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HomeMy WebLinkAboutSUB201800021 Approval - Agencies 2018-03-15COMMONWEALTH of VIRGINIA DEPARTMENT OF TRANSPORTATION 1601 Orange Real Cuo"r. Virginia 22701 Stephen C. 9:ich, P.E. Commissioner April 17, 2018 County of Albemarle Department of Community Development 40I McIntire Road Charlottesville, VA 22902 Attn: Faruk Hesenjan Re: SUB -2018-00021- Emma Pryor- Rural Subdivision Plat. Review# 1 Dear Mr. Hesenjan The Department of Transportation, Charlottesville Residency Transportation and Land Use Section has reviewed the Emma Pryor Rural Subdivision Plat, dated January 19, 2018 as submitted by Roger W. Ray & Associate Inc., and find it to be generally acceptable. A VDOT Land Use Permit will be required prior to any work within the right-of-way. The owner/developer must contact the VDOT Charlottesville Residency Land Use Section at (434) 422-9399 for information pertaining to this process. If you have further questions, please contact Willis C. Bedsaul at 434-422-9856. Sincerely, a4ott " Ate{• Adam J. Moore, P.E. Area Land Use Engineer VDOT - Charlottesville Residency VirginiaDOT.org WE KEEP VIRGINIA MOVING COUNTY OF ALBEMARLE Department Community Development . Planning Services Division 401 McIntire Road North Wing • Charlottesville, Virginia 229024596 v Phone: (434) 296-5823 • Fax: (434) 9724035 Transmittal From: Fay L& Date: 04/06/18 To: 0 10 OAdam Moore-VDOT 0 0 0 0 0 0 0 JOB #/FILE NAME: SU SjoIT 00021 We are sending you the following items: ® Attached or ❑ Under separate cover ❑ Copy of Letter ❑ Prints ❑ Plans ® Plats ❑ Specifications ® Other Subdivision Application # of Date Description copies 2 1/19118 Subdivision Plat - Rural Subdivision Plat Pryor, Emma 2 1130118 Subdivision Application These are transmitted as checked below: For review and comments IXI For Other Remarks: This plat requires VDOT's approval of entrance to a public road- Simmons Gap Road (as shown on the attached subdivision plat) Comments are due in City View or email by: 04/13/18 Signature: COUNTY OF ALBEMARLE Department of Community Development 401 McIntire Road, Room 227 Charlottesville, Virginia 229024596 Phone (434) 296-5532 Fax (434) 972-4126 2/16/2018 Josh Kirtley Virginia Department of Health 1138 Rose Hill Drive Charlottesville, VA 22906 RE: SUB201800021 Pryor Dear Mr. Kirtley: The County of Albemarle has received an application for a two -lot division, involving Tax Map Parcels (TMP) #F9 - 14E. This project requires Health Department approval before receiving final County approval. The applicant has provided copies of the soils work associated with these parcels, dated January 31, 2018. Two copies of those reports are attached, as is the proposed plat dated January 19, 2018, and an application for subdivision review dated February 5, 2018. Please review the proposals for suitable subsurface drainfields which comply with the provisions of Chapter 18, Sections 4.2.2, 4.2.3, 4.2.4, and Chapter 14, Sections 14-309 and 14-310 of the Albemarle County Code. Should you have any questions or comments, please feel free to contact me. Review comments are due on Friday, March 2. Please call or email me if you have any questions or requests for assistance. Thank you very much for your assistance. Sincerely, Will Cockrell, AICP On -Call Planner I Department of Community Development Email: wcockrell(Wbemarle.org Voice: (434) 296-5832 ext. 3307 Fax: (434)972-4035 Encl. LINEI BEARING DISTANCE Lil SBO'00'58"E 81.87 L21 S82'57'44"E 59.76 L3 S87051'21"E 72.88 L4 NB1'16'39"E 62.45 L5 N74'27'49"E 34.72 L6 N66'03'03"E 66.60 L71 N62'18'4VE 69.45 L81 N62'01'00"E 140.15 L9 N62'39'25"E 38.07 LIO N06'07'26"W 66.93 L11 N16'54'56"W 76.23 L12 NO2'34'26"W 50.37 L13 N09 -27-04--E 61.55 L14 N01'17'04"E 53.34 L151 N28 .56'56"W 55.26 L161 N42'44'56"W 82.32 L171 N49408'56"W 54.96 LIBI N61'29'26"W 42.98 Li9l N64'05'06"W 130.06 L201 N50'22'11"W 89.06 L21j N28'29'59"W 188.69 L22 N21'09'13"E 19.68 L23 S28'3i'30"E 198.63 L24 S50'17'03E 85.37 DENOTES NONBUILDABLE AREA FOR A RESIDENCE HEALTH DEPARTMENT COPY NOT FOR RECORDATION STATE ROUTE 663 SIMMONS GAP ROAD 40'R/W(D.B.401-336) / IRON �0 >r�--t SET . 6 V NAIL FOUND � eL_2L� L4 ��0�d-k�,�T. M.9 -14E1 % AT 5.00 AT _ OP'.::.;;, ry ti , BASE OF PIPE , m +�:. S66 • / m w 00, �E _ H T - �r PARCEL A3 -j FLAG 2-A2 / T . M . 9-14C M . 9 14B 6.03 ACRES 6 Z tir,oFLAG 3-A2Q FLA(' PROPOSED d 1-Ae, R/Q O, Cn �� 1r6 DRAINFILED X ,� T. M. 9 14E FLAG 4-A2 AREA =3 ti IRON/Q H"' _ O T . M. 9-14 ca\SET T OI SEPTICD FLAG Op /P) DRAINFILEEDD 4A3AREA T . M . 9-14D ` ` FLAG , FLAG D^ (V PARCEL A2 LOT A �''O� i -A3 ®� ` �3-A3 ,y= 8. 01 ACRES (19 AW" `'may Do p �� 19 SOPHIES PINE LANE L18 J 20'ACCESS EASEMENT p (D. B. 1489-607, L17 �.