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HomeMy WebLinkAboutSUB202000027 Correspondence 2020-02-21 OF A tow COUNTY OF ALBEMARLE Department of Community Development 401 McIntire Road,Room 227 Charlottesville,Virginia 22902-4596 Phone(434)296-5832 February 21, 2020 Michele Napper Virginia Department of Health 1138 Rose Hill Drive Charlottesville,VA 22906 RE: SUB2019-00032 Dear Ms.Napper: The County of Albemarle has received an application to adjust the parcel line between Tax Map 59 Parcels 12B and 12F.This project requires Health Department approval before receiving final County approval,m accordance with 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. The applicant has not provided soils information,however since these lots are developed,please confirm if this change to the boundary line will potentially impact any wells and/or subsurface drainfields.I've attached documentation from the applicant regarding the current sewage systems on the subject property. Should you have any questions or comments please feel free to contact me. Sincerely, /444- Senior Planner Department of Community Development Voice: (434)296-5832 ext. 3097 Sewage Disposal System Operation Permit Commonwealth of Virginia Department of Health Health Department Sn-90.-36 . Identification No. •17 • ss-1, s- i Thomas Jefferson Health Department axMap No. 11P Valley Investment Group • is Hereby Granted Permission to Operate a (Type) Sewage Disposal System Having a Design Capacity of 600 gpd, at aUa9LVIS1QtI SECTION/BLOCK LOT Oak Knoll • p 1 This permit is Issued in Accordance with the Provisions of 32.1, Chapter 6 of the Code of Virginia as Amended and Section(s) 3.22 of the Sewage Handling and Disposal Regulations of the Virginia Department of Health and with Previously Issued permits 90-125r Dated with the understanding that the Owner and/or any Subsequent. Owner will operate the Sewage Disposal System in Accordance with the Sewage Handling and Disposal Regulations of the-Virginia Department of Health and any Variances or Conditions Granted. Issuance of an Operating Permit does not imply or Guarantee that the Sewage Disposal System will Function for any Specified Period of Time. VARIANCES GRANTED SPECIAL CONDITIONS - o NONE ❑ SEE ATTACHED in;`NONE 0 SEE ATTACHED 7C- 2 2 - 7o 1\k-A Effective Date • `"" Recommended (Sanitarian) - Approved (State Health Co issloner) CAS. 2os gill. 4/83 • ,1,. -- I -. Comp#etirornn Statement. Commonwealth ''oftyiginia • ii\) , ( -1 State Department of Health • '''0 . ' .Health Department Identification Number _ • _ Health Department r ration/Individual: 14///1/1-4v7d,r-,. I- ( 4 I A f'Name of Company/Co po • 7 /// l A' Le.hA !� i _ T hone: 9 '_ (i, ( 7 ele � Address. � __ ,�"' r P ,6' Owner's Name c Owner's Address _ Location of Installation: Lot _ Block Section: Subdivision: Other: I hereby certify that the onsite sewage disposal system has been installed and completed in accordance with the con- struction permit. issued (date) and is in compliance with Part D of the Sewage Handling and Disposal- Regulations and when apprdpr ate the plans and specificatipris for the project. R/g 7. 7 /10/40,-frogie._.., ge, (r:- ,e .1 ..d f Date _ , Signature and Title C.H,S.203 Rev.4/83 4`•,, , - i Z' • Sewage Disposal System Construction Permit PAGE OF Commonwealth of Virginia Health Department ll p - --4. Depa q t o lealth 1 1' - Identification Number .Noi.S`( ' Health Department Map Reference 9 - /7 'T/ ✓r General Information New [epair 0 Expanded 0 Conditional ❑ FHA ❑ VA ❑ Case No. Based on the application for a sewage disposal system construction permit flied in accordance with Section 3.13.01, a.dpn t ction permit is hereby issue to:/ p p-�?. 