HomeMy WebLinkAboutWPO201700019 Application WPO VSMP 2018-04-03 Virginia Stormwater Management Program (VSMP) .,�_ '
Application for Albemarle County 3111ir
Project Name: Scottsville Elementary School Security Addition
(The name should be the same as it appears on plans)
Is this an amendment to an approved plan? Yes B No ❑
Is this a revision or resubmission for review? Yes D No a
County File Number:UJ Qi 7 (to 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 items 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,/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.
13000-00-00-025P0 Albemarle County School Board
Tax Map&Parcel Print Name of Property Owner Si nature of Owner / Date
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Tax Map&Parcel Print Name of Property Owner Sigaturb of Owner Date
Tax Map&Parcel Print Name of Property Owner �gnature 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 Albemarle County School Board Contact: Joeseph Letteri
Address 401 McIntire Road
City Charlottesville State VA Zip 22902
Daytime Phone(434) 9759340 E-mail jletteri@kl2albemarle.org
7/1/14,Revised:7/10/14, 1/7/14 Page 1 oft
❑ B. All Fees [Code section 17-208]
For new or modified plans;Total acres proposed to be disturbed 0.61
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; $150
® C. Registration Statement on the official DEQ form.
1 D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
El E. Stormwater Management Plan satisfying the requirements of code section 17-403.
El F. Pollution Prevention Plan satisfying the requirements of code section 17-404.
❑ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405.
❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
stream buffers.
❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408.
❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Provide 2 copies of all plans and any supporting documents. Professional seals must have original
signatures.
Additional information if not provided on plans and documents:
Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent)
Print Name Craig Kotarski, PE
Address 608 Preston Avenue, Suite 200
City Charlottesville State Va Zip 22903
Daytime Phone(434) 327-1688 E-mail eraig.kotarski@timmons.com
*When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months
from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's
signatures will not be considered valid.
FOR OFFICE USE ONLY WPO#
Fee Amount$ Date Paid By who? Receipt# Ck# By:
7/1/14,Revised: 7/10/14, l/7/14 Page 2 of 2