` `L 616 & 617 PLAT) / L 16 �` O /��P' IRON L15 FOUND T. M.9-1401 LOT B TASHA I.CHERRY D.B.3881-745 D.B.1708-724 & 725 PLAT GRAPHIC SCALE 'D2 L14 L 13-x'' �� ,b►y� L12 T.M.9-14F LI++ FOR L10 l REVIEW i"=200' SCALE: 1" = 200' DATE: JANUARY 19.2018 ROGER W.RAY & ASSOC.,INC. 663 BERKMAR COURT CHARLOTTESVILLE,VIRGINIA 22901 TELEPHONE: (434) 293-3195 RAYSURVEYING.COM GL SHEET 3 OF 3 10229G In Cooperation with the State Department of Health COMMONWEALTH ®f VIRGINU Thomas Jefferson Health District 1138 Rose Hill Drive Phone (434) 972-6219 P. O. Box 7546 Fax (434)972-4310 Charlottesville, Virginia 22906 March 15, 2018 Will Cockrell County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, Virginia 229024596 ALBEMARLE - CHARLOTTESVILLE FLUVANNA COUNTY (PALMYRA) GREENE COUNTY (STANARDSVILLE) LOUISA COUNTY (LOUISA) NELSON COUNTY (LOVINGTON) RE: Review of Proposed Subdivision Plat and attached Soils Information for Individual Onsite Sewage Systems as part of a division of Tax Map 9 Parcel 14E located in Albemarle County, Virginia. Dear Mr. Cockrell: On February 16, 2018, the County of Albemarle requested the Virginia Department of Health (via the Albemarle County Health Department) review the proposed subdivision plat identified above. This letter is to inform you that the above referenced subdivision plat is approved for individual Onsite Sewage Systems in accordance with the provisions of the Code of Virginia, the Sewage Handling and Disposal Regulations, and local ordinances. This request for subdivision review was submitted pursuant to the provisions of § 32.1-163.5 of the Code of Virginia which requires the Health Department to accept private soil evaluations and designs from an Authorized Onsite Soil Evaluator (AOSE) or a Professional Engineer working in consultation with an AOSE for residential development. This subdivision was certified as being in compliance with the Board of Health's Regulations by: Jason Kyser OSE #1940001357. This subdivision approval is issued in reliance upon that certification. Pursuant to § 360 of the Regulations this approval is not an assurance that Sewage Disposal System Construction Permits will be issued for any lot in the subdivision identified above unless that lot is specifically identified on the above referenced plat as having an approved site for an onsite sewage disposal system, and unless all conditions and circumstances are present at the time of application for a permit as are present at the time of this approval. This subdivision may contain lots that to do not have approved sites for onsite sewage systems. This subdivision approval does pertain to the requirements of local ordinances. Sincerely, jr—i Travis T. Davis, OSE Environmental Health Specialist, Sr. l avis v� ,r 6 L U bY A ks ircnvve.' T4 tlow th S0ryices.� MAS 0 8" 2018 COUNTY OF ALBEMARLE Department of Community Development 401 McIntire Road, Room 227 Charlottesville, Virginia 22902-4596 Phone 434)296-5832 Fax 434)972-4126 2/16/2018 Josh Kirtley Virginia Department of Health 1138 Rose Hill Drive Charlottesville, VA 22906 RE: SUB201800021 Pryor Dear Mr. Kirtley: D IrPROWED The County of Albemarle has received an application for a two -lot division, involving Tax Map Parcels (TMP) #9- 14E. This project requires Health Department approval before receiving final County approval. The applicant has provided copies of the soils work associated with these parcels, dated January 31, 2018. Two copies of those reports are attached, as is the proposed plat dated January 19, 2018, and an application for subdivision review dated February 5, 2018. Please review the proposals for suitable subsurface drainfields which comply with the provisions of Chapter 18, Sections 4.2.2, 4.2.3, 4.2.4, and Chapter 14, Sections 14-309 and 14-310 of the Albemarle County Code. Should you have any questions or comments, please feel free to contact me. Review comments are due on Friday, March 2. Please call or email me if you have any questions or requests for assistance. Thank you very much for your assistance. Sincerely, -•- "% -moi Will Cockrell, AICP On -Call Planner I Department of Community Development Email: wcockrell(a7,albemarle.or Voice: (434) 296-5832 ext. 3307 Fax: (434) 972-4035 Encl. VIRGINIA tow (D: DEPARTMENT HOF HEALTH M' Protecting Your and Your Envkonm&# Albemarle County Health Department 1138 Rose Hill Drive Charlottesville, VA 22903 (434) 972-6219 Voice (434) 972-4310 Fax Private Well System Operation Permit t. Property Owner David & Joanna Euans Health Dept. ID: 101-17-0114 1715 Painted Sky Terrace Tax Map/GPIN: 71-4H Charlottesville, VA 22901 Locality: Albemarle County Phone: (434) 825-0982 Property Location Property Address: 6850 Castleberry Court Crozet, VA 22932 Subdivision: Castleberry Court Section: Lot: 5 David & Joanna Euans is Hereby Granted Permission to .Operate a Class 11M Well located at the above referenced location. This Permit is Issued in Accordance with the Provisions of Title 32. 