HomeMy WebLinkAboutBNB201900003 Approval - Agencies 2019-08-02Received
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Working together,
for a healthy community
1138 Rose Hill Drive . PO Box 7546
Charlottesville, Virginia 22906
APR - 9 2019
Chadottesvi Ile/Albemarle
Health Department
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THOMAS JEFFERSON HEALTH DISTRICT
TRANSIENT LODGING REVIEW
Operating Name of Business:
Facility Address:
Tax Map Number: 15q _ 10
Subdivision: Section: Lot:
Owner/Agent: Q
Address:
Will food be prepared for guests? _ n O
Total Number Bedrooms: 3_Z
Water Source (check appropriate):
Home Phone: S�
CellPhone; Y7G
Email: /72:7//C'0/�
Owner -occupied:
Public Water System
Other (please specify):
Guest:
Private Well
Sewage Disposal (check appropriate): Public Sewer Private Septic
Will the proposed lodging involve any new construction? n
If so, please specify:
Signature (owner or agent)
Date:
Health Department Use
VDH PERMITTING REQUIRED: B&B Permit Hotel Permit V-"- None Required
SEWAGE DISPOSAL SYSTEM:
ADEQUATE
A review of our records and/or assessment by a licensed professional, and all other
information available, has indicated that the existing sewage disposal system (SDS)
and reserve area (where indicated) appears to have been designed with adequate
capacity for the proposed use. This does not imply that the existing SDS will
continue to function properly for any minimum period. A site visit and inspection
may not have been performed.
• Note: For optimum preventative care, septic tanks should be pumped out by a licensed
sewage hauler every 3 to 5 years.
INADEQUATE
A review of our records and/or assessment by a licensed professional, and all other
information available, has indicated that the existing sewage disposal system is not
adequate for the proposed use.
WATER SOURCE: V Approved Not Approved
• B&B (w/ food service) & Hotel: coliform bacteria & nitrate testing required
initially, then annually thereafter, prior to permit renewal.
• Transient lodging w/o food service: coliform bacteria & nitrate testing
recommended initially, then annually thereafter.
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Health Department Official
Date