HomeMy WebLinkAboutWPO201600051 Application WPO VSMP 2016-08-04lbernar County Community DevelopmentDepartnCounty401McIntireRoadCharlottesville,VA 22902-4:
Voice:(434)296-5832 Fax:(434)972-4-
Planning Application
PARCEL/ OWNER INFORMATION
TMP 056A2-01-00-00500 owner(s): HOWARD,ALAN D OR PATSY MARLOWE
Application # WPv 0i 160005
PROPERTY INFORMATION
Legal Description I ACREAGE 1B
Magisterial Dist. White Hall Land Use Primary Residential---Sintgle-family(hid.modular homes)
Current AFD Not in AjF District Current Zoning Primary R2 Residential
APPLICATION INFORMATION
Street Address 5812 DUNVEGAN LN CROZET, 22932 Entered
Judy Martin
Application Type Water Protection Ordinances
ua'8/4/2016
Project Crozet Ph,3 Water Main Replacement Project VESCP
Received Date 08/01/16 Received Date Final Submittal Date Total Fees 1
Closing File Date Submittal Date Final Total Paid
Revision Number
Comments
Legal Ad
SUB APPLICATION(s)
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APPLICANT j CONTACT INFORMATION
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Applicant JEREMY M. LYNN, SA 168 SPOTNAP ROAD CHARLOTTESVILL 22911 4349774511
Primary Contact HEATHER A. CAMPBELL P.E.IDEWBERRY E 4805 LAKE BROOK DRIVE,STE GLEN ALLEN, VA. 23060 8042053351
Signature of Contractor or Authorized Agent Date
of ALfc.,
Virginia Erosion and Sediment Control Program (VESCP) 44.41
Application for Albemarle County
This application is only to be used for projects exempt from the Virginia
Stormwater Management Program,VSMP,and the DEQ General Permit)
Project Name: Crozet Phase 3 Water Main Replacement Project
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 0 No IZ
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.
see attached Albemarle County Service Authority
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
Tax Map&Parcel Print Name of Property Owner Signature of Owner Date
here propbsechilliMMINMEINP
ontact In ormation for the Owner(s)to receive correspondence:
Print Name Jeremy M. Lynn, P.E.,Albemarle County Service Authority
Address 168 Spotnap Road
City Charlottesville State VA Zip 22911
Daytime Phone(434) 977-4511 E-mail jlynn@serviceauthority.org
7/1/14,Revised: 7/10/14, 1/7/15 Page 1 of 2
Sod
WI B. All Fees [Code section 17-207]
Total acres proposed to be disturbed 0.41
Acres to be disturbed Total Fee
Less than 1 150 per review
More than 1 300 per review
For amendments to an approved plan;$200 per review
Variances; $150(per request)
Exceptions;$240
Mitigation Plan;$150
Construction Record Drawing;$300
C. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
D. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
stream buffers.
E. Requested Variations or Exceptions as provided in code sections 17-407 and 408.
O F. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Provide 2 copies of all plans and any supporting documents. Professional seals must have original
signatures.
Additional information if not provided on plans and documents:
Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent)
Print Name Heather A. Campbell, P.E.,, Dewberry Engineers Inc.
Address 4805 Lake Brook Drive, Suite 200
City Glen Allen State VA Zip 23060
Daytime Phone(804) 205-3351 E-mail hcampbell@dewberry.com
When applications and plans are reviewed,but not approved,and a response to comments is not received
within 6 months from the date of county comments,the application will be deemed withdrawn. Applications
without valid owner's signatures will not be considered valid.
FOR OFFICE USE ONLY WPO#
Fee Amount$ Date Paid By who? Receipt# Ck# By
7/1/14,Revised: 7/10/14, 1/7/15 Page 2 of2
ANTICIPATED EASEMENTS TO BE ACQUIRED BY ACSA
Tax Map & Parcel Dimensions Description
056A2-01-00-00500
056A2-01-00-005A0
Waterline along Dunvegan Lane:056A2-01-00-00400 20' wide
permanent utility easement05600-00-00-04300
056A2-01-00-00100
056A2-01-00-00400 20'x20' Meter removal: Temporary
construction easement
05600-00-00-04300 20'x10' Hydrant: Permanent utility easement
05600-00-00-045A4 20'X10' Hydrant: Permanent utility easement
056D0-00-00-00100 20'x7' Hydrant: Permanent utility easement
056D0-00-0A-00300 20'x10' Hydrant: Permanent utility easement
056D0-00-OB-02100 10'X5'
Hydrant: Permanent utility easement056D0-00-0B-020A0 10'x5'
056D0-00-0B-01600 20'x5' Hydrant: Permanent utility easement
056D0-00-0E-00200 10'x5'
Hydrant: Permanent utility easement056D0-00-0E-00100 10'x5'
05600-00-00-04800 20'x10' Hydrant: Permanent utility easement
1111001
40(001
AL{I{trVirginiaErosionandSedimentControlProgram (VESCP) rTi 9
Application for Albemarle County
This application is only to be used for projects exempt from the Virginia
Stormwater Management Program,VSMP,and the DEQ General Permit)
Project Name: Crozet Phase 3 Water Main Replacement Project
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 0 No
County File Number: WP0201600051 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 providedfor 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.
see attached Albemarle County Service Authority V/4Ia0
Tax Map&Parcel Print Name of Property Owner Si atur of O e 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
Majority of work within VDOT right-of-way; ACSA will acquire easements where proposed waterline is located on
private property.
Contact Information for the Owner(s)to receive correspondence:
Print Name Jeremy M. Lynn, P.E., Albemarle County Service Authority
Address 168 Spotnap Road
City Charlottesville State VA Zip 22911
Daytime Phone(434) 977-4511 E-mail jlynn@serviceauthority.org
7/1/14,Revised: 7/10/14, 1/7/15 Page 1 of2
WI B. All Fees [Code section 140011t 07]
Total acres proposed to be disturbed 0.41
Acres to be disturbed Total Fee
Less than 1 150 per review
More than 1 300 per review
For amendments to an approved plan;$200 per review
Variances;$150(per request)
Exceptions; $240
Mitigation Plan; $150
Construction Record Drawing;$300
C. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
D. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
stream buffers.
E. Requested Variations or Exceptions as provided in code sections 17-407 and 408.
F. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Provide 2 copies of all plans and any supporting documents. Professional seals must have original
signatures.
Additional information if not provided on plans and documents:
Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent)
Print Name Heather A. Campbell, P.E., Dewberry Engineers Inc.
Address 4805 Lake Brook Drive, Suite 200
City Glen Allen State VA Zip 23060
Daytime Phone(804) 205-3351 E-mail hcampbell@dewberry.com
When applications and plans are reviewed,but not approved,and a response to comments is not received
within 6 months from the date of county comments,the application will be deemed withdrawn. Applications
without valid owner's signatures will not be considered valid.
FOR OFFICE USE ONLY WPO 51
Fee Amount$ f Late Paid 5f)7 In By who?us 4 Receipt# hX i Ck#5. L) By;,jp
7/1/14,Revised: 7/10/14, 1/7/15 Page 2 of 2
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Albemarle County Service Authority.168 Spotna• Charlottesville VA 22811 Page of 1 Check Number. {10452544
3/612017 ENG-131
A
ES Plan Review 150.00 0.00 150.00
Operating Account
1058 County of Albemarle 00052544 3/1512017 150.00