOTTESVILLE,VA22901
REPONSIBLE LAND SCOTT KINNAN Phone: (434)245-5370
DISTURBER: 1625 COUNTRY CLUB CIRCLE
CHARLOTTESVILLE,VA22901
Certification/License#: 01941 Type:
Plans Prepared By: MCKEE CARSON
Plans Dated: 02/25/2015 Last Revised: 02/25/2015
Plans Entitled: FARMINGTON CONTRY CLUB ALBEMARLE Location:
COUNTY,VIRGINIA DUMP REGRADING PLAN
(WPO201400100)
Dist. 1.63
Acreage:
Tax Map: 060E2-00-00-00100 Hydrological JR07
060E1-00-0C-01000 Unit:
Issued By:Kenny Thacker Title:Erosion Control Officer
sSignC 7_/5 4.5-
Signature
ature Date