7 7 CO Owner V.1-� ' i t1-e4 C:,Y0*•�-,l) �T // Address f'D • V*Jx I& Z Zy IU3 L- ., Telephone For a Type Sewa e_d' osai system which is to be constructed on/at Subdivisio L. Section/Block Lot / Actual or es ' DESIGN NOTE: INSPECTION RESULTS Wafer super existing: (describe) Water supply location: Satisfactory yes no ❑ �� comments To be installed:class G.W.2 Received: yes Err-to ❑ not applicable p cased 7.1_ grouted Building sewer: Building sewer: yes e no 0. comments ll--�i I.D. PVC-40, or equivalent. Satisfactory Slope 1.25" per 10'(minimum). ❑ Other _ Septic tank: Capacity __.__)?mod gals. (minimum). Pretreatment unit:. yes Zno ❑ comments 0 Other Satisfactory r Inlet-outlet structure: Inlet-outlet structure: yes 0 no 0 comments PVC 40,4"tees or equivalent. Satisfactory - ❑ Other Pump and•pump statioi_ IC r station: yes 0 no ❑ comments . No ri7,- Yes 0 dE if yes: - Gravitymains:..... " or' 'method: . 1 yes p" no ❑ comments 100', 1500 lb. crush I CJ V core Ai- ❑ Other ll Distribution box: -1 coIx: no yes ❑ comments Precast concrete with! �� ❑ Other • i • Header lines: yes no ❑ comments Material: 4" I.D. 1500 Ib! ' lent from distribution ti \ - . Slope 2"minimum. Cl Other Percolation floes: y7 is: yes no 0 comments Gravity 4" plastic 1000� l t r c equivalent, slope 2" 4" ( _ O Other —_— Absorption'trenches�YnA • Absorption trenches: yes Ern; ❑ comments - Square ft. required ,( , depth from ground su fact' Satisfactory to bottom of trench `► ; aggre ate sizy �1,.: Trench bottom slope 1.-4 e. (O � center to center spacing_„ q r ; trench width �`_r Date o � � Y� Inspect'd`,and�approved by: Depth of aggregate ) 3 , , . V im✓+ Trench length 99 ; Number of trenches .. ` ° V V Sanitarian C.M.S.202A Revised 6184 it-2 FILE COPY f • J • - 1 . 1, I • . • .• ' . • , I I • • f • Yofa34aiie3 .ripiasb viorle ons odiiott L , • .I-•i : • • • .o:tr, ' vazr log11;1 "-9 murairtim I•:1.1. m-2161 u f • . . 1(t=•:a. .:;;:... •:ralZVILNO 1n I. 741014:: - �,"• . .� I ±-1o:a;_;_1. •P , •1.11011 —__,.._, • ,...._,--•.. •....,..1.1 I 4 . . .• Tar, !*...i: :1il:, ,.IC).nieliig r''iai]'-•••;;:f}cu1.)' I.&;i^,? r' 11,1rz cb r ri, 'S+ D? ),It. • 1 I I 1. 11 ^r'_,1-...L 2 '?. Qf1i1:;3Ci ;4Cf Y_^ •fil t , • • .'Q;1' •.S:2Ct (x.'.ii ..:!n- , • 1 It . - I i . . I. r • . I ' - . ` - • I ••I I . . • - ) - •. I . ,_ . Sewage Disposal System Construction Permit PAGE ,i L of Commonwealth of Virginia Health Department O , '3 Depa mgapt of.Heattt�h - identification Number -68-j �, ]] • V_ Health Department Map Reference 9 /7 7 1 General Information New Er-lepair 0 Expanded'❑ Conditional 0 FHA 0 VA D Case No. Based on the application for a sewage disposal system construction permit filed in accordance with Section 3.13.01, a,don�trfiction permit is hereby issue to:," Q'7�j Owner V�VJCx-'.,i �� 1 Telephone r 7 l - 7 7 S.t� Address 00 f Z Z Y t 3 L For a Type L Sewa e.di osal system which is to be constructed on/at Subdivislo L- A Section/Block • Lot / Actual or es ' DESIGN NOTE: INSPECTION RESULTS Water sue.existing: (describe) Water supply location: Satisfactory yes [�"no ❑ comments /' To be Instal .class G.W.2 Received: yes 0 no ❑ not applicable l� cased grouted Buildings wpr: Building sewer: yes t<] nO 0 comments I.D. PVC 40, or equivalent. Satisfactory Slope 1.25" per 10'(minimum). _ ❑ Other Septic tank: Capacity 17.Q d gals. (minimum). Pretreatment unit: yes (2Kno ❑ comments ❑ Other , Satisfactory Inlet-outiet structure: Inlet-outlet structure: yes Ono 0 comments PVC 40,4"tees or equivalent. Satisfactory . I 0 Other - Pump and-pump station: Pump&pump station: yes 0 no ❑ comments No ID" Yes ❑ describe and show design. Satisfactory AiJ if yes. 11 1 / , Gravity mains':)&o larger I.D., minimum 6" fall per Conveyance method: . yes Q" no ❑ comments 100', 1500 lb. crush strength or equivalent. Satisfactory . ❑ Other ... Distribution box: - Distribution box: yes no ❑ comments Precast concrete with—�ports. Satisfactory O Other Header lines: Header lines: yes no ❑ comments Material: 4" I.D. 1500 lb. crush strength plastic or equiva- Satisfactory lent from distribution box lb 2' into absorption trench. Slope 2"minimum. n Other - Percolation lines: Percolation lines: yes Olio 0 comments Gravity 4" plastic 1000 lb. per foot bearing. load or Satisfactory equivalent, slope 2" 4" (min. max.) per 100'. ❑ Other Absorption-trenches:/ Absorption trenches: yes p 0 comments Square ft. required r�f� no: depth from group su faces Satisfactory to bottom of trench "r Z ; a$gre ate size �j. 5. Trench bottom slope ?-4 ( 0 - center to center spacin� _; trench width. Depth of aggregate Date _ IV+pAct an approved by: Trench length - 9,4 _; Number of trenches T 1t.) Sanitarian C.H.S.202A Revised 8414 11.2 FILE COPY k/ • '• Health Denartment L • ldentifica Number GO— '°— " Schematic drawing of sewage disposal system and topographic features. PAGE _.OF 7/ Show the lot lines of the building lot and building site, sketch of property showing any topographic features which may impact on the design of the system, all-existing and/or proposed structures including sewage disposal systems and wells within 100 feet of sewage disposal system and reserve area. The schemitie.di•awmg of the sewage disposal system shall show sewer lines, pretreatment unit, pump station, conveyance sys- tem. and subsurface soil absorption system, reserve area, etc. When a nonpublic drinking water supply is to be located on the same lot show all sources of pollution within 100 feet. _ ✓ 0 The information required above h been drawn on the attached copy of the sketch submitted with the application. Attach additional sheets as n•d ssary t 1 strate the design. • • •ll ‘ . q . 4) ns V � l• o • 1 l l& s...--.--) -di - ‘4 / I /Q�` \ - cijk I • Aid top' ` ,' 1 / \/ `\ \ , \./ - --Jr- %A- r . S /.r • The sewage disposal system is to be constructed as specified by the permit rnirattached plans and-specifications ❑. This sewage disposal system construction permit is null and void if (a) conditions are changed from those shown on the application, (b) condi- tions are changed from those shown on the construction permit. ' No part of any installation 'shall be covered or used until inspected, corrections made if necessary. and approved, by the local health department or unless expressly authorized by the local health.dept. Any part of any installation which.has been covered prior to approval shall be uncov- ered,if necessary,upon the direction of the Department. v .------ Date: _ L d Issued by: . - .% . t • This Construction 2 L thYiv , J " i 9G Reviewed L '9' t Date: by: � .` Supervisory•Sanit$rian� , (-'} If FHA or VA financing i Reviewed by Date Date Supervisory Sanitarian Regional Sanitarian .• • ; • • • • • • • „ , • • • ` - + • _1 J L7/ tI 1 1 ; OP f r •ff % •1 •. •SS. + t �.l !!! i 1 '1 r I •„ mil' .1. 1 ,• ;!)- r 1 ,• t - 1 Y �' `1 .1 /I 1 ' I . ; I ., t f I• •1 ....-1 -- - i, f I • it ! 1 .' I I (.• 1 , 1 I ,.. 