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HomeMy WebLinkAboutSUB202000057 Study 2020-05-08 1 ' Page 6 of 6- OSE/PE Report for: Construction Permit Certification Letter n Subdivision Approval 12 Property Location: �/ 911 Address. 2 S'Z �lya�1j< L9J City* ,v11.-so le Lot �gia,�e Section Subdivision Pes etcfruit # GPIN or Tax Map# fir par cc l- ; Health Dept ID# Latitude Longitude Applicant or Client Mailing Address: Name: yParnnn, Rae Street: ZScz .Serwel 19ryc 4al • City:__ .Sc,n4M4/;I0e State (/4 Zip Code 2'Ir.7® i Prepared by: OSEName l ltliAnnik £d ensii.it, Ice q y-2a/9r®Z98 License 69 /®OD/3s7 Address Po. 75 City kiesuet State 1/4 Zip Code ZZ9'/7 . PE Name: License.# Address • City State Zip Code Date of Report or/d$t'" ZD Date of Revision#1 OSE/PE Job# Date of Revision#2 Contents/index`of this reporto (e.g. Site.Evaluation Summary,Soil Profile Description :Site Sketch,h,Abbreviated Desig ,etc.) if3 2 OE �j< J �e�wen� 1tK><tOs+ r. g , al gr.,, � v i`/tn•s j 1 / Y tt / - / / . 7 cSt541eds+ ije frteArav- • _Certification Statement t..: i hereby certify that the evaluations and/or designs contained herein were conducted in accordance with the Sewage Handling and Disposal Regulations(12 VAC5-610).the Private Well Regulations(12 VACS-630)and all other applicable laws.regulations and policies implemented by the Virginia Department of Health. i further certify that I currently possess-any professional license required by the laws and regulations of the Commonwealth that have been duly issued by the applicable agency charged with licensure to perform t�,..wolk contained herein. The work attached to this cover page has been conducted under an exemption to the practice of engineering.specifically the exemption in Code of Virginia Section 54 1-402.A.11 i recommend that a(select an constructio pertnit❑ certification letter subdivision approval• be(select one)issued denied❑ OSE/PE Signature , '' ;tr. Date 195705r` o Commonwealth of Virginia VDHUseonly Health Department ID# Application for: 1-''ewage System ljWater Supply Due Date Owner J.)t r,erA ?tkia Phone 7S'7-Ca 17-.5"32s Mailing Address 2$SZ &ire L p Aj Phone •d44sville 0. 2rI,c c Fax Agent Pnw•.in A-ce Phone 75-7-6/7 -532s- Mailing Address 7 s.2 See ve ri#7 c ) Phone 5:4044surIle IVA 2gS9s Fax Site Address 47V Jee r ta+y c Li St.41,ivale 1/9 2its-to Email Directions to Pro Aperty: rl•L.4 .e II tub 7i1 ,:,t.o; 4/ •if. Voi ,i /Cow e 4.7.1 Subdivision R-.ice .Fr/m a 0l Section Block Lot /egalve Tax Map //fp«ra,./S Other Property Identification r: is easion/Ac gage ofProperty•Z/O7 ik•es 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 systern and to apply for a construction permit(valid for 18 months)only when ready to build. 9C-ertification l etter - £onst uction.Permit Dyoluntary Upgrade epair Permit, y ..v Proposed Use: Single Family Rome(Number of Bedroonols .3 . )'1,, Multi-Family Dwelling(Total Number of Bedrooms ) Other(describe) Basemen► o Walk-out-Basements Fixtures in Basement es o Conditional permit desiredltresardr If yes,which conditions do you want? []Reduced water flow []Limited Occupancy ❑Intermittent et seasonal c 0 Temporary use not to.exceed 1 year Do you wish to apply a betterment loan eligibility letter ' ,.p,*There is a$50 fee for determination of eligibility. Water Supply Will_the,.waterS beePat lie lde? .- Is._th:watersup. i'-'•_.a. ' . `.