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HomeMy WebLinkAboutWPO201700079 Application WPO VSMP 2018-01-18Virginia Stormwater Management Program (VSMP) Application for Albemarle County a+ Project Name: Wilson Residence 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 fa/No 0 County File Number: w Z1:01/0077411 (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. 88-2H Benjamin B.Wison,JR&Carol Wilson 45/' Tax Map&Parcel Print Name of Property Owner Signet ref Own Date/-/j_/ 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 N amen Wilson Address 19607 White Oak Road City Sutherland State VA Zip 23885 Daytime Phone(804) 731-4924 E-mail wilsongrpac@rcn.com 7/1/14,Revised:7/10/14, 1/7/14 Page 1 of2 B. All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed ma OU 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 WI 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. H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. O 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 allplans and any supporting documents. Professional seals must have original signatures. Additional information tf not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Waterstreet Studio-Alan Franklin,PE Address 418 East Main Street City Charlottesville State VA Zip 22902 Daytime Phone(434) 295-8177 E-mail afranklin@waterstreetstudio.net 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 Amour¢f.r Date Paid By who? Receipt# Ck# By. 7/1/14,Revised:7/10/14, 1/7/14 Page 2 of 2 Albemarle Cour4- v Community Development Department 443. titre Road Charlottesville,VA 22902-4596So.'ice:(434)296-5832 Fax:(434)972-4126g' Planning Application PARCEL/ OWNER INFORMATION 1TMP08800-00-00-002H0 Own er(s): WILSON, BENJAMIN B JR&CAROL WILSON Application* WP0201700079 PROPERTY INFORMATION Legal Description 1 BEAMEMAR FARM ESTATES 9 PHU 44. 4- Magisterial Dist.I_Sf.trnuei Miller M.1 Land Use Primary Agricultural LICurrentAFDNotinA/F District El Current Zoning Primary I Rural Areas APPLICATION INFORMATION Street Address Entered By I BUcIcS—M-ith ElApplicationTypeiWaterProtectionOrdinancesE. 1 ilmmy-fr-Project WILSON RESIDENCE Received Date I 12/07/17 Received Date Final 1 I Submittal Date 12/07/17 Total Fees 1700 Closing File Date Submittal Date Final Total Paid 1700 Revision Number 1 I Comments Legal Ad SUB APPLICATION(s) Type I Sub Appileatio I Co-ronetStormtvaterManagement/BMP Pian 112/07/17 APPLICANT/CONTACT INFORMATION ContaotType I Name 1 Address I CityState 1 Zip I Phone j PhoneCellownerheopstantiWILSON,BENJAMIN BA&CAROL 19647 WHITE OAK RD SUTHERLAND VA i 23685OrarnaryContactFRANKLIN,ALAN 418 EAST MAIN ST CHARLOTTESVILL 22902 4342958177 m..........„ Signature of Contractor or Authorized Agent Date Nor' sad Virginia Stormwater Management Program (VSMP) Application for Albemarle County Project Name: Wilson Residence 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 0 County File Number: to be provided by the County for new applications) The following are required elements of new applications ffrom 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. 88-2H Benjamin B.Wilson,JR&Carol WilsonI'a Tax Map&Parcel Print Name of Property Owner Signal re of Owne Date (2— 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 Ben Wilson Address 19607 White Oak Road City Sutherland State VA Zip 23885 Daytime Phone(804) 731-4924 E-mail wilsongrpac©rcn.com 7/1/14,Revised:7/10/14,1/7/14 Page 1 of 2 S B. All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed 6.00 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;$150 i C. Registration Statement on the official DEQ form. 21 D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. E. Stormwater Management Plan satisfying the requirements of code section 17-403. F. Pollution Prevention Plan satisfying the requirements of code section 17-404. G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. J. Construction Record Drawings(as-builts)for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Waterstreet Studio-Alan Franklin,PE Address 418 East Main Street City Charlottesville State VA Zip 22902 Daytime Phone(434) 295-8177 E-mail afranklin©waterstreetstudio.net When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO#-40(( Gt7c' I' /Fee Amount$} I tyt) ' Date' Paid 11'1'11 By who? 1',J011 wk 16Un Receipt# 1191b' ? Ck# 24 ei B ; .5(f,(' , Y 7/1/14,Revised:7/10/14, 1/7/14 Page 2 of 2