1, Chapter 6 of the Code of Virginia as Amended and Section(s) 12-VAC5-630-330 of Private Well Regulations of the Virginia Department of Health and permit dated April 19, 2017. February 22, 2018 " _ Effective Date rJosh Kirtley, EHSS VI INIA tqw�7D DEPARTMENT HOF HEALTH Protecting You and Your En ronment Albemarle County Health Department 9138 Rose Hill Drive Charlottesville, VA 22903 (434) 972-6219 Voice (434) 972-4310 Fax Sewage Disposal System Operation Permit Property Owner David & Joanna Euans Health Dept. ID: 101-17-0227 17 15 Painted Sky Terrace Tax Map/GPIN: 71-4H Charlottesville, VA 22901 Locality: Albemarle County Phone: (434) 825-0982 Property Location Property Address: 6850 Castleberry Court Crozet, VA 22932 D Apfflove Subdivision: Castleberry Court Section: Lot: 5 David & Joanna Euans is hereby granted permission to operate a Residential Conventional Onsite Sewage System at the above referenced location, under the following parameters: Daily Flow: 600 gallons Number of Bedrooms: 4 This permit is issued in accordance with the provisions of Title 32.1, Chapter 6 of the Code of Virginia as Amended, and Section 12VAC 5-610-340 of the Sewage Handling and Disposal Regulations of the Virginia Department of Health. The issuance of an operation permit does not denote or imply any guarantee by the department that the sewage disposal system will function for any specified period .of time. It shall be the responsibility of the owner or any subsequent owner to maintain, repair, or replace any sewage disposal system that ceases to operate in accordance with the regulations. February 22, 2018 Josh KirtIey Effective Date Environmental Health Technical Sign Specialist .a VIRGINIA Albemarle County Health Department tw 'n HOF DEPARTMENT 1138 Rose Hill Drive HEALTH Charlottesville, VA 22903 (434) 972-6219 Voice Protecting You and Your Environment (434) 972-4310 Fax Private Well System Operation Permit Property Owner David & Joanna Euans Health Dept. ID: 101-17-0114 1715 Painted Sky Terrace Tax Map/GPIN: 714H Charlottesville, VA 22901 Locality: Albemarle County Phone: (434) 825-0982 ProoCMLocation Z rplan Property Address: 6850 Castleberry Court Crozet, VA 22932 Subdivision: Castleberry Court Section: Lot: 5 David & Joanna Euans is Hereby Granted Permission to Operate a Class MB Well located at the above referenced location. This Permit is Issued in Accordance with the Provisions of Title 32.1, Chapter 6 of the Code of Virginia as Amended and Section(s) 12-VAC5-630-330 of Private WeII Regulations of the Virginia Department of Health and permit dated April 19, 2017. February 22, 2018 Effective Date FJosh Kirtley, EHSS VIRGINIA tWW 'ADENNEW- DEPARTMENT HOF HEALTH Protecting You and Yw Envkonment Albemarle County Health Department 1138 Rose Hill Drive Charlottesville, VA 22903 (434) 972-6219 Voice (434) 972-4310 Fax Sewage Disposal System Operation Permit Property Owner David & Joanna Euans 1715 Painted Sky Terrace Charlottesville, VA 22901 Phone: (434) 825-0982 Health Dept. ID: 101-17-0227 Tax Map/GPIN: 714H Locality: Albemarle County Property Location Property Address: 4850 Castleberry Court�.�r/..1� i�nlEJl� Crozet, VA 22932 Subdivision: Castleberry Court Section: Lot: 5 David & Joanna Euans is hereby granted permission to operate a Residential Conventional Onsite Sewage System at the above referenced location, under the following parameters: Daily Flow: 600 gallons Number of Bedrooms: 4 This permit is issued in accordance with the provisions of Title 32. 1, Chapter 6 of the Code of Virginia as Amended, and ,Section 12VAC 5-610-340 of the Sewage Handling and Disposal Regulations of the Virginia Department of Health. The issuance of an operation permit does not denote or imply any guarantee by the department that the sewage disposal system will function for any specified period of time. It shall be the responsibility of the owner or any subsequent owner to maintain, repair, or replace any sewage disposal system that ceases to operate in accordance with the regulations. February 22, 2018 JoshKirtley Effective Date Environmental Health Technical SignAre Specialist OSE/PE Report for: Construction Permit -E] Certification Letter JI Subdivision Approval Property Location: 911 Address: City:_ Lot�Section Subdivision Lar GPIN or Tax Map # Ow Health Dept ID # Latitude Longitude Page _L_ of O Applicant or Client Mailing Address: Name: Street:_ S r City: INigr 1..-4gy lie, State V-4 Zip Code 47 Prepared by: OSE Name ; /_ License # I TV40013rZ Address &C -f T City 6",''k State f4 Zip Code ZZ9Y7 PE Name: License # Address _ City State Zip Code Date of ReportD1�3l.tBIg _ Date of Revision #1 OSE/PE Job # Date of revision #2 Contents/Index of this report (e.g., Site Evaluation Summary, Soil Profile Descriptio ns, Site Sketch, Abbreviated Design, etc.) L x Qs`� t�Cri:. cin{.rl /'C>�POI� f/Bf - I �iai+�•t lsu►�tiC�rl-.� Esc 'Le.'.�I� ►� Certification Statement I hereby certify that the evaluations and/or designs contained herein were conducted in accordance with the Sewage Handling and Disposal Regulations (12 VAC5-610), the Private Well Regulations (12 VAC5-630) and all other applicable laws, regulations and policies implemented by the Virginia Department of Health. 