1 j i. i' '?'. . r. • • %i • : c , - �:- • ; r ! 4''i ------'' .. / Itom•;, J•' ,I ;\ f i/f cc •r4 • • c • t, • Soil Evaluation Form PAGE / OF Z— Commonwealth of Virginia Health Department Department of Health Identification Number t%a)- 9 d _ 3 Tax Map Number 5..-1 -/Z F- 7 General Information Date 2".G2- TO T 1 • i �r Health Department Applicant V CCLA, r1 VV e,%41G G rap Telephone No. 7 - 77(0 6 Address_ SR �` I (c` / Z ZJ ) Z Owner -i Address Location S .>'?. <0/ O• , (��) tdd • Le) (it dr7 U1 Subdivision 04- 11 Block/Section Lot Soil Information Summary 1.Position in landscape satisfactory Yes I"No 0 Describe 2.Slope 8- % 3.Depth to rock/impervious strata Max. Min. None 4.Depth to seasonal water table(gray mottling or gray color) No I2 Yes 0 inches 5.Free water present Noes 0 range in inches 6.Soil percolation rate estimated Yes[ Texture group j. II OP IV No❑ Estimated rate s/ min/inch 7.Percolation test performed Yes 0 )lumber of percolation test holes No LY Depth of percolation test holes Average percolation rate Name and title of evaluator. Signature: yiDepartment Use ite Approved: Drainfield to be placed at_f d�depth at site designated on permit ❑Site Disapproved: Reasons for rejection: 1.❑ Position in landscape subject flooding or periodic saturation. 2.❑ Insufficient depth of suitable oil over hard rock 3.❑ Insufficient depth of suitabi soil to seasonal water table. 4.❑ Rates of absorption too s . 5.❑ Insufficient area of accep ble soil for required drainfield,and/or Reserve Area 6.❑ Proposed system too cl e to well. 7.❑ Other Specify' C R S.201A Revised 4/87 V-1 Date of Evaluation Z-G+q b Profile Description Health Department SOIL EVALUATION REPORT Identification No I)—I v - ''' Page Z of "` Wherethe 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 )-and reserve site shall be showne reverse side of this page or prepared on a separate page and attached to this form. dSee application sketch egee construction permit 0 See sketch on reverse side or page attached to this form, Hole# Horizon Depth(Inches) y Description of,color,texture,etc. Texture Group - 30 67 6 ." c -60 by id, t/ rr" 0 /24 0- K. 9-1)12,5(0)1 z-e_-_-_ t.,e._C 4v GI 67 "i1 () 14 0-(0' ,--- Zg--67o yf-i L Kl Gam-- c 0 A . 01:"^-4.o7 mac. • � o , � ..7:11- ----Vir �vo 4 i Remarks • CAS 20111 w.sre4n7 V-1A Application for a Se ige Disposal System lonstruction Permit Commonwealth of Virginia For r ment1$e On Health Department ed ` _�p��� Department of Health *9 1 1 Identification Numb tof 1 D c. Map Reference 5 R'`I Z I%- .1 i Health Depar t Date Received 1 ^ 31 _ To Be Completed By The Applicant Type sewage system: , 1241ew ❑ Re air 0 Expanded ❑ Conditional FHA/VA yes no ,p 6 Owner v U I� a"5 Address P U k 16 ti 9 Phone `- 7‘® r � � n� Agent 6 rG l ‘4YG Address 5a""`�---- Phone Directions to Property (o56 61k, !; TMP 5G -I2 'ctcJ, ,96 - 5Ate Subdivision 6 {i IN-had Section Block Lot Other Property Identification _ I 441 Dimensions/size of Lot/Property 6 ' 6rt-s • Other Application Information I. Building/facility New 0 Existing Intermittent Use 0 Yes [-No If yes, describe: II. Residential Use �Y 0 No� Termite Treatment l�'Tes 0 No 0 Single Family ❑ Multifamily Number of Units — Number of Bedrooms Basement Tee 0 No Fixtures in Basement ❑ Yes 0 No iii0 ,.41 _f--, III. Commercial Use 0 Yes (o Describe: Commercial/Wastewater ❑ Yes Erg; Number of Patrons Number of Employees If yes, give volumes and describe IV. Water Supply: 0 Public 0 New Describe: ❑ Private ❑ Existing _ V. Proposed Installation: ,��6 ! O Sep is tank