HomeMy WebLinkAboutWPO201700050 Application WPO VSMP 2017-07-12 Albemarle Cnty Community Development Department
‘111i 1 Mclntire Road Charlottesville,VA 22902-4596
Voice:(434)296-5832 Fax:(434)972-4126
--- a Planning Application
PARCEL/ OWNER INFORMATION
TMP 03200-00-00-009C0 Own er(s)c CRUTCHFIELD CORPORATION
Application# WPO2OI 700050
PROPERTY INFORMATION
Legal Description I ACREAGE
Magisterial Dist.'Rio ::,®! Land Use Primary Commercial
Current AFD !Not in A/F District El Current Zoning Primary L ht Industry
APPLICATION INFORMATION
Street Address 1540 QUIET ACRES LN CHARLOTTESVILLE,22911 Entered By
Judy Martin Irj
Application Type `Water Protection Ordinances
Project Crutchfield Corporation- VSHP
Received Date 06/29/17 Received Date Final Submittal Date Total Fees 2700
Closing File Date Submittal Date Final Total Paid 2700
Revision Number
Comments
A
Legal.Ad
SUB APPLICATION(s)
Type Sib Applicatio Comment
Stormwater Management/BMP Plan 06/29/17
Erosion and SedtmentCo P i 06/29/17
APPLICANT /CONTACT INFORMATION
Contaetlype Name Address CityState Zip Phone PhmeCell
owneriAppScant CRUTCHFIELD CORPORATION j*1 CRUTCHFIELD PARK CHARLOTTESN1LL 22901
Primary Cantn t ERIC WOOLLEY,PE 220 EAST HIGH STREET CHARLOTTESVILL 22902 4349730045
Signature of ContractororAuthorized Agent Date
Virginia Stormwater Management Program (VSMP) h "°2;$1
Application for Albemarle County litroft
Project Name: Crutchfield Corporation
(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
County File Number: t .1 � ''EO (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.
PI 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 1 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.
1CD
TMP 32-9C Crutchfield Corporation �NJ�7l�r� ,s ,. \�, \Z11`2 11
Tax Map&Parcel Print Name of Property Owner Signature of wner 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 Bill Crutchfield
Address 1 Crutchfield Park
City Charlottesville State Virginia Zip 22911
Daytime Phone(434) 817-1000 E-mail
7/1/14,Revised:7/10/14, 1/7/14 Page 1 of 2
Oure
El B. All Fees [Code section 17-208]
For new or modified plans; Total acres proposed to be disturbed 4.90 ac.
Acres to be Total Fee Fee Due with this Fee with Transfer or
disturbed Application modification of permit
Less than l 5290 $145 $20
1 and less than 5 $2 70Q,..' $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;$150
0 C. Registration Statement on the official DEQ form.
O D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
O E. Stormwater Management Plan satisfying the requirements of code section 17-403.
O F. Pollution Prevention Plan satisfying the requirements of code section 17-404.
O G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405.
❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
stream buffers.
❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408.
O J. Construction Record Drawings(as-builts) for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Provide 2 copies of all plans and any supporting documents. Professional seals must have original
signatures.
Additional information if not provided on plans and documents:
Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent)
Print Name Eric Woolley, PE
Address 220 East High Street
City Charlottesville State Virginia Zip 22902
Daytime Phone(434) 973-0045 E-mail ewoolley@woolley-eng.com
*When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months
from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's
signatures will not be considered valid.
FOR OFFICE USE ONLY WPO#
Fee Amount$ 2�UV°--'Date Paid 67-2447 By who? Mlkelj Receipt# !G Zlg Ck#335�7�By:Jee k..,
7/1/14,Revised:7/10/14, 1/7/14 Page 2 of 2
Stormwater Pollution Prevention Plan (SWPPP)
Crutchfield Corporation
CERTIFICATION AND NOTIFICATION
I certify under penalty of law that this document and all attachments were prepared under my
direction or supervision in accordance with a system designed to assure that qualified personnel
properly gather and evaluate 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 ' priso ent for knowing violations.
Name: \\\VN.r r.. , ��S. c
‘t:\ Title:
Signature: Date: IA \ "Z 0 \s-A
I certify under penalty of law that this document and all attachments were prepared under my
direction or supervision in accordance with a system designed to assure that qualified personnel
properly gather and evaluate 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.
Name: Title:
Signature: Date:
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