1 further certify that I currently possess any professional license required by the laws and regulations ol'the Commonwealth that have been duly issued by the applicable agency charged with licensure to perform the work contained herein. KThe,work attached to this cover page has been conducted ander an exemption to the practice of engineerinp, specifically the exemption in Code of Virginia Section 54.1-402.A.11 I recommend that a (select ): construction permit certification letter subdivision approval be (select one) issued enied ❑ . ,7 OSE/PE Signature Datepfg Commonweaa th of Virginia Application for: ❑Sewn a System BWater Supply i5 Owner Ern Mailing Address �10 "gs G � Z735 - Agent �F Mailing Address IU R;d f Site Address i` z VDH Use only Health Department ID# Due Date Phone `13Y - 17' 6 sb Phone Fax Phone y - 7 SO Phone Fax Email Directions to Property: S t ' +/" . zr IM6 o �- 3 Subdivision Section Block L.ot 14 2- 1 Tax Map IYE. Other Property Identification Dimension/Acreage of Property 6• D1 /s Sewage System Type of Approval: Applicants for new construction are advised to apply for a certification letter to determine if land is suitable for a sewage system and to apply for a construction permit (valid for IS months) only when ready to build. Certification LL.�tter 13 Construction Permit Proposed Use: Single Family Home (Number of Bedrooms. 3 ) © Voluntary Upgrade EJ Repair Permit -- Multi -Family Dwelling (Total Number of Bedrooms --, Other (des�esnio Basement? Wails -o Basement �No Fixtures in Basement es�Io Conditional permit desired?DYes o If yes, which conditions do you want? ]Reduced water flow []Limited Occupancy ❑ Intermittent or seasonal use ❑ Temporary use not to exceed I year Do you wish to apply for a betterment loan eligibility letterV. Yes - o *'£here is a $50 fee for determination of eligibility. Water Supply Will the water supply beMblic oroirivate? Is the water supply[3Existing oror sed? If proposed, is this a replacement well? Yes If yes, will the old well b abandoned? Yes Mo Will any buildings within 50' ofthe proposed well be termite treated? [3 s 0 All Applicants 1s this a private sector OSCE application? . es �No If yes, is the OSE/PE package attached? C'3Yes ONo Is this property indeed to serve as your (owners) principal place of residence? OYes B<O In order for VDH to process your application for a sewage system you must attached a plat of the property and a site sketch. For water supplies, a plat of the property is recommended and a site sketch is required The site sketch should show your property lines, actual and/or proposed buildings and the desired location of your well and/or sewage system. When the site evaluation is conducted the property lines, building location and the proposed well and sewage sites must be clearly marked and the property sufficiently visible to see the topography. I give permissiou to the Virginia Department of Health to enter onto the property described during normal business hours for the purpose of processing this apphcataoni and to perform quality assurance checks of evaluations and designs certified by a private sector Onsite Soil Evaluator or Professional Engineer as necessary until the sewage disposal system and/or private water supply has been constructed and approved. Signature of Owner/ Agent Date Ibis form contains personal information subject to disclosure under the Freedom of Information Act. Revised 1211f2014 r7t, 3 ort ? YDH Use OnI_v Health Depanment [D# Due Date Site and Soil Evaluation Report (For certification Ietters and subdivisions) General information Date : DI 31 /toil 4A,%eb%*Ae, County Health Department Applicant : y Telephone Number:_ J3q —x'77 4 SD Address: 116 i d e. 4,RVS ' e, V11 7,7,703 Owner: rmrtr,,4 pd ypr Address : 0110 Aloc .yeof L"ii�rrtr�o4 syfa(�G �A Location : ,5"&v4AV s; f d,,+c. 64 t •1„� ltJas d Subdivision o,r Block/Section Lott Soil lnfor 'on Summar I. Position in landscape satisfactory Yes _ No _ Describe 2. SIope_N °/a 3. Depth to rocklimpervious strata Max. Min. %S None _ 4. Free water present No ✓ Yes _ Range in inches 5. Depth to seasonal water table (gray mottling' or gray color) *V14 inches 6. Soil percolation rate estimated Yes J Texture group ❑I Oil111 01V No Estimated rate min/in 7. Percolation test performed Yes ulnber of percolation test holes No _ Depth of percolation test holes Average percolation rate __ mpi Name and title of evaluator: K. Ap., 04-P. Signature: , Department Use -lite approved: Draeld Trench oms to be placed at (inches) depth at site designated on permit. _ Site disapproved: Reasons for rejection: (check all that apply) . _ Position in landscape subject to flooding or periodic saturation. 2. —Insufficient depth of suitable soil over hard rock. 3. —Insufficient depth of suitable soil to seasonal water table. 