°F':fiee 0_4 02„^_<._: . If proposed,is this a replacement well?Dyes IINo If yes,will the old well be abandonetl9 :es. l o Will any buildings within 50'of the proposed well be termite treated""Yes No .- All Applicants . Is this a private sector OSE/PE.applioation7 7Ye 1 Q If yes,is the OSE/PE.package.attache•q No Is this property indeed:to serve as your(owners)principal place of residence7 IIP,. _.'-_ ?n order for.'DH3;opiopesss'3 your'applica?ion:for•a ewage system youmtal ling14 PTati0fTerprnpertyi ..' ?siteSketc"h; For water supplies,a plat of the property is recommended and a site sketch is required. The site sketch should show your property lines,actual and/or proposed buildings and the desired location of your well and/or sewage system. When:the site evaluation is conducted-the lines, .-building-location-and-the-proposed well and sewage sitesmust be elearly-marked-and-thepropertysufficiently visible to-seethe-topography. I give permission to the Virginia Department of Health to enter onto the property described during normal business hours for the purpose of processing this application and to perform quality assurance checks of evaluations and designs certified by a private sector Onsite Soil Evaluator or Professional Engin necessary until the sewage disposal system and/or private water supply has been constmcted and approved. - C-bC/ c%,i ,cam' -.. . .5 - .�"'2G. Signature of.Owner/Ag nt Date This form contains personal information subject to disclosure under the Freedom of Information Act. Revised 12/1/2014 NTH Use Only Health Department ID: Due Date Site and Soil Evaluation Report (Fbr certification letters ane subdivisions) General information Date .8 2.• , iQ/A,n,,r/e County Health Department Applicant. Amp", Pf; Telephone Number` 7S7'617-S3zs Address. 2982 Se eo�eylwrj,� /Po .Seoks,://r_ .¢/4 ZV5Y0 Owner ir,kz Address: ZrS,T$P6rein,.rr igooj F s,,,//s thizerb Location igefitSde Q J iro, >_. 74e ,414141e5 tail of 624 Subdivision A,c �M,m;'1 - Block/Section_ Lot. es; u Q/ e Soil Informati©irSu mmary I Position,in landscape satisfactory Yes No Describe " , zoNrs i 2. Slope ff 3 Depth to rock/irimper.vious strata Max.52. Min.St None_ 4 Free water present 'No Yes Range in'inches 5 Depth to seasonal,water table(gray mot'tl rgray color) .. inches 6. Soil percolation rate estimated Yes_ Texture group El I 011 11 DIV No, Estimated rate 46—min/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: db Stgna: _ De artm t Use _'Site approved: Drainfield tcenc ottoms to be pl ed at_/i (inches)depth at site designated.on permit. _ Site disapproved: Reasons for rejection. (check al (hat apply) 1 Position in landscASe subject to oding 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. _Proposed system too close to well. 7 Other(Specify) OSE Form G(pg.1)Revised 7/02/2009 • Page If of- Date of Evaluation: /Wit/Z-020 Profile Description SOIL EVALUATION RE O/RT Property ID' MX/rp //S./iarcc4 s - ZBS.o'..cera¢/r+j'S find Where the local health deppartment 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 and attached to this-form. e a 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 d A (eInches) A Ue �°f� 1 1 fj� 1 Group 1 V`S lolK 9/�' Yk ���(Pwr<A Mme.l yf. '�' Kn.4M R 38''s. Rnek 5e1se4� y q e =s`- /o Y91:y�G TIA.%R yi I�e y.PS i�/SrJ drl i /��qrnxc . :Tye s// 'ye 118,.drsl. 11,1 Si*/ e/43 t ►w. _ 7c . 