The URL can be used to link to this page

Home My WebLink AboutWPO201600027 Application 2016-04-19 Albemarle 'ounty Community Development Departrr 401 McIntire Road Charlottesville,VA 22902-4f *go Voice:(434)296-5832 Fax:(434)9724- Planning Application -.. . PARCEL / OWNER INFORMATION TMP 00600-00-00-028B0 Owner(s): HEARTROCK FAMILY FARM LIC Application # WP0201600027 PROPERTY INFORMATION Legal Description I ACREAGE TRACT C Magisterial Dist. White Hall I'v I Land Use Primary Forest Current AFD " Not in A/F District v Current Zoning Primary Rural Areas _ . [APPLICATION INFORMATION Street Address 6600 B LACKW ELLS HOLLOW RD CROZET, 22932 Entered rzi Judy Martin Application Type Water Protection Ordinances . 14/19/2016 Project Wildrock-VSMP Received Date 04/15/16 Received Date Final Submittal Date 04/25/16 Total Fees 13 Closing File Date Submittal Date Final Total Paid 13 Revision Number Comments Legal Ad SUB APPLICATION(s) Type Sub Application Comment Erosion and Sediment Control Plan 04/25/16 Stormwater Management/BMP Plan 04/25/16 APPLICANT/ CONTACT INFORMATION ContactType Name Address CityState Zip Owner/Applicant HEARTROCK FAMILY FARM LLC r- 2521 SUMMIT RIDGE TRL Primary Contact JUSTIN SHIMP 201 E. MAIN ST., STE. M .CHARLOTTESVILL CHARLOTTESVILL 2290222911 Phone PhoneC_t 4342275140 1 I miliiiimmt Signature of Contractor or Authorized Agent Date • *ow ,ftsige Virginia Stormwater Management Program (VSMP) 00-0 for Albemarle County Project Name: W i J C1 s-o G k (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes 0 No 51 Is this a revision or resubmission for review? Yes 0 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. 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 l 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. YM 60 — 286 ctau\` C-'14r�L-�Tax Map&Parcel Print Name of Property O�er Signature of Owner Jia/zoi e 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 Address ZO 1 E fit 4,A C4/01. City C hcr (o+ 3 v,'I It / State VA Zip Z7J2Q 7 Daytime Phone(((lq) 2.2.7 — s1 Li0 E-mail jsS1/ti a T�,' o,Gins l4ter f'45 . coil 7/1/14,Revised:7/10/14, 1/7/14 Page 1 of2 liB. All Fees [Code section 17-208] For new or modified plans; Total acres proposed to be disturbed N 1G 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;$150 d C. Registration Statement on the official DEQ form. 6�D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. EWE. Stormwater Management Plan satisfying the requirements of code section 17-403. ❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404. ❑ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. ❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ J. Construction Record Drawings(as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Address City State Zip Daytime Phone( ) E-mail *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# Fee Amount$ 550 Date Paid /i6/i By who? q.QQY1l 6„,/./ Receipt# 10 4103 Ck# I C f'1 By E.42-4-- �arOA. LLe 7/1/14,Revised:7/10/14, 1/7/14 Page 2 of 2 *41I1W 441.01K t ' Registration Statement General VPDES Permit for Discharges of Stormwater from Construction Activities(VAR10) (Please Type or Print All Information) 1. Construction Activity Operator: (General pemtit coverage will be Issued to this operator. The Certification in Item h112 must be signed by the appropriate person associated with this operator.) Name: llfntib!C K F i-nn LAA, Contact ° ramti14 MalNng Address: 2-524 S urn aufi P-t City: mki P.1 cttf1 vi t State: VA Zip: 2211 1 Phone: Email address(d available): 111 4 L'Wt.[keg C k. Indicate if DEQ may transmit general permit correspondence electronically YesiK No 0 2. Existing General Permit Registration Number(for renewals only): W 3. Name and Location ot the Construction Activity: Name: Afild Address 0f available): l0 —2S fg City: State:VA Zip: County(If not located within a City): 4.4%emQ A 0.1.(' Latitude(decimal degrees): Longitude( degrees): Name and Location of all Offslte Support Activities to be covered under to general permit Name: Address(if avaible): City: State: Zip: County(if not located within a City): � Latitude(decimal degrees):3& .A i 1")Ot7 Longitude(decimal degrees): —7E.(4,91 (1 ( 4. Status of the Construction Activity(check only one): Federal 0 State❑ Public 0 Private re 5. Nattwe of the Construction (e.g.,commercial,industrial.residential,agricultural,oil and gas,etc.): CUmmjA� mh - 409 i C&tile B. Name of the Receiving Waters)and Hydrologic Unit Code(HUC): Name: BL Gk MOLLK Glu iti (JL€L Name:- HUC: 0108024 0 20 1 HUC: 7. If th. rgs is through a Municipal Separate Storm Sewer System(MS4),the name of the MS4 operator: I. Estimated mated Project Start and Completion Da Start Date(mmiddiyyyy): (n 0(�2U os Completion Date(mmlddiyyyy): 01/0(1 ZO 11 9. Total Land Area of Development(to the nearest one-hundredth acre): 4110A111111 2-g..01 C. C Estimated Area to be Disturbed(to the nearest ons-hundredth acre): t.+.43 Lo OrjC 10. Is the area to be disturbed part of a larger common plan of development or sale? Yes 0 No(14. 11. A stonnwatsr 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 subnhlting tris 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 ail attachments ware prepared hi accordance with a system designed to assure that audited personnel properly gathered and evaluated the Inforn allon submitted. Based on my inquiry of the person or persons who manage the system or those persons directly responsible for gathering the kNbmaation. the information submltsd is to the best of my knowledge and belief true, accurate,and complete. I am aware 10t�hhatt there am significant penalties for submitting false information Including the possibility of fine and�p 'for tuhowirhg<y;..f\ "t, CT/YAW- (Please � n n,,- Printed 1 'k 'e Title: I R� Main Signature: i fir" Date: 4 / Di (Please sign in INK This Certification must be signed by the appropriate person associated with the operator Identified In item S1.) 07/2014 Page 1 of 1