And drainfield 0 Other If other, describe q / J SITE Attach a site plan (rough sketch) showing dimensions of property, proposed and/or existing structures and PLAN driveways, underground utilities, adjacent soil absorption systems, bodies of water, drainage ways, and wells and springs within 200 feet radius of the center of the proposed building or drainfield. Distances may be paced or estimated. The property lines and building location are clearly marked and the property is sufficiently visible to see the to- pography. I give permissio to the Department to enter onto the property d scribed for the purpose of processing this appl ation. 014_ 1 0( • �-� 0 '.‹.- I 1 '3/' CO /ingnature ownedegent Date C.H.S.200 Revised 4/E3 r 5s6,15 — !l �-. •..---- ••95 a .,.....\c..././ i .1 0 - • J- ;7 f • F 1 .„- y i l PT Fi - I - ter- 1�/�'' r r ; ... 1, y c. r' ('i +�. ,4:_ E • • l� ',`' •' !/ r t \L J ' CY f ;,���4�'^ 4.0 •0 =ar 4 z1: j.21 i• 1•11.. • e-r"` . .• %. :TY • / 1 r` t / !/io / i `r:- BtWE?11T h © . • air • hr t �• i re-o=i _ ,2'DRa;;ti4CE �--� �F 1. , '_ v. 1 -T 2 r N..40,1)_3% + / I i i`` .....V - ,'" • '".7t.t*.,.- "., Q - • ' • •0 ..)). t• i ir ' o y' ��'j�.`' A Wit- '.� tl : `# `' CI 0' ` V `'Q�J ;9°03 29-'E 25.82' /I Q; , 4 S 43°47.19' E 69 00' .i S4;°34, $40°42':.t"E secs f/ 2 '1� Zc.• S 25°C4'Co,.E 'E 21' / LI Sv'O58`3i:"E 63 95' %/"i `? r---t,- ?.. S00°34.0i"W 6700' r J rh' 46 13 S02°39'50'''N 84 C3' :-.� ':-'FE Sib°32';3"w 98 85' ^j SI2°17'53"W 51.14' 2 SOO°59'531E 32.!1 `' PSZ4°0023'E 5000 _ _ S38°34'09"E 60.89' N �,r,` --�C--= - r,•.iSTH NGTON 527O51.24..E 52 ry a DR - DB 61 42.E. 427 o_AT; 516°!1'52..` 32 9i' • paa _ ' S06°00'23'+X 44.0C' . ~lP_i�T. S19°18'58''W 87.79- ? S32°35'35''w 45 38' S 48°30'03"W 814 2t' • ; PT 8 1 6)- k Qf\ 6 Q\\\ • °b of * o,!I F- ,./ • ' Q Z I .. . . /°8l THOMAS JEFFERSON HEALTH DISTRICT • Important Notice PLEASE READ BEFORE FIUNG YOUR APPLICATION AND PAYING YOUR FEE This is to inform you that the fees for environmental health permits mandated by the State, cannot be refunded once the application has been filed and the fee paid except for the following reasons: 1. If you , as the applicant, withdraw your application before the sanitarian makes a visit to evaluate the property. 2. The Health Department is unable to issue a permit and then only if you • own the lot and:,are seeking to construct your principal place of residence on this lot and you provide written notification to the Health Department that you are foregoing your right to appeal the• denial of your request for a permit. In order for you to then appeal at a later date, the .above• refunded fee would need to be paid before a hearing date would be scheduled. BEFORE YOU PAY THE FEE FOR A SEPTIC SYSTEM PERMIT PLEASE READ THE FOLLOWING CAREFULLY It is your responsibility to make it clear to the , sanitarian which one or two areas on your lot you'want tested, although he will advise you which areas appear more suitable for a septic system. No more than two areas will be tested and the permit will be issued showing the location of the system in only one suitable site. The site cannot be changed later without additional expense on your part. (You will need to hire a private soil consultant to test another site and submit his report, along with a new application and fee to the health department). If you do not intend to build now but only need the soil tested before a sale is made, we recommend that you hire a soil consultant to do the test and apply for a Health Department permit when you know