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HomeMy WebLinkAboutWPO201500005 Application 2015-02-09 Community Devel opment Department * Albemarle Couns 401 ta re Road Charlottesville,VA 22W2-4596 Nor, \Nowa:(434)296-5832 Fax:(434)972-4126 Planning Application PARCEL/ OWNER INFORMATION TMP 07700-00-D0-011EO Owner(s): AVON HOLDINGS LLC Application# WP0201500005 PROPERTY INFORMATION Legal Description I ACREAGE Magisterial Dist. Scottsville 11:1 Land Use Primary Commercial Current AFD Not in A/F District ,2:1 Current Zoning Primary I Planned Development Shopping Center APPLICATION INFORMATION Street Address Entered By anielle Application Type Water Protection Ordinances 1-2W2013--- Project 5th Street Station- Land Capping - VSMP Received Date 02/06/15 Received Date Final Submittal Date Total Fees Closing File Date Submittal Date Final Total Paid Revision Number Comments Legal Ad SUB APPLICATION(s) Type Sub Appdicatio Comment Stormwater Management/BMP Plan Erosion and Sediment Control Plan Stream Buffer Mitigation Plan ..... APPLICANT /CONTACT INFORMATION ContactType Name Address CityState Zip Phone PhaieCeil Oyoner/AppOzent l'AVON HOLDINGS LLC !P 0 BOX 1467 CHARLOTTESVILL 22902 appTcs rt DANIEL R HINES,P.E. 28 BLACKWELL PARK LANE, WARRENTON VA 20186 5403494500 Signature of Contractor or Authorized Agent Date c,A Virginia Stormwater Man gement Program (VSMP) !'�'` ► . Application for Albemarle County Project Name: 5th Street Station -Landfill Capping WPO (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes 0 No III Is this a revision or resubmission for review? Yes 0 No DKI 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. ISl 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. 77-11E Avon Holdings, LLC 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 Alan Taylor Address P.O. Box 1467 City Charlottesville State VA Zip 22902 Daytime Phone(434)245-4932 E-mail alan.taylor@redlightmanagement.com 7/1/14,Revised:7/10/14 Page 1 of 2 IQ 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 Transferor disturbed Application modification of permit Less than 1 $290 $145 $20 1 and less than 5 S2,700 $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;$150 ❑ C. Registration Statement on the official DEQ form. Do D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ❑ E. Stormwater Management Plan satisfying the requirements of code section 17-403. ❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404. ❑ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. ❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ J. Construction Record Drawings(as-bunts)for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Daniel R. Hines, P.E. Address 28 Blackwell Park Lane, Suite 201 City Warrenton State VA zip 20186 Daytime Phone(540)349.4500 E-mail. dhines©bohlereng.com *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# Fee Amount$ Date Paid By who? Receipt#— Ck# By: 7/1/14,Revised:7/10/14 Page 2 oft 28 Blackwell Park Lane,Suite 201 B p jiL E 11�` PHONE 540.349.4500 l: N E a IN Li 1<. 1 ;N I February 6,2015 Via Hand Delivery Albemarle County 401 McIntire Road Charlottesville,VA 22902 Attn: Glenn Brooks Re: VSMP Modification Form Justification Letter 5th Street Station 5th Street SW&Avon Street Ext. Charlottesville,VA 22902 Albemarle County BE#V122001 Dear Mr.Brooks: On behalf of the applicant, 5th Street Station Ventures, LLC, Bohler Engineering hereby requests a modification to the current VSMP Permit in place for the 5th Street Station project. As design has progressed, an additional Water Protection Ordinance Plan is necessary and shall be included in the overall set of plans for this project. With this new WPO plan being added, the overall Limits of Disturbance is increased from 62.0 acres to 64.0 acres. Thus,the VSMP permit modification is needed to include this WPO plan,and increase our disturbed acreage accordingly. Upon your review of the above, should you have any questions or require additional information, please do not hesitate to contact this office at(540)349-4500. Sincerely, Bohler 'veering Daniel R. Hines,P.E. DRH/1b H:\I2\V122001\ dministrative\L.etters\150206 VSMP LOD Increase Justification Letter.doc CIVIL AND CONSULTING ENGINEERS • PROJECT MANAGERS • SURVEYORS • ENVIRONMENTAL CONSULTANTS • LANDSCAPE ARCHITECTS WWW.BOHLERENGINEERING.COM 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: 5th Street Station Ventures, LLC Contact: la r" Ttke tv.r- Mailing Address: 5 SW Broad Street City: Fairburn State: GA Zip: 30213 Phone: 770-692-8300 Email address(if available): dan@sjcollinsent.com Indicate if DEQ may transmit general permit correspondence electronically: Yes ErNo 0 2. Existing General Permit Registration Number(for renewals only): 3. Name and Location of the Construction Activity: Name: 5th Street Station Address(if available): North Interstate 64 Between 5th Street and Avon Street Extended City: Charlottesville State: VA Zip: 22092 County(if not located within a City): Albemarle County Latitude(decimal degrees): 180 0' 36" Longitude(decimal degrees):-78° 30' 03" 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 0 State 0 Public❑ Private QX 5. Nature of the Construction Activity(e.g.,commercial,industrial,residential,agricultural,oil and gas,etc.): Commercial 6. Name of the Receiving Water(s)and Hydrologic Unit Code(HUC): Name: Moore's Creek Name: HUC: JR15 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): 6/1/14 Completion Date(mm/dd/yyyy): 6/30/19 9. Total Land Area of Development(to the nearest one-hundredth acre): 86.9 AC Estimated Area to be Disturbed(to the nearest one-hundredth acre): 64.0 AC 10. Is the area to be disturbed part of a larger common plan of development or sale? Yes 0 No NI 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: d.1N T G(f,*iS Title: Ape Signature: -- �tt(/,C- Date: �/5'/ 117;14--- (Please sigMh INK. 