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Home My WebLink AboutWPO201500039 Application 2015-06-23 ..,...r, ,, • . Community Development Department ta: Albemarle County 401 McIntire Road Charlottesville,VA 22902-4596 Voice: 296-5832 Fax:(434)972-4126 lt .--- .?1 Planning Application Nee '4001 PARCEL/ OWNER INFORMATION TMP 07700-00-00-015130 Owner(s): STATE BOARD FOR COMMUNITY COLLEGES C/O VA COMMUNE Application# WP0201500039 PROPERTY INFORMATION Legal Description I ACREAGE BICENTENNIAL CENTER .* Magisterial Dist,IrScottsville : Land Use Primary Public -- ------,. - • . •:,----,„„ --- . - Current AFD , Not in A/F District ,. Current Zoning Primary R1 Residential [APPLICATION INFORMATION Street Address 600 COLLEGE DR CHARLOTTESVILLE,22902 Entered By . .. . ......1 Emily Lantz ir] Application Type : Water Protection Ordinances .27..1 023,12015 Project Michie Tavern Water Main Replacement Received Date 06/19/15 Received Date Final Submittal Date Total Fees 300 Closing File Date Submittal Date Final Total Paid 300 Revision Number Comments A .., Legal Ad A ,• SUB APPLICATION(s) Type Sub Applicatio Comment Erosion and Sediment Control Plan APPLICANT /CONTACT INFORMATION ContactType Name Address CityState Zip Phone PhoneCell 0AmersAppacant STATE BOARD FOR COMMUNITY 101 NORTH 14TH STREET RICHMOND VA 23219 ' .i . nrnary Czrtrzt CHARLES LUCK ' '9030 STONY POINT PARKWAY RICHMOND VA 23235 B0427213700 Signature of Contractor or Authorized Agent Date pF AL Virginia Erosion and Sediment Control Program (VESCP) Application for Albemarle County '" I F7 (This application is only to be used for projects exempt from the Virginia Stormwater Management Program,VSMP,and the DEQ General Permit) Project Name: Michie Tavern Water Main Replacement Project (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes ❑ No Is this a revision or resubmission for review? Yes ❑ 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. Fr 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. Tax Map 77& State Board for Community Parcel 07700-00-00-015B0 Colleges A++ .1 Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Tax Map 77& University of Virginia Real Parcel 07700-00-00-02500 Estate Foundation SLC t }-a.d.4d ) zd 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 City State Zip Daytime Phone( ) E-mail 7/1/14, Revised: 7/10/14, 1/7/15 Page 1 of 2 New Noe VB. All Fees [Code section 17-2071 Total acres proposed to be disturbed 1.8 Acres Acres to be disturbed Total Fee Less than 1 $150 per review More than 1 $300 per review For amendments to an approved plan;$200 per review Variances;$150(per request) Exceptions;$240 Mitigation Plan;$150 Construction Record Drawing;$300 ❑ C. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. El D. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ E. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ F. Construction Record Drawings(as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Charles Luck, P.E. Address 9030 Stony Point Parkway Suite 220 City Richmond State VA Zip 23235 Daytime Phone(804) 272-8700 E-mail cluck@wrallp.com *When applications and plans are reviewed, but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# C 0. rnuLr� Co Fee Amount$ Date Paid By who? {`V 1 .1 Receipt# [(JO 239 Oct) S 00 o By: CC'// • 7/1/14,Revised: 7/10/14, 1/7/15 Page 2 of 2 Virginia Stormwater Management Program (VSMP) "J / 1 '� Application for Albemarle County .'was, Project Name: Michie Tavern Water Main Replacement Project (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes ❑ No El Is this a revision or resubmission for review? Yes a No ❑ County File Number: W (c•Lot S - (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. Tax Map 77& State Board for Community Parcel 07700-00-00-015B0 Colleges Tax Map& Parcel Print Name of Property Owner Signature of Owner Date Tax Map 77& University of Virginia Real Parcel 07700-00-00-02500 Estate Foundation 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 *Easement Acquisition Plats were included with initial submittal. Address City State Zip Daytime Phone( ) E-mail 7/1/14, Revised: 7/10/14, 1/7/14 Page 1 of 2 Nfte ❑ B. All Fees [Code section 17-208] For new or modified plans; Total acres proposed to be disturbed 1.8 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 Charles Luck, P.E. Address 9030 Stony Point Parkway Suite 220 City Richmond State VA Zip 23235 Daytime Phone(804) 272-8700 E-mail cluck@wrallp.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$110 50 Date Paid g,11 15 By who? Al6. Co JPS. Au 11 Receipt# (U( t 1 Ck#Ct9)2(L By: 7/1/14, Revised: 7/10/14, 1/7/14 Page 2 of 2 *We Virginia Stormwater Management Program (VSMP) Application for Albemarle County I . Project Name: Michie Tavern Water Main Replacement Project (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes El No 0 Is this a revision or resubmission for review? Yes 8 No El County File Number: (to be provided by the County for new applications) The following are required elements of new applications ffrom 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. Tax Map 77& State Board for Community Parcel 07700-00-00-015B0 Colleges Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Tax Map 77& University of Virginia Real Parcel 07700-00-00-02500 Estate Foundation 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 *Easement Acquisition Plats were included with initial submittal. Address City State Zip Daytime Phone( ) E-mail 7/1/14,Revised: 7/10/14, 1/7/14 Page 1 of 2 O B. All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed 1.8 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;$150 ❑ C. Registration Statement on the official DEQ form. O D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ❑ E. Stormwater Management Plan satisfying the requirements of code section 17-403. ❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404. ❑ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. O H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ J. Construction Record Drawings(as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Charles Luck, P.E. Address 9030 Stony Point Parkway Suite 220 City Richmond State VA Zip 23235 Daytime Phone(804) 272-8700 E-mail cluck@wrallp.com *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# Fee Amount$ Date Paid By who? Receipt# Ck# By: 7/1/14,Revised: 7/10/14, 1/7/14 Page 2 of 2 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: Albemarle County Service Authority Contact: Jeremy Lynn, P.E. Mailing Address: 168 Spotnap Road City: Charlottesville State: VA Zip: 22911 Phone: (434)977-4511 Email address(if available): jlynn@serviceauthority.org Indicate if DEQ may transmit general permit correspondence electronically: Yes n No❑ 2. Existing General Permit Registration Number(for renewals only): 3. Name and Location of the Construction Activity: Name: Michie Tavern Water Main Replacement Project Address(if available): 600 College Drive/ 1085 Lyman Manson Road City: Charlottesville State: VA Zip: 22911 County(if not located within a City): Albemarle Latitude(decimal degrees): N 38.0075 Longitude (decimal degrees): W 78.4789 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 n State n Public n Private n 5. Nature of the Construction Activity(e.g., commercial, industrial, residential,agricultural,oil and gas,etc.): Municipal 6. Name of the Receiving Water(s)and Hydrologic Unit Code(HUC): Name: Rivanna River/ Mechunk Creek/Moores Creek Name: HUC: 02080204/0208020404/020802040402 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): November 2015 Completion Date(mm/dd/yyyy): August 2016 9. Total Land Area of Development(to the nearest one-hundredth acre): 1.80 acres Estimated Area to be Disturbed(to the nearest one-hundredth acre): 1.80 acres 10. Is the area to be disturbed part of a larger common plan of development or sale? Yes❑ No ❑x 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: Title: Se^*'✓c- ,•• Signature: Date: 3117��r s" (Please sign in INK. is Certification must be signed by the appropriate person associated with the operator identified in Item#1.) 07/2014 Page 1 of 1