HomeMy WebLinkAboutWPO201800060 Permit 2019-02-08.t'' ���;• Official Receipt
Albemarle Circuit Court
Jon R. Zug
501 E. Jefferson St
Charlottesville, VA 22902
(434) 972-4083
Receipt For: GRANTOR
Cashier: MEB
Instrument Type :
CSTP
Receipt # :
2019-036077
Instrument # :
201900001211
Date
02/08/2019 01:52pm
Book/Page :
05135 / 0780-00782 Pages : 3
Document
1 of 1
1 st Grantor :
COUNTY OF ALBEMARLE
Ex.
N
1st Grantee :
COUNTY OF ALBEMARLE
Ex:
N
Description:
ACREAGE MINT SPRINGS PARK
Consideration:
0.00 Assumed Value: 0.00
Pct :
100.00%
1 st City:
Y
Item #
Description
Oty
Unit Cost
Extended
035
VOF
1
0.00
0-00
301
Clerk 1-10 Pages
1
0.00
0.00
145
VSLA
1
0.00
0.00
106
TTF
1
0.00
0.00
Document 1
0.00
Grand Total
0.00
Balance
0.00
Customer Copy
VIRGINIA LAND RECORD COVER SHEET
FORM A - COVER SHEET CONTENT
Instrument Date: 11 /26/2018
Instrument Type: CSTP
Number of Parcels: Number of Pages:
[ ] City M County
ALBEMARLE
TAX EXEMPT? VIRGINIA/FEDERAL LAW
[ ] Grantor:
[ ] Grantee:
Consideration: $0.00
Existing Debt: $0.00
Actual Value/Assumed: $0.00
PRIOR INSTRUMENT UNDER § 58.1-803(D);
Original Principal: $0.00
Fair Market Value Increase: $0.00
2
Original Book Number: Original Page Number:
Prior Recording At:[ ] City [ ] County
(Area Above Reserved For Deed Stamp Only)
Original Instrument Number: - - -
Percentage In This Jurisdiction
BUSINESS / NAME
1 pq Grantor: COUNTY OF ALBEMARLE
[ ] Grantor:
1 pQ Grantee: COUNTY OF ALBEMARLE
2 pQ Grantee: ALBEMARLE COUNTY HEALTH DEPARTMENT
GRANTEE ADDRESS
Name: COUNTY OF ALBEMARLE
Address: FINANCE ADMINISTRATION RM 149 401 MCINTIRE ROAD
City. CHARLOTTESVILLE State: VA Zip Code:
Book Number: Page Number: Instrument Number:
Parcel Identification Number (PIN): 05500-00-00-02800 Tax Map Number: 05500-_00-00-02800
Short Property Description: ACREAGE
MINT SPRINGS PARK
Current Property Address 6659 MINT SPRINGS PARK
City: CROZET State: - VA
Instrument Prepared By: MICHELE R NAPPER Recording Paid By
Recording Returned To: COUNTY OF ALBEMARLE
Address: FINANCE ADMINISTRATION RM 149 401 MCIN_ TIRE ROAD_
City:. CHARLOTTESVILLE State: VA
FORM CC-1570 Rev: 7/15 Page 1 of 1
§§ 17.1-223, 17.1-227.1, 17.1-249
Zip Code:
GRANTOR
100%
22902
22932
Zip Code: 22902
Cover Sheet A
Copyright C 2014 Office of the Executive Secretary, Supreme Court of Virginia. All rights reserved.
Page 1 of 2
V'DHOF
VtRGINIA Albemarle County Health Department
DEPARTMENT 1138 Rose Hill Drive
HEALTH Charlottesville, VA 22903
(434) 972-6219 Voice
Protecting You and Your Environment (434) 972-4310 Fax
Conditional Sewage Disposal System Construction Permit
November 13, 2018
County of Albemarle
Dept of Facilities and Environmental Services
401 McIntire Road Room 420
Charlottesville, VA 22902
Tax Map/GPIN: 55-28
HDID: 101-18-0492
Dear County of Albemarle Dept of Facilities and, Environmental Services,
Your application for a conditional sewage disposal system permit filed with the Albemarle County
Health Department has been approved with the following conditions:
• Conditional Permit limiting the daily water usage to 140 gallons. Per OSE Report, the system will
serve a maintenance building with up to four (4) employees.
Your permit is issued in accordance with -the Code of Virginia,_ Title 32.1-164 and 32.1-164.1 Article _I,
Board of Health, Commonwealth of Virginia, Sewage Handling and Disposal Regulations, and
current agency policy. This letter shall become and is a part of the sewage disposal system permit issued
for the above referenced location. Due to the conditional nature of this system, this permit shall not
become valid until the following items are completed.
1. The permit shall be recorded in the Grantor Index of the land records of the Circuit Court of the
County of Albemarle.
2. The owner or his agent shall furnish to the Albemarle County Health Department certification by
the Clerk of the Circuit Court of the Deed Book Number and Page Number upon which the
permit and all provisions have been recorded. The Deed Book Number and Page Number must
be placed on all copies of the permit prior to giving validation to the building officials for
issuance of a building permit.
In accordance with the Sewage Handling and Disposal Regulations, you have the right of appeal to
obtain a modification or elimination of the conditions set herein. A written request to review the
conditions must be submitted to Denise Bonds, MD, MPH, Director, Albemarle County Health
Department, 1138 Rose Hill Drive, Charlottesville, VA 22903.
This Permit has been issued in accordance with applicable regulations based on the information and
materials provided at the time of application. There may be other local, state, or federal laws or
regulations that apply to the proposed construction of this onsite sewage system. The owner is
responsible at all times for complying with all applicable local, state, and federal laws and regulations.
Tax Map/GPIN: 55-28 Page 2 of 2
HDID: 101-18-0492
This construction permit is transferrable until expired or deemed null and void.
A permit transfer form may be found on the VDH website at
http://www.vdh,virginia. ov/enviroamental-health/gM-201S-01-forms) .
If you have any questions, please contact me. This authorization to construct a sewage disposal system
expires: .
Issued by:
Josh Kirtley,
Environmental Health Technical Specialist
As owner/legal representative of the property included in this permit, I have reviewed and accept
all prov' ' ns in the on itionaI sewage disposal system permit.
• - 5 I
County of Albemarle
es Date
COMMONWEALTH OF VIRGINIA, C UN+WCITY OF Lac Ir4�y��NG , to wit:
r
Subscribed and acknowledged before me this �day of ` 201 by County of
'ces.
l Registration #:
NOTARY BUC for -the
COMMONWEALTH OF VIRGINIA AT LARGE My Commission expires;