'I s Certification must be signed by theappropriate Item#1.) person associated with the operator identified in 01/2014 Page 1 of 1 Instructions for Completing the Registration bvdtement General VPDES Permit for Discharges of Stormwater from Construction Activities (VAR10) GENERAL stormwater pollution prevention plan or comply with other permit conditions). A.Coverage Under this General Permit. The entities that are considered operators will commonly consist of the Any operator applying for coverage under this general permit who is owner or developer of a project(the party with control of project plans required to submit a Registration Statement (see Section B below) and specifications)or the general contractor(the party with day to day must submit a complete Registration Statement to the Department. operational control of the activities at the project site which are The Registration Statement serves as a Notice of Intent for coverage necessary to ensure compliance with the general permit). under the General VPDES Permit for Discharges of Stormwater from Construction Activities(VAR10). Provide the legal name(do not use a colloquial name),contact,mailing address, telephone number, and email address (if available) of the B.Single-family Residences. construction activity operator;general permit coverage will be issued to this operator. Indicate if the Department may transmit general permit Operators with an existing stormwater discharge or proposing a new correspondence electronically. stormwater discharge associated with the construction of a single- family residence separately built, disturbing less than one acre and Item 2:Existing General Permit Registration Number. part of a larger common plan of development or sale is not required to submit a Registration Statement, provided that the stormwater For reapplication only, provide the existing general permit registration management plan for the larger common plan of development provides number for the construction activity. This item does not need to be permanent control measures (i.e., stormwater management facilities) completed for new construction activities applying for general permit encompassing the single family residence. 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,10"'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 off-site support activities to be covered under this general permit. 01/2014 Page 1 of 2 Hydrologic Unit Code or HUC is a watersho,1 ,rit established in the gather complete.r„,td accurate information for permit application most recent version of Virginia's 66'order national watershed boundary requirements; and where authority to sign documents has been dataset. assigned or delegated to the manager in accordance with corporate procedures. Item 7:MS4 Information. b. For a partnership or sole proprietorship: by a general partner or If stormwater is discharged through a municipal separate storm sewer the proprietor,respectively. system(MS4),provide the name of the MS4 operator.The name of the MS4 operator is generally the Town, City, County, Institute or Federal c. For a municipality,state,federal,or other public agency:by either facility where the construction activity is located. a principal executive officer or ranking elected official. For purposes of this part,a principal executive officer of a public agency includes: Item 8: Construction Activity Start and Completion Date information. (i)The chief executive officer of the agency,or Provide the estimated start date (month/day/year)of the construction (ii)A senior executive officer having responsibility for the overall activity. Provide the estimated completion date (month/day/year) of operations of a principal geographic unit of the agency. the construction activity. 