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HomeMy WebLinkAboutWPO201700038 Application 2017-09-25 Mrd '011.00 of Auits Virginia Stormwater Management Program (VSMP) Application for Albemarle County 1Ukfi Project Name: University of Virginia Foundation Squash Facility (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 gi No 0 Ll°O - 20/003 ' County File Number: CDP 284-1.-082 . (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,l 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. r OF TMP 56D2-01-15 Chris Schooley, UVAF ) ,r •- , 11 Tax Map&Parcel Print Name of Property Owner Sign.%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 Chris Schooley c/o University of Virginia Foundation Address PO Box 400218 City Charlottesville State VA Zip 22904 Daytime Phone(434) 982-3777 E-mail cds7c@virginia.edu 7/1/14,Revised:7/10/14, 1/7/14 Page 1 of2 i B. All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed 1.40 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 1 C. Registration Statement on the official DEQ form. El 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. 1 F. Pollution Prevention Plan satisfying the requirements of code section 17-404. l G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. Il 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. 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 Devin Keeler Address 4805 Lake Brook Dr., Suite 200 City Glen Allen State VA Zip 23060 Daytime Phone(804) 205-3321 L'-mail dkeeler@dewberry.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$357 Date Paid 1 �/]By who? Q Receipt H /Ill C 6 Ck# 626123 2 ) y:<j4 7/1/14,Revised:7/10/14, 1/7/14 Page 2 oft NNW Virginia Stormwater Management Program (VSMP) Application for Albemarle County },,1 Project Name: University of Virginia Foundation Squash Facility (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes ® No D Is this a revision or resubmission for review? Yes El No 0 County File Number: SDP-2011-082 (to he 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. Al1 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. Or EP TMP 56D2-01-15 Chris Schooley, UVAF _ L If /7 Tax Map&Parcel Print Name of Property Owner Signature of el 1110Date 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 Chris Schooley c/o University of Virginia Foundation Address PO Box 400218 City Charlottesville State VA Zip 22904 Daytime Phone(434) 982-3777 E-mail cds7c@virginia.edu 7/1/14,Revised:7/10/14, 1/7/14 Page 1 of2 M B. All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed 1.40 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;$150 1 C. Registration Statement on the official DEQ form. 0 D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. M E. Stormwater Management Plan satisfying the requirements of code section 17-403. ® F. Pollution Prevention Plan satisfying the requirements of code section 17-404. ® G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. 121 H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Devin Keeler Address 4805 Lake Brook Dr., Suite 200 City Glen Allen State VA Zip 23060 Daytime Phone(804) 205-3321 E-mail dkeeler@dewberry.com *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# Fee Amount$ Date Paid By who? Receipt# Ck# By: 7/1/14,Revised:7/10/14, 1/7/14 Page 2 oft v./ ACif 7 Virginia Stormwater Management Program (VSMP) ® Application for Albemarle County ,31flio '., ��iac�N�r Project Name: University of Virginia Foundation Squash Facility (The name should be the same as it appears on plans) Isthis an amendment to an approved plan. o ❑ Is this a revision or resubmission for review' es ►- 1.1) -° County File (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. 1 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. TMP 56D2-01-15 Chris Schooley, UVAF 9 z(f(7 Tax Map&Parcel Print Name of Property Owner Signatur caner ate 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 Chris Schooley do University of Virginia Foundation Address PO Box 400218 City Charlottesville State VA Zip 22904 Daytime Phone(434) 982-3777 E-mail cds7c@virginia.edu 7/1/14,Revised:7/10/14,1/7/14 Page 1 of 2 • • ▪ B. All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed 1.39 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;$150 1 C. Registration Statement on the official DEQ form. 11 D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. 