3!4't _ /1,4- Se4of • 3 R. O-4y' tsArK 417.44., 3? $11121fl s ,61. oxt 31- . Y,1 sib I, him 7 .mr� y q //-G i4Vit3//. p.4.4 73vs,d,‘.S,4 to-,3y 5Yas/ ) ll�,rid,Ad.f/�rG/as Iiin ; 39=.Tz SI*37G yzl r;sl Ai I,,hi �,l+ . � - . R. ;'+ - - .Roc&• 1- • REMARKS - OSE Form G(pg.2)Reviscd7/02/2009 Page of g Design Calculations Property ID: 1-pix Zisz. - A:serve. Flow Type of use(residgntial, etc) ReSkj.ey..44)1 Show Calculations Here' No. of bedrooms: ,3 gg No.of employees: //74 Square Footage of building Space:W.7.A . Daily flow (peak design) in GPI): V.C.0 G.PD Treatment No.of septic tank : Show Calculations Here' , S ize‘Of septic tank(s): /AV 64/0A pretreatment required? yes If yes, specify type of treatment device: 13S/T Absorption area,design Soil Texture Group: ICC If pump Systern, enhanced flow; or LPD show Reserve area no •calcu ations here or on a separate sheet. 50% other(check one) (dosing volume, head, pump design,etc.) Specify other Water Supply Class Of well: -3IC.c. Describe (bored, dtilled) EvskyAraled'Well Distance between septic tank(s) and well:. Distance between absorption area and well: foo:f Information and calculations required for commercial and/or conditional use applications only OSE Font I Revised 7/2/2009 Page Of f Abbreviated Design Form This form is for use with gravity,pump to gravity,enhanced flow,and low pressure distribution(LPD)sewage system designs and when applying for a certification letter or subdivision approval This abbreviated'design covers the O primary and reserve area, O only the primary area, E4nly the reserve area(check one)for 7,7y% // ,, g/S -2i Ste � 44,/ (property ID). Design Basis Total length of available area. Total width of available area. 39 Estimated Perc. Rate: (a$'- at _ /g' in..(depth) Number of bedrooms(or.GPD): 3.BiQQ. /s Gip Conveyance Method • 4•. ,, Distribution method(specify): L- -.CA0 Dispersal system basis /4, s-y®/'.sp/D!' -(fP/35, LGMI required? (YeE Effluent quality required. Petv*n., 1MEM,Secondary,,Advanced Secondary) Square feet per bedroom: 37Z . ir Total trench bottom area required: fd/ ,4. Gravity,pump.siphon s Enhanced flow;LPD,or Drip Dispersal 3 Table 5.4 of SI-IDR or identify,the GMP used Area.Calculations Number of trenches S .(Note if a pad is used) Length of pad or trenches: YD'_ Width of pad or trenches: 5 Center to center spacing: ,/ Reserve required? Yes Percent reserve area required: k'®oA Total width of absorption area required .9, Total trench bottom area provided: /206 ,4 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 fit 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 7/2/09 • Page 7 of g System Specifications Property ID: %/5thfr e—j.S - ZITS-2.S�.ere¢wrrs /9o)4 - 4servc Applicant Information Name- , ,n c,�,r ' Phone 7i 7-6/7-532$ Address Z$S2 ,a,„, _ icAddr//e 1/A ,ns o Location Information Tax Map No. . s Pro e address 2 9I P �'� 852 Jiterefihys/Qr,,orf 'GPIN No. Scolim,l e .144 . if.51 Directions yi mh,,rr 4 ifeatc 706. . Subdivision ?e;ce f/ .$°_,41r14. (14,44 o%kufc Section Blocl( Lot ,eesarac General Information System Type Number of bedrbom8 4154 (e.g. septic tank; drapinfield) ' Daily flow t/S®6PD(gpd) Type of property es,-01„t,,4/ (e.g. commercial,residential, etc.) Conditions C /3s'q Sewer Line Septic Tank—Inlet/Outlet.Structure Schedule.40 PVC,4" . or equivalent Capacity: mop gallons - (add check or describe equivalent below) '2°d'septic tank Ali gallons Per the.2000 Sewage Handling&Disposal Regulations, Check which option chos Septic tank with inspection port Septic tank with effluent filter Reduced maintenance septic tank Conye ance:line/force main Information