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HomeMy WebLinkAboutWPO201500046 Application 2015-07-20 Albemarle Cot cy ,' Community DevelopmentDepartment cintire Road Charlottesville.VA 2 2 9132-4 595 4 'sari Voice: (434)296-5832 Fax : (434)972-4126 •-�.: Planning Application (PARCEL/ OWNER INFORMATION TMP 07800-00-00-055A6 Owner(s): WESTMINSTER- CANTERBURY OF THE BLUE RIDGE ATTN: MAI Application# WPO2OI500046 PROPERTY INFORMATION Legal Description I ACREAGE WESTMINISTER CANTERBURY Magisterial Dist, Rivanna I+ Land Use Primary Residential -- Single-family attached Current AFD Not in A/F District El Current Zoning Primary Planned Residential Development APPLICATION INFORMATION Street Address 236 PANTOPS MOUNTAIN RD CHARLOTTESVILLE, 22911 Entered By � anielle Roth El + Application Type Water Protection Ordinances 1 7/20/2015 Project Westminster-Canterbury Final Site Plan Amendment - VSMP Received Date 07/17/15 Received Date Final Submittal Date Total Fees 1350 Closing File Date Submittal Date Final Total Paid 1350 Revision Number Comments I Legal Ad SUB APPLICATION(s) Type Sub Applicatio Comment Stream Buffer Development Request • Stormwater Management/BMP Plan Erosion and Sediment Control Plan APPLICANT / CONTACT INFORMATION ContactType Name Address CityState Zip Phone PhoneCell C.wo r:'Applicant WESTMINSTER- CANTERBURY OF THE 250 PA,NTOPS MOUNTAIN CHARLOTTESVILL 22911 =nmary C_-tact WW ASSOCIATES, INC - HERBERT F 3040 AVEMORE SQUARE PLACE CHARLOTTESVILL 422911 4349842700 Signature of Contractor or Authorized Agent Date o ,up Virginia Stormwater Management Program (VSMP) �u '" Application for Albemarle County ,^ Project Name: Westminster-Canterbury Final Site Plan Amendment (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes 0 No Is this a revision or resubmission for review? Yes 0 No WI 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. ® 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. C ' ^ 78-055A6 Westminster-Canterbury of the Blue Ridge �A .- Kr Tax Map&Parcel Print Name of Property Owner nature f 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 Westminster-Canterbury of the Blue Ridge;Attn: Gary B. Selmeczi, President&CEO Address 250 Pantops Mountain Rd. City Charlottesville State VA Zip 22911 Daytime Phone(434) 972-3151 E-mail gary.selmeczi©wc-br.org 7/1/14,Revised: 7/10/14, 1/7/14 Page 1 of 2 4 0 B. All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed 1.71 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 11,350) $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. VD. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. VrE. Stormwater Management Plan satisfying the requirements of code section 17-403. O 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 0 H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. N/A 0 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 WW Associates, Inc.;Attn: Herbert F. White, Ill, P.E. Address 3040 Avemore Square Place City Charlottesville State VA Zip 22911 Daytime Phone(434) 984-2700 E-mail hwhite@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# Fee Amount$10 5- O Date Paid 7-17-I5 By who? i ie /+ ✓►.fr`U Receipt# I0t1 66 9 Ck# 8 1. .3 By: cc, 11 101 (-463-C, 7/1/14,Revised: 7/10/14, 1/7/14 Page 2 of 2 dor Virginia Stormwater Management Program (VSMP) Application for Albemarle County Project Name: Westminster-Canterbury Final Site Plan Amendment (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes ❑ No WI Is this a revision or resubmission for review? Yes ❑ No m 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. ® 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. 78-055A6 Westminster-Canterbury of the Blue Ridge " 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 Westminster-Canterbury of the Blue Ridge; Attn: Gary B. Selmeczi, President&CEO Address 250 Pantops Mountain Rd. City Charlottesville State VA Zip 22911 Daytime Phone(434) 972-3151 E-mail gary.selmeczi@wc-br.org 7/1/14,Revised: 7/10/14, 1/7/14 Page 1 oft O B. All Fees [Code section 17-208] For new or modified plans; Total acres proposed to be disturbed 1.71 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;$150 ▪ C. Registration Statement on the official DEQ form. 1D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. �E. Stormwater Management Plan satisfying the requirements of code section 17-403. ® F. Pollution Prevention Plan satisfying the requirements of code section 17-404. ▪ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. N/A 0 H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. N/A 0 I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. O J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name WW Associates, Inc.;Attn: Herbert F. White, III, P.E. Address 3040 Avemore Square Place City Charlottesville State VA Zip 22911 Daytime Phone(434) 984-2700 E-mail hwhite@wwassociates.net *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# Fee Amount$ 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:Westminster-Canterbury of the Blue Ridge Contact:Gary B.Selmeczi,President&CEO Mailing Address:250 Pantops Mountain Rd. City:Charlottesville State:VA Zip:22911 Phone:(434)972-3151 Email address(if available):gary.selmeczi@wc-br.org Indicate if DEQ may transmit general permit correspondence electronically: Yes Q No❑ 2. Existing General Permit Registration Number(for renewals only): 3. Name and Location of the Construction Activity: Name:Westminster-Canterbury of the Blue Ridge Address(if available):Pantops Mountain Road City:Charlottesville State:VA Zip:22911 County(if not located within a City):Albemarle Latitude(decimal degrees):38.028081 N Longitude(decimal degrees):78.438131 W 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❑✓ 5. Nature of the Construction Activity(e.g.,commercial, industrial, residential,agricultural,oil and gas,etc.): Residential construction,parking lot and park 6. Name of the Receiving Water(s)and Hydrologic Unit Code(HUC): Name:Rivanna River Name: HUC:JR17 HUC: 7. If the discharge is through a Municipal Separate Storm Sewer System(MS4),the name of the MS4 operator: N/A 8. Estimated Project Start and Completion Date: Start Date(mm/dd/yyyy):10/01/2015 Completion Date(mm/dd/yyyy): 12/31/2016 9. Total Land Area of Development(to the nearest one-hundredth acre):1.71 Estimated Area to be Disturbed(to the nearest one-hundredth acre):1.71 10. Is the area to be disturbed part of a larger common plan of development or sale? Yes❑ No❑ 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:9ary B.Selmeczi f/ Title:President&CEO Signature: / � Date:08/21/2015 (Please sign in INK This Certificatio4i must be signed by the appropriate person associated with the operator identified in Item#1.) 07/2014 Page 1 of 1