where you want to build. • I have read and understand the above application notice. /77 gnature' App cant Date v ` Note that the back of this form may be used for your site plan sketch. A. • ;ao..r, cw.2 :OMMONWEALTH OF VIRGINIA tgza•+o,000 WATER WELL COMPLETION REPORT • ewcM No. •State Water Control Board (Certification of Completion/County Permit) • P.O.Box 11143 • SWCB Permit_2111 North Hamilton St. . Richmond,Va.23230 County Permit Certification of inspecting official: County/City Q__, This well does does not County/City Stamp - meet code/low requirements. S. _ •Virginia Plane Coordinates - lt — Date N •Owner Val (� t�rlvv��]I2 Ns(�[�t� . ` l For Office Use E *Well Designation or Number Latitude& Longitude . _ ,Address f oar) .IGI t4-1 p N haJNICtLE4V1i IX. ,_C)nI . Tax Map I.D No. w Phone Subdivision •Topo.Map No. Section •Elevation• ft. •Drilting Contractor ) � l_.l/ ( Block - •Formation Address / t Lot •Lithology 1 V 3 Class Well: 1 ,HA , •River Basin_ Phone &Kr) 97.3 '9075 - IIB. , 111A , IIIB _____ •Province IIIC _IIID II1E •Type Logs WELL LOCATION: (feet/miles direction) of •Cuttings and feet/miles (direction) of -�- �_^_ ---__ •Water Analysis • (If possible please include map showing location marked) � _ r •Aquifer Test ,.�/ Date started '-•! q t • Date completed c')q 0 Type rig I.WELL DATA: New Y- Reworked Deepened 2.WATER DATA •Water temperature _ _ ___ OF •Total depth_ eQ,D. ft, *Static water level(unpumped level-measured) __ ft. 'Depth to bedrock CI ft. •Stabilized measured pumping water level__ �T ft. •Hole size(Also include reamed zones) /� •Stabilized yield gpm after _hours • ID . inches from __ to 3.�.�9 _ft. Natural Flow: Yes No flow rate 7 _ 3 pm •_ Q orr-r_inches from to ]— _tt. Comment on quality__ _ • inches from to ft. 3.WATER ZONES. From To____� -� •Casing size(I.D.) and material From To , From To • to'W inches from v to 3� ft. From — - 1, To From To Material_ �IQ, tom, 4. USE DATA: Wt.per foot or watt thickness in. - Type of use: Drinking 34 . Livestock Watering_ _ • inches from _to ft. Irrigation Food processing.___ .Household Material Manufacturing ,Fire safety __ ,Cleaning_ _ • Wt.per toot or watt thickness in. Recreation ,Aesthetic .Cooling or heating • inches from to .ft. Injection Other Material •Type of facility Domestic % _,Public water Supply, Wt.per toot ' 'or wall thickness --in. Public institution Farm__,.. , Industry • _ •Screen size and meth for each zone(where applicable) Commercial ,Other ' • inches from_ to— ft. 5.PUMP DATA: Type _ 'Rated H.P. •Mesh size Type •Intake depth ♦Capacity at head . • inches from __Jo ft. 6.WELLHEAD: T T YPc welt seal •Mesh size Type Pressure tank gal., Loc. __ a inches from to ft. Sample tap ,Measurement port •Mesh size Type _. Well vent , ,Pressure reli:f valve • inches from to ft. Gate valve .Check vat a Heinen required) •Mesh size Type_ Electrical disconnect switch on power supply •Gravel pack 7.DISINFECTION: Well disinfected ___ yes no •From to ft. Date _,Disinfectant used ' •From — to It. Amount , flours used •Grout 8.ABANDONMENT(where applicable) •yes no •From b to c^0 I t.,Type e_ Casing pulled yes_ no•___ not applicable •From to Typeft., to Plugging grout From _ _ --material • OVER , • 'Owner -- ,• BWCM No. -----.