4. Rates of absorption too slow. 5. Insufficient area of acceptable soil for required drainf[eld, and/or Reserve Area. 6. _ Proposed system too close to well. 7. Other (Specify) OSE Form G (pg.1) Revised WOV2009 Page -�— of Date of Evaluation: i 2 27 .Z.O_I7 Profile Description SOH. EVALUATION REPORT Property ID: t fir£ to.1 - AL Where the local health department conducts the soil evaluation the location of profile holes may be shown on the schematic drawing on the construction permit or the sketch submitted with the application. If soil evaluations are conducted by a private soil scientist, location of profile holes and sketch of the area investigated including all structural features i.e. sewage disposal systems, wells, etc. within 100 feet of site (See section 4) and reserve site shall be shown on the reverse side of this page or prepared on a separate page his farm. and aZlicationsketchSee construction permit ._ _ See sketch on reverse side or page attached to this form. Hole # Horizon Depth Description of color, texture, etc. (Inches) Texture Group V-3, 7. SYR s 3OwAn Login 8�Air l 3Y -6z slaty ,�r '� GZ G2- S . ZAIF TY9-f BE k3 2-S'YX r V1 111 ' CZ71R mslk y A - W - 9 - 577 .T Y SI L 7 -79 REMARKS OSE Form G (pg.2) Revised7102/2009 Page S of Design Calculations Property ID: _-Z-Zr- r, t," /y,C r4�I AZ Flow Type of use (residential, etc)] Show Calculations Here No. of bedrooms: 3 OR calculations here or on a separate sheet. No, of employees: NIW (dosing volume, head, pump design, etc.) Square Footage of building space:15-101. Daily flow (peak design) in GPD: q!r#00 Class of well: --LTC (,l Treatment No. of septic tanks: ( Show Calculations Here Size of septic tank(s): /ya,9 fon Pretreatment required? _yes If yes, specify type of treatment device: ' Information and calculations required for commercial and/or conditional use applications only Abso flon area design Soil Texture Group: _;gP� If pump system, enhanced flow, or LPD show Reserve area rre }uired? _ yes _ no calculations here or on a separate sheet. 50% _--f00% _other (check one) (dosing volume, head, pump design, etc.) Specify other Water Supply Class of well: --LTC (,l Describe (bored, drilled)1+�G�r /] Distance between septic tank(s) and well: 5-0,+- 0`fDistance Distancebetween absorption area and well: `{- ' Information and calculations required for commercial and/or conditional use applications only OSE: form [ Revised 71212009 Page 6 Of Abbreviated Design Form This form is for use with gravity, pump to gravity, enhanced flow, and low pressure distribution (LPD) sewage system designs and when applying for a certification letter or subdivision approval. This abbreviated design covers the Coprimary and reserve area, ❑ only the primary area, ❑ only the reserve area (check one) for ,r,, (If /fL (property ID). Design Basis r Total length of available area: (eS Total width of available area: /OL Estimated Perc. Rate: SD at S`/ in. (depth) Number of bedrooms (or GPD): 3 Y�O6& Conveyance Method: Distribution method (specify): 6rfwej 7e�eneA Dispersal system basis LGMI required? Ale (Ye<Q Effluent quality required:;,,��,, Square feet per bedroom: 374 51,4, I6f Gravity. pump. siphon 'Enhanced flow, LPD. or Drip Dispersal 'Table 5.4 of SHDR or identify the GMP used Area Calculations Number of trenches tv (Note if a pad is used) Width of pad or trenches: a Ro.srr%.c re,jriirL:d' Yes Total width of absorption area regT�Pred. rimary Secondary, Advanced Secondary) Total trench bottom area required: //ZT r Length of pad or trenches: ` S Center to center spacing: , Percent reserve area required: /,00A,9_ Total trench bottom area provided: The required width is calculated by multiplying the center -to -center spacing by one less than the number of trenches and adding 1 trench width plus any required reserve area. If the topography is not uniform across the length of the site the trenches will need to flare apart on one end to maintain contour. When this occurs it is necessary to use a center -to -center spacing that accounts for the flair or the installer will not be able to ft the system within the approved area. It is perfectly acceptable to have more area available, especially up and down the slope, than is required. OSE Form E Revised 712109 Page % of —9— System I System Specifications Property ID: �,. A ANG, I NE -Rx Applicant Information Name_ Phone t13V- 977 - `TGSO Address ?