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. hem 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 01/2014 Page 2 of 2 .tetransfer of Ownership Agreement For, General VPDES Permit for Discharges of Stormwater from Construction Activities (VAR10) (Please Type or Print All Information) Instructions: This agreement form must be signed in INK by properly authorized individuals as specified in the General VPDES Permit for Stormwater Discharges from Construction Activities (VAR10), Part III K (Signatory Requirements). Please retain a copy of this agreement form for your records. Mail the original agreement form to: Department of Environmental Quality Office of Stormwater Management, 10th Floor P.O. Box 1105 Richmond,VA 23218 General Permit Registration Number: VAR1 OE 97 6 Date of Transfer(mm/dd/yyyy): Construction Activity Name: 5th Street Station CURRENT CONSTRUCTION ACTIVITY OPERATOR: Name: 5th Street Station, LLC Contact: Daniel S . Tucker Mailing Address: 5 SW Broad Street City: Fairburn State: GA Zip: 30213 Phone: 770-692-8300 Email Address(if available): dan@sjcollinsent . com "I (We) hereby agree to the transfer of ownership modification to the referenced General VPDES Permit for Discharges of Stormwater from Construction Activities (VAR10)." ,/� Printed Name:S' stied J� C'o!!,;� i Title: t't0.tr1Q Signature: TR/ eSty. Date: of 5 is NEW CONSTRUCTION ACTIVITY OPERATOR: Name: 5th Street Station Ventures, LLC Contact: Daniel S . Tucker Mailing Address: 5 SW Broad Street City: Fairburn State: GA Zip: 30213 Phone: 770-692-8300 Email Address (if available): dan@s jcollinsent . com Indicate if DEQ may transmit general permit correspondence electronically: Yes to 0 I (We) hereby agree to the change of ownership modification to the referenced General VPDES Permit for Discharges of Stormwater from Construction Activities (VAR10), and agree to accept all responsibility, coverage, and liability of the general permit." /� Printed Name: o r1 t,:0 f(rVr Title: rilaittir Signature: or, Date: �151/5— 1 01/2014 Page 1 of 1 BOHLER ENGINEERING 28 Blackwell Park Lane,Suite 201,Warrenton,VA 20186 Professional Engineering Services Telephone:(540)349-4500 Fax:(540)349-0321 LETTER OF TRANSMITTAL VIA: Hand Delivery TO: Albemarle County RE: WPO Landfill Capping Plan 401 McIntire Road 1 s`Submission Charlottesville,VA 22902 5th Street Station Charlottesville,VA 22902 (434)296-5832 Albemarle County ATTN: Glenn Brooks DATE: February 6,2015 JOB NO: V122001 WE ARE SENDING YOU ❑Shop drawings 0 Copy of letter ®Attached 0 Prints 0 Change order COPIES JOB# DATE REVISION REVISION SHEET NO. DESCRIPTION DATE 1 V122001 2/6/15 1 of 1 Cover Letter 1 V122001 2/5/15 1-2 of 2 Virginia Stormwater Management Program(VSMP)Application for Albemarle County 1 V122001 2/6/15 1 of 1 DEQ Modification Justification Letter 1 V122001 2/5/15 1-3 of 3 DEQ Registration Permit Application 1 V122001 2/5/15 1 of l Transfer of Ownership Agreement Form 2 V122001 12/23/14 1 2/6/15 1-9 of 9 WPO Plan—Landfill Capping These Are Transmitted: 0 For approval ['For your use DAs requested For review and comment ❑Approved as submitted DApproved as noted ❑Returned for corrections REMARKS: Please find enclosed the above mentioned items for the 5th Street Station project in Charlottesville,VA. If you have any questions or require additional information, please do not hesitate to contact this office at (540) 349-4500. COPY TO: SIGNED: /OW File rani- R. Hines,P.E. TMB O Hi r Warrenton,VA 20186 n q� i aa1� (` PHONE 540.349.4500 NGIEFFebruary 6,2015 Via Hand Delivery Albemarle County 401 McIntire Road Charlottesville,VA 22902 Attn: Glenn Brooks Re: Landfill Capping Plan Cover Letter 5th Street Station 5th Street SW&Avon Street Ext. Charlottesville,VA 22902 Albemarle County BE#V122001 Dear Mr.Brooks: Please note that a fee check for the VSMP modification and ownership transfer has not been included in this package. Please confirm where the fee check should be submitted to and to whom it should be made payable to. Also, if original signatures are required for the package to DEQ they can be provided. Should you have any questions or require additional information, please do not hesitate to contact this office at(540)349-4500. Sincerely, Bohler E ineering :'niel • . 'ines, P.E. DRH/Ib H:\l2\V122001\Administrative\Letters\150206 Landfill Capping Submission Cover Letter.doc CIVIL AND CONSULTING ENGINEERS • PROJECT MANAGERS • SURVEYORS • ENVIRONMENTAL CONSULTANTS • LANDSCAPE ARCHITECTS WWW.BOHLERENGINEERING.COM t� On� f . Virginia Stormwater Management Program (VSMP) r' Application for Albemarle County ®" Project Name: 5th Street Station - Landfill Capping WPO (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes 0 No lE Is this a revision or resubmission for review? Yes ]Sl No 0 County File Number: WPO201500005 (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. ® 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. 77-11E Avon Holdings, LLC Tax Map&Parcel Print Name of Property Owner Si ature 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 Alan Taylor Address P.O. Box 1467 City Charlottesville VA 22902 State Zip Daytime Phone(434)245-4932 E-mail alan.taylor@redlightmanagement.com 7/1/14,Revised: 7/10/14 Page 1 of 2 l 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;$150 ❑ C. Registration Statement on the official DEQ form. 150 D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ❑ E. Stormwater Management Plan satisfying the requirements of code section 17-403. ❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404. ❑ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. ❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Daniel R. Hines, P.E. Address 28 Blackwell Park Lane, Suite 201 City Warrenton State VA Zip 20186 Daytime Phone(540)349-4500 E-mail dhines@bohlereng.com *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# Fee Amount$ Date Paid By who? Receipt# Ck# By: 7/1/14,Revised: 7/10/14 Page 2 of 2