— .. • wv • : 9. Stale law requires submitting to the Virginia State Water Cons,ol Board information about groundwater and wells for every well made in the State intended for water,or any other non-exempt well. This information must be submitted whether the well is completed, on standby.or abandoned. Information required includes: an accurately and completely prepared-water well completion report, full data from any aquifer pumping tests,drill • cuttings taken at ten foot intervals (unless exemption is secured). the results of any chemical analyses,and copies of any geophysical togs. Quarterly pumpage and use reports are required from owners of public supply and industrial wells,County or State permits to drill may be required in some pans of . . the state. Some counties require submission of a water well completion report.The Virginia State Health Department requires a water well completion: - . report for public sypply wills. 10.DRILLERS LOG (use additional Sheets if necessary) 11. 12.DIAGRAM Of WELL • CONSTRUCTION ' (with dimensions) DEPTH(feet) TYPE OF ROCK OR SOIL . _ REMARKS Drilling . from To . (color,material,fossils,hardness. (water.caving,cavities. Time . iiiium .etc.) broken,core.shot,(atc,1 '(shin.( 0 3q L,-YTh(,cd. 1 %IDi„W',' • . 39 5' --, 3Q t • - . • I /I "404 .. 13. Well lot dedicated? .Sue ft.X ft.;Well house? — • Distance to nearest pollutant source ft..Type. Distance to nearest property line _ ft.,Building It. 14. WATER SERVICE PIPE: Chec*ad under p.s.i. for State Water Control Board Regional Offices minutes. Pips size inches. Material Valley Reg.Off. Piedmont Peg.Off, Installer 116 North Main Street 4010 West Broad Street Dote — ____ _ P.O.Box 268 P.O.Box 6616 Brldgswater,Va.22812 Richmond.Va.23230 ' 70342e-2595 004.257.1006 Southwest Reg.Oft. Tidewater Reg.Off. 15. I certify that the information contained herein is true and correct and that this well 408 East Main Street 287 Pambroks Office Park and/or system has been installed and constructed in accordance with the requirements P.O.Boa 476 .Suite 310 Pembroke No.2 for well construction a specified in compliance with appropriate county or independent Abingdon.Va.24210 vs.Beach,Va.23462 city ordinances and the laws and rules of the Commonwealth of Virginia, 703-628•5183 e04.4994742 �I West Cerium Rag.Off. Northern Virginia Reg.Oft. • bI J4 fi. _�7 ISeal).Date c -a3 —9 CSExecutive Park 5515 Cherokee Avenue • • •_I driller or authorized b rson) 5512 Peters Cr“k Road Suite 404 L e 'o. . Roanoke,Va.24019 Alexandria.Va.22312 — -- ' 705-982-7452 703.750.9111 • • . f-1 G-!U -A I Fes• I Biological, Chenical, ana rnysical Analysis of Pater, Mr, and Solids; I Biological and Cheaical Treatability Studies: Flog Measurenents .L.A 3E1 a F.:Ar T Q F~: I X INC: I -P.O Bo: 4005 : Charlottesville, Va. 22903-0841 Phone (804)295-17I6 - • VALLEY INVESTMENT GROUP 08/16/90' ATTN: ,BRAD COGAN P.O.BOX 1648 CHARLOTTESVILLE, VA. 22902 • '•'''��....•�.r`.,►,y,n„rwt.r•..ti.k:�r .z�}- .'_• -•.. ayr�.. .�i.�:. +r....a.1s• :1.� .. .... _ .. .. J._. • _.-....-c •._ _ BACTERIOLOGICAL ANALYSIS 'REPORT TOTAL COLIFORM IN DRINKING WATER JOB NUMBER: 0117O7 SAMPLE NUMBER: 0117O7 DATE RECEIVED: 08/15/90 DATE REPORTED: 08/16/90 • • IDENTIFICATION: • OAK KNOLLS WELL, IVY 8-15-90 9:30AM SAMPLE MEETS STATE STANDARD FOR COLIFORM BACTERIA '• IN DRINKING WATER. • RUN BY THE MEMBRANE FILTER PROCEDURE. M6Ylt•1t�' i L- 1 <1 COLIFORM BACTERIAL COLONIES PER 100 ML. OF WATER; `' TO MEET THE STATE STANDARD FOR COLIFORM, DRINKING RATER SAMPLES RUN BY THE:;.• 3 - • • MEMBRANE FILTER PROCEDURE MUST HAVE NO MORE THAN ONE COLIFORM BACTERIUM PER• " • .100 ML., AND NO MORE THAN 2Q04BACTERIAL COLONIES ON THE•MEMBRANE FILTER. - • _ '•"_." • • • THE SYMBOL ')' SHOULD BE READ 'GREATER THAN' • THE SYMBOL '(' SHOULD BE READ 'LESS THAN' • • - AQUA•—AJ;R LABO AT I NC REPORTED BY 2