11 E. Stormwater Management Plan satisfying the requirements of code section 17-403. ® F. Pollution Prevention Plan satisfying the requirements of code section 17-404. El G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. • H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. i I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. A*. El J. Construction Record Drawings(as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Devin Keeler Address 4805 Lake Brook Dr.,Suite 200 City Glen Allen-- State VA Zip 23060 Daytime Phone(804) 205-3321 E-mail dkeeler@dewberry.com *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# Fee Amount$ Date Paid By who? Receipt# Ck# By: 7/1/14,Revised:7/10/14,1/7/14 Page 2 of 2 `r✓ ,,,,ma k,,,_Virginia Stormwater Management Program (VSMP) � . Application for Albemarle County ' _ `,RGiN« Project Name: University of Virginia Foundation Squash Facility (The name should be the same as it appears on plans) Is this an amendment to an approved plan? No 0 Is this a revision or resubmission for review? es X County File Number: SDP-2011-082 (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. l 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. TMP 56D2-01-15 Chris Schooley, UVAF& •d 'r� -, 2 4 f Tax Map Parcel Print Name of Property Owner Signatures c caner ►ate 4111) 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 Chris Schooley do University of Virginia Foundation Address PO Box 400218 1 City Charlottesville State VA Zip 22904 1 Daytime Phone(434) 982-3777 E-mail cds7c@virginia.edu I 1 i i 1 4 7/1/14,Revised:7/10/14, 1/7/14 Page 1 of 2 I B. All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed 1.39 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;$150 ® C. Registration Statement on the official DEQ form. ID D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ® E. Stormwater Management Plan satisfying the requirements of code section 17-403. ® F. Pollution Prevention Plan satisfying the requirements of code section 17-404. El G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. 1 H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. M I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. M J. Construction Record Drawings(as-builts)for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Devin Keeler Address 4805 Lake Brook Dr., Suite 200 City Glen Allen State VA Zip 23060 Daytime Phone(804) 205-3321 E-mail dkeeler@dewberry.com *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# Fee Amount$ Date Paid By who? Receipt# Ck# By: 7/1/14,Revised:7/10/14, 1/7/14 Page 2 of 2 Albemarle Count Community Development Department 401 t,t^inti re Road Charlottesville.V'.A22902-4596 ae:1434)296-5832 Fax:(434)972-4126 Planning Application ,.,r ;PARCEL / OWNER INFORMATION THP 05902-01-00-01500 ,er(s): UNIVERSITY OF VIRGINIA HOST PROPERTIES INC Application? WP0201700038 PROPERTY INFORMATION Legal Description ' ACREAGE PARCEL D-3 SPORTS CLUB .- Magisterial Dist Samuel Miller Land Lise Primary Commercial Current ..FD Not in A/F District ±] Current Zoning Primary Highway Commercial APPLICATION INFORMATION Street Address 1200 WELLINGTON DR CHARLOTTESVILLE,22903 Entered By Application Type Water Protection Ordinances Jgnnifier Pntch + 552417 Project UVA Foundation Squash Facility Received Date 05/08,17 F cei•aed Date Final Submittal Date 05/08/17 Total Fees 1350 Closing File Date Submittal Date Final Total Paid 1350 Revision Number Comments Legal Ad SUB APPLICATION(s) Type ` t Applicatio Comment Stormwater Management/BMP Plan 05/03/17 Erosion and Sediment Control Plan 05/03/17 APPLICANT /CONTACT INFORMATION ntactTr �R�.__ Name { Address � �� �e to i Zip ! Phone PhoneCell UNIVERSITY OF VIRGINLA HOST P O BOX 5397 ILL 229:5- CHFIS _CHOOLE PO BO 4:-: 1 4349833777 Signature of Contractoror Authorized Agent Date 11611, .411111f , ALN: Virginia Stormwater Management Program (VSMP) Application for Albemarle County lar: Project Name: University of Virginia Foundation Squash Facility (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes ® No 0 Is this a revision or resubmission for review? Yes 0 No 11 County File Number: SDP-2011-082 (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 le i roperty as required to ensure compliance with the approved plans and permits. TMP 56D2-01-15 Chris Schooley, UVAF Sq-j(1 Tax Map&Parcel Print Name of Property Owner Signat re o 6wner at 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 Chris Schooley do University of Virginia Foundation Address PO Box 400218 City Charlottesville State VA /; 22904 Daytime Phone(434) 982-3777 E-mail cds7c@virginia.edu 7/1/14,Revised:7/10/14,1/7/14 Page 1 of 2 • B. All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed 1.39 Acres to be Total Fee Fee Due with this Fee with Transfer or disturbed Application modification of permit Less than 1 $290 $20 1 and less than 5 $2,700 $1,350 $200 5 and less than 10 $3,400 , $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. ll D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. M 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. El 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: PI CI Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) 0 s m r— n Print Name Devin Keeler ,O C m 177 4805 Lake Brook Dr., Suite 200 Z Address Z City Glen Allen State VA Zip 23060 —1 Daytime Phone(804) 205-3321 E-mail dkeeler©dewberry.cam *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$13 SO—Date Paid 5A5-7/?3y who? rJo 4 O (ei t# By Mil.) ' 7/1/14,Revised:7/10/14,1/7/14 Page 2 of 2