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Home My WebLink AboutWPO201500053 Application 2015-08-11 Albemarle C rity F=,„ Planning Application PARCEL I/ OWNER INFORMATION 07700-00-00-03100 THOMAS JEFFERSON FOUNDATION INC Application# WP0201500053 PROPERTY INFORMATION MOUNT ALTO Le;a• ACREAGE ma; 3ter'a Scottsville ;:r•'''"B' Residential -- Single-family (incl. modular home!: CurrA.,,rtF Not in A/F District ; :'r,,rlar Monticello Historic District APPLICATION INFORMATION LC7)P R.E' OH L .'rE ;ILE 22 R ;oth v 7,Pi Water Protection Ordinances ; ; s 11.N1.5 Proiezt Thomas Jefferson Foundation Water &Wastewater Improvements Part II - VSI C•ate 108/07/15 ..S.,;;;rn<tta. L'Bt Fee5 I 1350 Cos't,g ' 1350' • • ,SUR APPLICATION(s) Sut: Erosion and Sediment Control Plan Stream Buffer Development Request Stormwater Management/BMP Plan APPLICANT CONTACT INFORMATION Name .2kddte5•S. Lity:Aate re PhoreCe,11 LI;'',77.r.t'actor,:',!'AcDate. Virginia Stormwater Management Program (VSMP) Application for Albemarle County Thomas Jefferson Foundation Water and Wastewater Improvements Part II Project Name: VSMP Plan (The name should he the same as it appears on plans) Is this an amendment to an approved plan? Yes 0 No GiJ Is this a revision or resubmission for review? Yes 0 No County File Number: (to be prorrded by the County for new appbcanons) The following are required elements of new applications from code section 17-4011. For revisions or amendment', please indicate which items are being amended. Signatures'must he 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. 77-31 Thomas Jefferson Foundation, Inc. v S ZQ�S^ Tax Map& Parcel Print Name arse of Property Owner � ature of Owne �Date Tax Map& Parcel Print Name of Property Owner Signature of Owner Date Tax Map& Parcel Pant 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 Thomas Jefferson Foundation, inc.,Attn: Ken Mitchell Address PO Box 316 City Charlottesville State VA zip 22902 Daytime Phone(434) 984-9814 E;-maii kmitchell@monticello.org 7:1114, Revised- 7110/14, 1/7/14 Page 1 of 2 B. All Fees [Code section 17-208] For new or modified plans; Total acres proposed to be disturbed 1.29 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 11,35?)) $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. CI 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. 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) Print Name WW Associates, Inc.,Attn: Herbert F. White, HI, P.E. Address 3040 Avemore Square Place City Charlottesville State VA Zip 22911 Daytime Phone(434) 984-2700 E-mail hwhite a@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# �7 Fee Amount S 1-CS o•u: Date PaidS-7-1S By who?I,)'^1 A5 S 0 r- Receipt I W`'l3 1 Ck4a' v�1 i7 5— By: AS 7/1/14.Revised: 7110/14, 1/7/14 Page 2 oft Registration Statement `isi"' 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: Thomas Jefferson Foundtion,Inc. Contact: Ken Mitchell Mailing Address: P.O. Box 316 City: Charlottesville State: VA Zip: 22902 Phone: (434) 984-9814 Email address(if available): kmitchell@monticello.org 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: Montalto Address(if available): Montalto Loop City: Charlottesville State: VA Zip: 22902 County(if not located within a City): Albemarle Latitude(decimal degrees): 38.003304N Longitude(decimal degrees): 78.464578W 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 ❑X 5. Nature of the Construction Activity(e.g., commercial, industrial, residential,agricultural, oil and gas,etc.): water and wastewater improvements 6. Name of the Receiving Water(s)and Hydrologic Unit Code(HUC): Name: Moore's Creek Name: HUC: TR15 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): 09/01/2015 Completion Date(mm/dd/yyyy): 08/31/2016 9. Total Land Area of Development(to the nearest one-hundredth acre): 1.29 acres Estimated Area to be Disturbed(to the nearest one-hundredth acre): 1.29 acres 10. Is the area to be disturbed part of a larger common plan of development or sale? Yes❑ NoX❑ 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 imprisonme for kn.wing vio:tions." Printed Name: en • el / ' I /, Title: I/P °c �}k C t p PS ) �F- Signature: Date: Augtt'st 6,2015 (Please sign in . This Certification must be signed by the appropriate person associated with the operator identified in Item#1.) 07/2014 Page 1 of 1 .....„ ,...... ENGINEERS 1174A SURVEYORS PLANNERS ASSOCIATES TRANSMITTAL To: John Anderson Date: August 7, 2015 Organization: County of Albemarle, VA WWA Project No: 215015.02B Dept. of Community Development 401 McIntire Road, North Wing Charlottesville, VA 22902 Project: Thomas Jefferson Foundation Water and Wastewater Improvements Part II —VSMP Plan No. of Copies Description 2 VSMP Plan 1 VSMP Application and Check 1 SWPPP with PPP Plan 1 Registration Statement WW Associates, Inc. ':#1' /- r75 / r,,` / l Robert Umberger Project Manager 3040 Avemore Square Place•Charlottesville,VA 22911 Telephone(434)984-2700 •Fax(434)978-1444 Charlottesville ■Lynchburg