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Home My WebLink AboutWPO201700007 Application WPO VSMP 2017-03-24 +un Albemarle rle C nLCarr►rrtunityDevelopmentQepartrr 401 McIntire Road Charlottesville,VA 22902-4! Voice:(434)296-5832 Fax:(434)972-4- '3 Planning Application PARCEL/OWNER INFORMATION TMP 04800-00-00-05200 Owner(s): HAMPTON,ELLEN C,TRUSTEE OF THE PIEDMONT MANOR LAND rpt Application # W OI70ii 0? PROPERTY INFORMATION Legal Description ACREAGE Magisterial Dist. Rivatma LJ Land Use Primary Forest Current AFD I Not A/F District Current Zoning Primary Rural Meas [APPLICATION INFORMATION Street Address Entered E ...._.._......_� _____ .. .. d 1 Application Type Water Prot l y Project Flarmiga " VSNP Brandi Cross1/27Su/2tlMartin17 �` Received Date 01/27/17 Received Date Final Submittal Date 02/06/17 Total Fees 1 Closing File Date Submittal Date Final Total Paid j Revision Number Comments Legal Ad SUB APPLICATION(s) Type SubAion Erosion and Sediment Control Plan 02/06/17 1 i �ti� � � � .�..:�.o .y.,„s ...n.s.....a..m. .... »., - ..z.._..,,, a.............:e �....ms,..a x..,.i. ..,s...�r.c.a' ...�,.._.... #.:i ,......: ........ ........ ..._._..:. . ..._. _.............. ..:_. APPLICANT/CONTACT INFORMATION C r, , �.1 1 s ,] C I ... 1 � tfti�. ., Lp I tlE' THERE 12296/ Primary Contact ELLEN HAMPTON RR 1 BOX 730 ROSELAND, VA. 22967 7373257344 Signature of Contractor or Authorized Agent Date Virginia Stormwater Management Program (VSMP) Application for Albemarle County1/15' Project Name: Flannigan Branch Crossing (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes El No WI Is this a revision or resubmission for review? Yes El No l ' 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. 48-52 E I (C^ (4aAp4or\ '/ /. . S t 1 Tax Map&Parcel Print Name of Property Owner Signature of 0 er 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 E II e,-{ /4 ,vip 10.E Address AR I pox 7 3U City IQ O .(tna State 1/A- Zip ZZq '7 Daytime Phone(`t3Li) 325- 7349 E-mail CONFIRMS( vER\ZO1i.NET 711/14,Revised:7/10/14, 1/7/14 Page 1 of 2 "§iitte *tial . r ®B. All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed 0.20 AC 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. D 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 Justin Shimp, P.E. Address see plans City State Zip Daytime Phone( ) E-mail *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# In Fee Amount S 1 5040 Date Paid 1214► t By who?f)nn eal'oi rareiceipt# )0610'0 Ctd# 10:56:2 By: 7/1/14,Revised:7/10/14,1/7/14 Page 2 of 2 Now, Screening Form Number <.1',41?.41!!‘ Dl�Gt1`�P COUNTY OF ALBEMARLE Department of Community Development 401 McIntire Road,Room 227 Charlottesville,Virginia 22902-4596 Phone(434)296-5832 Fax(434)972-4126 LAND DISTURBANCE EROSION AND SEDIMENT CONTROL SCREENING FORM This form is intended to aid the Department in classifying a land disturbance. The form responses will be used to determine whether a disturbance is subject to the County's Water Protection Ordinance. Failure to respond or to fully complete the screening form within 72 hours may require the Department to stop all land disturbing activity. The Stop Work Order will remain effective until the classification of the disturbance and/or obtainment of all required permits associated with the disturbance. 'PIEDMONT MANOR LA ND TRUST ELLEN C. HAMprbTRJ5TEE 434) 315-734y Owner/Agent Name(Print) Home Phone Office/Other Phone RR 1� (box '730 Address ROSE LAND, VA 22967—9 212 City State Zip Code 1. Are there any streams on the property? No 2. If so,will land disturbing activity be within 100' of the stream? ofilaNO No 3. Will the project require grading,excavating,clearing, filling,or other land disturbing activity of any kind? Yes No Purpose of land disturbing activity: f 1 a.,nr. [R i/vc, l ij c r X;54-i”. 61 r,'ve. IA/ Directions to Property and Location of Activity: L Area to be disturbed: acres or i 0) o o sq.ft. Owner/Agent-Signature ) n,J tr Date JA N . 1.2, 2.417 (FOR OFFICE USE ONLY) Tax Map/Parcel: - Checked By Date Requires an Erosion and Sediment Control Plan Requires an Agreement in Lieu of an Erosion and Sediment Control Plan Exempt Activity October 9,2006 sloe ria/ Albemarle County Water Protection Ordinance Request P uest development in a stream buffer i Required Information for application; 0 A. Signature of the Property Owner for each parcel: (Required,NOT TO BE SIGNED BY AN AGENT, BUILDER,CONSULTANT,or anyone other than the owner) 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. ?1E'DMONT MANOR LA 141> " RUST Oy'oo-vo-oo05aoa � ,0.2gZ ) 01-12-1'1 Tax Map&Parcel Signature of Owner Date Contact Information for the Owner to receive correspondence: Print Name ELLEN G. VAAMPTON Address 'RR �. Sox '130 `' City 11 05e1„�rl'D State v l zip 22967 Daytime Phone(43+1) 325-73144 E-mail CO 1.1F IRM5 AER1ZON . NET ❑ B. A description or drawing of the proposed disturbance. (Typically this is a driveway,house,garage, grading activity, etc. It does not matter that it may be theoretical or exploratory. Any additional information,like a professional stream or buffer assessment,will be helpful.) FOR OFFICE USE ONLY WPO# Fee Amount S150. ate Paid I la.01/1 By w11071(1n11&I attired-Receipt# IC)1'Z cit# 105/0 By: _P 7/1/2014