HomeMy WebLinkAboutSUB202000128 Application 2020-06-19Commonwealth of Virginia
Application for Subdivision Review
(Page 1 of 2 to be filled out by the Owner or Agent)
Owner Israel's Gap Community Fund, LLC
Mailing Address 2100 Drovers Lane
North Garden, VA 22959
Developer/Agent Steve Gooch
Mailing Address 703 Oliver Creek Road
Troy, VA 22974
AOSE Steve Gooch
Mailing Address 703 Oliver Creek Road
Troy, VA 22974
VDH Use Only
Health Department ID#
Due Date
Phone (434)284-0808
Phone
Fax
Phone (434)531-0487
Phone
Fax
Phone (434)531-0487
Phone
Fax
Directions to Property: From Charlottesville Route 29 South, right on Plank Road to Batesville, right on Miller School Road, right on
Pounding Creek Road to 1 st property on right after 1245 Pounding Creek Road
Name of Proposed Subdivision
Tax Map 86-17C Other Property Identification Dimension/Acreage of Property 415 Ac.
Number of lots proposed 3 Proposed water source (note: new or existing, public or individual) existing, new, individual
General size of lots 100 Ac., 125 Ac., 190.01 Ac. (give range if appropriate)
Additional description of subdivision
Overview of soils and geology (optional but encouraged)
In order for VDH to process a subdivision application you must attach a plat of the property showing the location of the proposed onsite
sewage disposal systems and the reserve absorption areas (if required) and the location of the water supply system on each lot, if applicable.
Each plat or subsection of a subdivision shall be accompanied by specific soil information for each lot (absorption area and reserve area). If
not provided by the local subdivision ordinance, the district or local health department may require the plat to show streets, utilities, storm
drainage, water supplies, easements, lot lines, and original topographic contour lines by detail survey or other information as required.
When the AOSE site evaluations are reviewed, the property lines, building location and the proposed well and sewage system sites must be
clearly marked and the property sufficiently visible to see the topography, otherwise this application will be denied.
I give permission to the Virginia Department of Health (VDH) 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 an Authorized Onsite
Soil Evaluator (AOSE) or a Professional Engineer (PE) as necessary until the sewage disposal system has been constructed and approved.
Signature of Owner/Agent Date
Commonft'.of Virginia �th�MN.�
Appfica lou for Subdividon ReAew rA a Doe
(page 2 of to be filled out by the crnmty official requesting a WH review)
County Office inidwq rew"t
Content Individual Phone
Local offioas of die Yirsinia► D%wo" t of Health may review subdivision applications for compliance with state rules and
regulations gavtir4Wq sawa,p treatment and drat and private water supplies, compliance with local ordinance governing
sowaage geatow Md dispow if W private watepr lies and paWndatly for compliance with other local ordinances, Please
indicate the nature of review. you era asking the h= department to conduct,
1. ReviewRla'.ci&�10e with the Sewsga Handling and Disposal Regulations
2. Review fbr confbmance with local onsite wastewater ordinances
3. Other (describe below)
Rim- and ads of roquator B ste
on Norm F Revised 7/02/09