/,0_ V4 72 v Location Information Tax Map No. 9 & j,-* _ Property address GPIN No. Subdivision Pyuc Directions bum GF3 tl' .ZS Mel,c4 "I- OA -fz jr L0 Section Block _ L Lot-4-1- General Information General System Type 7:CZ7 Number of bedrooms (e.g. septic tank, drainfield) Daily flow tISV GSD (gpd) Type of properly (e.g. commercial, residential, etc.) Conditions Sewer Line Septic Tank — Inlet/Outlet Structure Schedule 40 PVC, 4" or equivalent Capacity: 1000 gallons (add check or describe equivalent below) 2nd septic tank ,l/# gallons Per the 2000 Sewage Handling & Disposal Regulations, Check which option chosen: Septic tank with inspection port ►�' Septic tank with effluent filter _ Reduced maintenance septic tank Conve ante line/force main Information Distribution box Information Method G No. of boxes t No. of outlets (e.g. gravity, pumpin , dosing siphon) If pumping, attach Pum Spec Sheet Surge or splitter box required: Material i r wa o �%G Yes No Pipe diameter _ Y" Slope of i e4'- too' in inches Header line Information Percolation line Information/Absorption Area 1500 pound c•ush strength YesCenter Yes _ � to center spacing ft. Required spacing'7 ft. Minimum slope is 2"1100 ft. Installation depth5j_ inches Aggregate depth /3 inches No. of Laterals G Lateral length ! sT ft. Lateral bottom slope: L3 inches In Lateral width 36 inches OSE OSE Form ] Revised 7/2/2009 Date 1 a/8 — 13 N09'27'04"E 61. 5--5] cr 14 N01°17'04"E 53.34 z 15 N28'56'56"W 55.26 �y� 190 S 16 N42 '44 ' 56 " W 82.32 r , 17 N49'0B'56"W 54.96 CL 18 N61°29'26"W 42.96 19 N64'05'06"W 130.06 20 N50'22'11"W 89.06 21 N28'29'59"W 188.69 22 N21 '09 ' 13 " E 19.68 ?3 S26 '31 ' 30 "E 198.63 STATE ROUTE 663 '_4 S50'17'03"E $5,37 SIMMONS GAP ROAD 40'R/W(D.B.401-336) A IRON SET �o(o NAIL FOUND AT 5.00' A®L2�L3 L4,` T, M. 9-14E1 / T SpA....::: BASE OF PIPE m Z� ...:.: 0i S6 Lo ... 250 AD \so yq" mw44 F z PARCEL A3 JM. K T 9-148 cQ�'/ 6.03 ACRES w EFLAG 2-a2 / T. M. 9-14C 40 J ;� \t, % oFLAG 3-A2 I m ` OfL104 PROPOSED O IA2 l'S ' � LED T. M. g 14E FLAG 4-A2 DRAAREA13 �pI -/aIRON SET 8 ; ^� T M. 9-14 `r\ I lo PROPOSED O /SEPTIC FLAG 00 /if �[� DRAINFILED 4-A3 T. M. 9-140C�QI/ AREA ` ` ` FLAG P (V PARCEL A2 LOT A �,.,` FLAG c3 -A3 z ti= 8.01 ACRES O i -A3 . �Q'�1 9 FLAG , �o v �� v ♦A30 4P' -)PHIES PINE LANE ----L18 'ACCESS EASEMENT (D.B.1489-607,L17�. �2 :116 & 617 PLAT) L15 �1 OIRON FOUND T. M,9-1401 LOT B TASHA I.CHERRY D.B.3881-745 D.B.17O8-724 & 725 PLAT GRAPHIC SCALE L14 L13---' li i�ti� L12A 1 T.M.9-14F L 11-� ► FOR L10/ REVIEW I"=200 0 200 400 600 SCALE: 1" = 200' DATE: JANUARY 19, 2018 ROGER W.RAY & ASSOC.,INC. 663 BERKMAR COURT CHARLOTTESVILLE,VIRGINIA 22901 TELEPHONE: (434) 293-3195 RAYSURVEYING.COM CUCCT n nr � ....,...... Property Location: 911. Address: _ Lot 43 Page _I of _ OSE/PE Report for: Construction Pem-iit FI Certification Letter F-1 Subdivision Approval Section GPIN or Tax Map # __ C/ on N,'l lqj: or Latitude Subdivision Health Dept I.D # Longitude City: Applicant or Client Mailing Address: Name: EMMA Enjoin Street: 10 City: C'h"L*Cso& State I/A Zip Code Za9d 3 Prepared by: OSE Nanne nS �,� L C e. 4/,T y -Z -,02Y$ License # 1 '71/6Do / 3S ] Address % City s r K State V,1 Zip Code PE Name: Address City State License # Zip Code Date of Report _% Date of Revision #1 OSE/PE Job # Date of Revision #2 Contents/Index ��o�fthis report (e.g., Site Evaluation Summary, Soil Profile Descriptions, Site Sketch, Abbreviated Design, etc.) .-��@ / � LrL�l man'_ ,' 4 /eCoh On Amp - ?.P�T�� � R%YiJY1� S- s pa Certification Statement I hereby certify that the evaluations and/or designs contained herein were conducted in accordance with the Sewage Handling and Disposal Regulations (12 VAC5-610), the Private Well Regulations (12 VAC5-630) and all other applicable laws, regulations and policies implemented by the Virginia Department of Health. i further certify that I currently possess any professional license required by the laws and regulations of the Commonwealth that have been duly issued by the applicable agency charged with licensure to perform the ork contained herein. The work attached to this cover page has been conducted under an exemption to the practice of engineering, specifically the exemption in Code of Virginia Section 54.1-402.A.11 I recommend that a (select ): construction permit❑ certification letter subdivision approval be (select one) issued denied ❑ . A OSE/PE Signature l Date Commonwealth of Virginia Application for: j]geo"w- age System [DNVater Supply Owner - Mailing Address iJV : - Agent ...,�. - Mailing Address Site Address Zo�� VDH Use only Health Department ID# Due Date Phone y3q- 977- l rO Phone Fax Phone V3 -9-77- q65-0 Phone Fax Email Directions to Property: So wsA,;L 6Pga � 4 61 3 ' }�- .2S O'iAS We0i 10 leo.�l 603 Subdivision n f Tax Map Section Block Lot 43 Other Property Identification Sewage System Dimension/Acreage of Property G• ®3 JOWI�s Type of Approval: Applicants for new construction are advised to apply for a certification letter to determine if land is ` suitable for a sewage system and to apply for a construction permit (valid for 18 months) only when ready to build. ElCerdfication Letter 0 Construction Permit © Voluntary Upgrade 0 Repair Permit-.- Proposed ermit- - Proposed Use: Single Family Home (Number of Bedrooms 3 ) Multi -Family Dwelling -(Total Number of Bedrooms Other (dve:scri Basement?