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Home My WebLink AboutWPO201500066 Application WPO VSMP 2017-12-01 Virginia Stormwater Management Program (VSMP) Application for Albemarle County Project Name: ON BLOCK 15& PH. II BLOCK 12 EC &SWM PLAN AMENDMENT (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes ® No ❑ Is this a revision or resubmission for review? Yes ❑ No County File Number: WP0201500066 (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. 055E0-01-00-00A1 U ct A N i D Y t I c1«)20/ Tax Map&Parcel Print Name of Property Owner Si• sip re of O er MGA-s- 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 DAVE BROCKMAN Address 1005 HEATHERCROFT CIRCLE SUITE 400 City CROZET State VA Zip 22932 Daytime Phone( ) E-mail DAVE@OLDTRAILVILLAGE.COM 7/1/14,Revised: 7/10/14, 1/7/14 Page 1 of2 91B. All Fees [Code section 17-208] For new or modified plans; Total acres proposed to be disturbed N/A-AMEND. 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 S 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;$150 ❑ C. Registration Statement on the official DEQ form. ❑ D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. • E. Stormwater Management Plan satisfying the requirements of code section 17-403. ❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404. ❑ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. El H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. ❑ J. Construction Record Drawings (as-builts)for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name JEREMY FOX Address 914 MONTICELLO RD City CHARLOTTESVILLE State VA Zip 22902 Daytime Phone(434) 977-0205 E-mail JFOX@ROUDABUSH.COM *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY ]� ` �/ WPO '`Ji Ij— ? /� Fee Amount$ .CO Date Paid IO' 1I By who./it &_{ '� ',�� 4. - Receipt# \l t O Ck#t ij2 By:s.I A9 - . 7/1/14,Revised:7/10/14, 1/7/14 Page 2 of 2 Albemarle Cour e _, Planning Application PARCEL] OWNER INFORMATION O55EO-O1-00-OOOA1 ,.C_ MARCH MOUNTAIN PROPERTIES LLC Application# WP0201500066 PROPERTY INFORMATION OW TRAIL PARENT TRACT _. _ _t White Hall • r _ Commercial _, Not in A/F District •• -=ar, Rural Areas • APPLICATION INFORMATION anrel€e Path Water Protection Ordinances Old Trrail Village, Block 15 Amendment - VSMP I f ... .. ...._ .. ___ .ek �a'._ _.e _ _�'' _,.. 't 3. ."3*2 „s. riE3 200; a'• •.. ».,,. ».,.. '•a __., a .'3` .s 200 SUB APPLICATION(s) 1.r. ....._,. ... _._.,..,., orf . .. .Erosion and Sediment Control Plan Stream Buffer Development Request Stormwater Management/BMP Plan APPLICANT ! CONTACT INFORMATION _r•: `t Fl-ore �•�i i'E:'ACL t" .11 LE EE TE- ._..r•r:-''T:---L_ ..,. -E=,LL Agent ... ..�C .isu, Virginia Stormwater Management Program(VSMP) d �V' Application for Albemarle County Nai- Project Name: Old 'Vail Village. , eIbc.V. 16 (The name should be the sew.wit appears on Is this an amendment to an approved plan? Yes No 0 ', Is this a revision or resubmission for review? Yes I No 0 County File Number: WPO Zo iii000 q7 00 be provided by the County for new applications) The following are required elements of new applications[from code section 17-4011. For revisions or amendments,please indicate which item:are being amended. Signatures must be provided for any submission. 0 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 nil requirements of these plans and permits will be complied with,and C have the authority to authorize the land disturbing aclivnies mid 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. 556-01 -gi ,....��cccc ' ''� .l�,/1.14/ ?).21 )/y Tox Map&Parcel Print Name of Property Owner (I e,..0 er in pit s.` i Daatte ' ;g4.%,.4'', '1 fi l 1 c . Tax Map&Parcel Print Name of Property Owner /' nature. e Date Tax Map&Parcel Print Name of Property Owner t Signature of Owner Dale Tax Map&Pared Print Name of Property Owner Signature of Owaer Date Contact information for the Owner(s)to receive correspondence:Print Name Mt rcik MUlirriAtvi P p'eeiies j-L.0 Address ��%C 5 HeakheY"Cruf-"b C'iv io Po j StAi-b°. ( City t«,r 1:1 24,6 state VP Zip 22013:x. Daytime Phone(70) gas--9ogt3 E-mail (A ave 6: old-hr-ai Nitta/3 e. carve 7/1/14,Revised:11(0/14 Page)oft ❑ B. All Fees [Code section 17-208J For new or modified plans; Total acres proposed to be disturbed Acres to be Total Fee Fee Due with this Fee with Transfer or disturbed Application modification of permit Less than 1 $290 $145 $20 I 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 $6,100 $3,050 $450 100 100 and more $9,600 $4,800 $700 For(minor)amendments to an approved plan;$200 per review Variances;$150 Mitigation Plan;$150 O C. Registration Statement on the official DEQ form. 2if D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. d E. Stormwater Management Plan satisfying the requirements of code section 17-403. a F. Pollution Prevention Plan satisfying the requirements of code section 17-404. O G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. ❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. a J. Construction Record Drawings(as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name c-hv15 M t.l 1119 L41 %,, V Lj 1 U Ltd�3e4 Address g 11-1 M o m C:e1(Q Pock.ci City Uri a(10- .e, Vlket: State \\IA Zip 22.'1Oz Daytime Phone(i 14) q7'7 (2/5 E-mail GMu,lj9curl ruur cL usi1., COi'i *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# Fee Amount$Z.00. 6 Date Paid 1(%)t< By who? N, /"/o-'i rL ry/,,Receipt# / O l \Ck# 7,27 cK By: 4'‘ v l� ,cam, Le t 7/1/14,Revised:7/10/14 Page 2 of2