HomeMy WebLinkAboutWPO201400008 VSMP Application WPO VSMP 2015-05-05 q8 AL
Virginia Stormwater Management Program (VSMP) x
Application for Albemarle County � + i
Project Name: Crozet GAC Upgrades
(The name should be the same as it appears on plans)
Is this an amendment to an approved plan? Yes ❑ No 911
Is this a revision or resubmission for review? Yes ® No 0
County File Number: WPO201400008 (to be provided by the County for new applications)
The following are required elements of new applications[from code section 17-401 J. 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.
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57-29B Albemarle County Service Authority '�� E'S"��
Tax Map&Parcel Print Name of Property Owner Signa Ike ItOwner 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 Doug March C/O Rivanna Water and Sewer Authority
Address 695 Moores Creek Lane
City Charlottesville State VA Zip 22902
Daytime Phone(434) 977-2970 E-mail dmarch@rivanna.org
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0 B. All Fees [Code section 17-208]
For new or modified plans;Total acres proposed to be disturbed (194
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;$150
6d C. Registration Statement on the official DEQ form.
O D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
6Z1 E. Stormwater Management Plan satisfying the requirements of code section 17-403.
GA F. Pollution Prevention Plan satisfying the requirements of code section 17-404.
64 G. Stormwater Pollution Prevention.Plan satisfying the requirements of code section 17-405.
❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
stream buffers.
❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408.
❑ J. Construction Record Drawings(as-builts)for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Provide 2 copies of all plans and any supporting documents. Professional seals must have original
signatures.
Additional information if not provided on plans and documents:
Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent)
Print Name Bret Edwards C/O Hazen and Sawyer
Address 4011 WestChase Blvd., Suite 500
City Raleigh State NC Zip 27607
Daytime Phone(919) 833-7152 E-mail bedwards@hazenandsawyer.com
*When applications and plans are revieWed,but not approved,and a response to comments is not received within 6 months
from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's
signatures will not be considered valid.
FOR OFFICE USE ONLY WPO#
Fee Amount$ Date Paid By who? Receipt# CidBy:
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