�io Walk -out Basemen . es0No Fixtures in Basement esTo Conditional permit desired?Mesm<o011*� If yes, which conditions do you want? Reduced water flow ❑ Limited Occupancy ❑Intermittent or seasonal use E]Temporary use not to exceed i year Do you wish to apply for a betterment loan eligibility lette esG<on*There is a $50 fee for determination of eligibility. Water Supply Will the water supply beMblic or riiwate? Is the water supplyE3ffixisting or ro 00'sed? If proposed, is this a replacement well?Dycs �Ko If yes, will the old we l be abandoned? Mes Mo Will any �s buildin within 50, ofthe proposed well be termite treated? [3Yes Ali Applicants -` ' - Is this a private sector OSE/PE application? Mes Mo ' If yes, is the OSE/PE package attached? C3Yes �No Is this property indeed to serve as your (owners) principal place of residence? 13Yes [3Ko In order for VDH to process your application for a sewage system you must attached a plat ofthe property and a site sketch. For water supplies, a plat ofthe property is recommended and a site sketch is required. The site sketch should show your property lines, actual and/or proposed buildings and the desired location of your well and/or sewage system. When the site evaluation is conducted the property lines, building location and the proposed well and sewage sites must be clearly marked and the property sufficiently visible to see the topography. I give permission to the Virginia Department of Health to enter onto the property described during normal business hours for the purpose of processing this application and to perform quality assurance checks of evaluations and designs certified by a private sector Onsite Soil Evaluator or Professional Engineer as necessary until the sewage disposal system and/or private water supply has been constructed and approved Signature of Ownerl Agent Date This form contains personal information subject to disclosure under the Freedom of Information Act. Revised 12/12014 7 3 #� 8 VIM Use Only Health Department TDO Due Date Site and Soni Evaluation Report (For certification letters and subdivisions) General Information Date: County Health Department Applicant: E MMA Eyef Telephone Number: 311- 977- WTO Address : `IID Rte Str�- 94 Owner: lr Address Location: J�Ou�ri�i af- ui t �(,Ad;�tS .G/�sf o� �ow1tG liD3 Subdivision Block/Section Lot /43 I Soil Informs 'on Summar 1. Position in landscape satisfactory Yes No Describe: s; a cSG 2. Slope 11 % 3. Depth to rock/impervious strata Max. 60 Min. S& None 4. Free water present No Yes _ Range in inches 5. Depth to seasonal water table (gray mottling or gray color)/V/# inches 6. Soil percolation rate estimated Yes _ Texture group RI [—]II [ 1l r]Iv No Estimated ratemin/in 7. Percolation test performed Yes /Number of percolation test holes No ✓ Depth of percolation test holes Average percolation rate _ mpi Name and title of evaluator:_ �Sow� (L� -er e.l%D- Signature: artment Use _ it, approved: Drainfitrench bo/,y) be placed at 3Z (inches) depth at site designated on permit. _ Site disapproved: Reasons for rejection: (check all that I. _ Position in landscape subject to flooding or periodic saturation. 2. —Insufficient depth of suitable soil over hard rock. 3. —Insufficient depth of suitable soil to seasonal water table. 4. —Rates of absorption too slow. 5. Insufficient area of acceptable soil for required drainfield, and/or Reserve Area. 6. w Proposed system too close to well. 7. Other (Specify) OSE Form G (pg. 1) Revised 7/022009 Page a of 9 Date of Evaluation: pI 114904P119 _ Profile Description SOIL EVALUATION REPORT Property ID: C A- ?w,.l irr - 43 Where the local health department conducts the soil evaluation the location ofprofile holes may be shown on the schematic drawing on the construction permit or the sketch submitted with the application. If soil evaluations are conducted by a private soil scientist, location of profile holes and sketch of the area investigated including all structural features i.e. sewage disposal systems, wells, etc. within 100 feet of site (See section 4) and reserve site shall be shown on the reverse side of this page or prepared on a separate page and attached to his form. __ See application sketch _. See construction permit See sketch on reverse side or page attached to this form. Hole # Horizon Depth Description of color, texture, etc. Texture (Inches) Group A 6-3 y.rY s 3 � 3- Z9 ie NI c j G Z9-" L ; Page ,1 of Design Calculations Property ID: TY Aj,.r� j Jy,r — 43 Flow Type of use (residential, etc) 1 Show Calculations Here No. of bedrooms: 3 EK No. of employees: Af/q Square Footage of building space: gl".4 Daily flow (peak design) in GPD: Y W.0 Treatment No. of septic tanks: Show Calculations Here Size of septic tank(s): tooy 6A#A Pretreatment required? _yes If yes, specify type of treatment device: Absorption area design Soil Texture Group: 7W / If pump system, enhanced flow, or LPD show Reserve area ire!? _ yes _ no re calculations here or on a separate sheet. _ 50% - 0% _other (check one) (dosing volume, head, pump design, etc.) Specify other Water Supply Class of well: C Describe (bored, drilled): 11Z /a sr Distance between septic tank(s) and well: 5"0`f Distance between absorption area and well: e=o #- ' Information and calculations required for commercial and/or conditional use applications only USF Form I Revised 7/7/2009 Page & Of 8 Abbreviated Design Form This form is for use with gravity, pump to gravity, enhanced flow, and low pressure distribution (LPD) sewage system designs and when applying for a certification letter or subdivision approval. This abbreviated design covers the u. rimary and reserve area, 17 only the primary area, Q only the reserve area (check one) for -T. -iv A. % , _I I r!E - ,Iq 3 (property ID). Design Basis Total length of available area: 7- 'l Total width of available area:_Sy r Estimated Pere. Rate: at 32 in. (depth) Number of bedrooms (or GPD): SP 4F1? / Conveyance Method : ;y Distribution method2 (specify): 6rrl✓j -ree ,4 Dispersal system basis _ 7T"1k S. q o+.5HDR LGMI required? f/c,— (Yew Effluent quality required:rim Secondary, Advanced Secondary) Square feet per bedroom: ZZ , h 1he Total trench bottom area required: _LJ(P 1 Gravity. pump. siphon Enhanced flow. LPD, or Drip Dispersal Table 5.4 of SHDR or identify the GMP used Area Calculations Number of trenches S Width of pad or trenches: _ (Note if a pad is used) 3t Reserve required?C Total width of absorption area required 37 0 Length of pad or trenches: 75- Center sCenter to center spacing: 9� Percent reserve area required: 1007, Total trench bottom area provided: The required width is calculated by multiplying the center -to -center spacing by one less than the number of trenches and adding 1 trench width plus any required reserve area. If the topography is not uniform across the length of the site the trenches will need to flare apart on one end to maintain contour. When this occurs it is necessary to use a center -to -center spacing that accounts for the flair or the installer will not be able to ft the system within the approved area. It is perfectly acceptable to have more area available, especially up and down the slope, than is required. OSE Form E Revised 712109 Page -3 of IV System Specifications Property ID:Txynop 7 p u j /yL- f3 Applicant Information Name E.n% y%Q Pru „r- Phone 1f3 y- 77 7 - 745-o Address 910 )P;'40 S'+re4 tJknr rlsi: ile� tM Z29d3 Location Information Tax Map No. ' o,L /N� - Property address GPIN No. Subdivision t Y01- Directions - Section Block Lot 43 General Information System Type 1 Number of bedrooms (e.g. septic tank, drainfield) Daily flow 41rp&rpp (gpd) Type of property RGS� c�4a a� (e.g. commercial, residential, etc.) Conditions Sewer Line Septic Tank — Inlet/Outlet Structure Schedule 40 PVC, 4" or equivalent Cajpacity: doo gallons (add check or describe equivalent below) 2° septic tank Allif gallons Per the 2000 Sewage Handling & Disposal Regulations, Check which option cho n: Septic tank with inspection part Septic tank with effluent filter _ Reduced maintenance septic tank Conveyance line/force main Information Distribution box Information Method 6f,*w No. of boxes (e.g. gravity, pumpin , dosing siphon) No. of outlets IL If pumping, attach Pump Spec Sheet Surge or splitter box required: Material 56ke" q'9 f pG Yes No f Pipe diameter Y" Slope of i e&"-!po` in inches Header line Information Percolation line Information/Absorption Area 1500 pound crush strength Yes Center to center spacing _T ft. Minimum slope is 2"/100 ft. Yes ,," Required spacing i ft. Installation depth 3Z inches Aggregate depth 13 inches No. of Laterals S"' Lateral length 75' ft. Lateral bottom slope 26 inches Lateral width Z inches OSE Date 101/! OSE Form J Revised 71212 131 N09'27'04"E 61.551 cr- 141NOi*17'04"El 53.341 z 15l N28'56-5ra"Wl 55.26 a 1I 161 N42'44'56"Wi 82.32 -� o. 17l N49'08'56"W 54.96 181 N61°29'26"W 42.98 19 N64'05'06"W 130.06 201 N50.22'11"W 89.06 211 N28'29'59"W 188.69 ?2 N21 '09' 13"E 19.681STATE ROUTE 6fi3 ?3 S28 •31 ' 30"E 198.63 ?4 S50.17'03"E ROAD 85.37 40'R/W DS B. GAP 01R--336) IRONSET �0 (o NAIL FOUND Ll Z ��0" ��Rjryti T. M. 9-14E1� AT 5.00' AT - BASE OF PIPE / m ..:;;;ci��.'� ���':::::. � , SSB •22 . <., 250 \2Sp 1q / u : `F z PARCEL A3 T. M.9-148 �"�/ 6.03 ACRES w �FLAG2-A2 T. M.9 -14C 10) n! z - .[a FLAG 3-A2 ,^ FLAG �% `� X24 PROPOSED p / d 1-A2 % - DO SEPTIC SEPTIC �Zl�\N ��B DRAINFILED X I@ T. M. 9 1 4 E FLAG 4-A2 AREA 3 /�, IRON B ,; T M. 9-14 r�\ SET O ,� T \ , PROPOSED /SEPTIC FLAG DRAINFILED 4-A3AREA R/ T. M. 9-14Q fir. FLAB -r` ;. FLAG P2� PARCEL A2 LOT A o i -A3 levo e� ti 8.01 ACRES FLAG 0 P H I E S PINE LANE18 'ACCESS EASEMENT (D. B . 1489-607, L17 i16 & 617 PLAT) / L16 OIRON L15 FOUND T. M.9--1401 LOT B TASHA I.CHERRY D.B.3881-745 D.B.1708-724 & 725 PLAT GRAPHIC SCALE L14 rr /� L13 L12; T•M.9-14F FOR L10�/ REVIEW 1"=200' 0 200 400 600 SCALE: 1" = 200' DATE: JANUARY 19, 2018 ROGER W.RAY & ASSOC.,INC. 663 BERKMAR COURT CHARLOTTESVILLE,VIRGINIA 22901 TELEPHONE: (434) 293-3195 RAYSURVEYING.COM CU=r n nr � --n---