Distribution box Information • Method eveiiu,h No. of boxes (e.g. gravity,..pumping; dosing siphon) No. of outlets ,to If pumping,attach Pump Spec Sheet Surge or splitter b x required: Material BSc Aird,tiJe -y' Yes_No Pipe diameter it Sloe of pipe/"-pp'(in inches) Header line Information Percolation line Information/Absorption Area 1 500 pound crush Strength Yes � Center to center spacing/ft. Minimum slope is 2"/100 ft. Yes 7 Required spacing L ft. Installation depth /f' inches Aggregate depth fl inches No. of Laterals 6' Lateral length 'h ff. Lateral bottom slopel-3 inches Lateral width if, inches OSE � Date 0.V6/0.7oZe, OSE Form]Revised 7/2/200• • UP t.r. FRONT (INTERNAL PRIVATE ROADS) - 25' • !I '� LF. SIDE - 25' '_.--- 'I�8�,9 L 1 1 REAR - 35' r E. • I N 66��2' RES. up L2 �DRAINFIELD `LF. I:F HOUSE L3•„ I.F. \` • •ta f DRAINFIELD� L4� I.F. I I I \ TMP 115-7 zoo :M TAX MAP 115 PARCEL 5 L5�• 20.0�' �, �\ D.B.. 732 P. 100 • N 8.0.5 ACRES S. D.B. 164 .P. 257 18, 76.3�, 1 �. D.B. 164 P. 257 TMP 115-4A z • S 76.34. RESIDUE' 41 I.F. JO E' 1 D.B. 522 P. 399 , 26 E 21.07 ACRES \ .722,g6 7°2.9. ` S 32'00'29" E D.B. '290 P.. 277 - r,, ' 7 I.s. o ' 1., 36.29 _-- , 98. 3• 25.00', IS, IS., - ., . \ 1 N !r !PRIMARY & + 1 ` I.F. - .. !' \ ' r r. RESERVE II ♦a 'fin {1A ., t ` .\�' \ GRAINFIELD I L6 1. Y� 1 _ .. \ O 1 \ 1 \\ ��pp, HOUSE SITE 1 C' \\ \\s'P 11 1 1 \\\ \ �. LOST 1 L' RESIDUEN. .t-,\ \ \ \ 21.01 ACRES 21.07 ACRES ° )% N \ I.S.to o � L8 ui z \\. `\ S.25.00. %`, PIPE \ \ \ 13.02 ACRES FOUND \\ \ \ 6g \ 8:05 ACRES { \ \\ 132 HOUSE SITE 21:07 ACRES PI HOUSE v' 5. 1" ` \ - - v .L9 3 • TMP 115-4B a r. \ \ �\ PRIMARY & N TMP 115-8 . • D.B. 1049 P. 514 ' o pc0 \ \ RESERVE _ v) D.B. 1365 P. 395 D.B. 680 P: 553 • 60� \ • \ •DRAINEIELO _ ° D.B. 244 P. 365 Z N 0 \\ \ ‘ - o D.B. 181 P. 356 • _ OT.{ t I.F.I F \ \ \\ 5:27 ACRES \1 EXISTING 30' PRIVATE `�` N 7S•45� . n \ \ \ 'L10 ACCESS EASEMENT A 24 W \ \ ALONG EXISTING ROAD • 04 Co \ 30:00' D.B. 741'.P. 738 0. \� \ 1622-44, L11 el I -' I.S. O 25.00' • TMP 115-9 TO STATE ROUTE 708 `: D.B. 1480- P. 110 D.B. 290 P. 278 D.B. ,51 P. 11,8. I Page of OSE/PE Report for: Construction Permit.7 Certification Letter I I Subdivision Approval R'`---- Property Location: 911 Address: City' Lot 1 Section Subdivision Diet- figN„,6, GPIN or Tax Map# (/-S'/q,4,4411 S Health Dept•iD# Latitude Longitude Applicant or•Client Mailing Address: Name:. ,PrlrotetA. Fr;aG. - --- _ ; Street: Z8sz Seeve lr+e.y c -Ali Ciity: SGQi<{gui llt / - State 1 - :Zip'Code .2'/S$� • Prepared by; OSE Namef1/t9>1nw ;J Cp„Ig,'�r�4 Lie �,3Y-zq - 029�' License•# 17'9400/3s-7 - Address 0 yx •.7S ' City rCcxw.a.l{e State- 1M _ Zip Code. 225Y7 PE Name: License.# Address City State Zip'Code 1 Date of Report 05 dR' 942.?? . Date of Revision#1' • QSE/PE Job# Date of Revision#2 Conntttents//Index,of thiss report(e.g.,Site Evaluation Summary;Soil Profile Descriptions,Site Sketch,,Abbreviated Design,etc.) P/t d�'1'2 OSE t • 55Nt,,m.,4 .! ltpim", a ILA, I s i'p,Lie F..dthh?t4S,J , n. 1_1 .5 at ' X7 5ys /net :5 ,isrl'' homes r Certification Statements 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 end eeul'ations of the Commonwealth that have been duly issued by the applicable agency charged with.licensure to perform th l rk 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 etf ): construction permit❑ certification letter subdivision approval Er, be(select one)issued denied OSE/PE Signature _mate ®5)48/,ZAZ® f' ' fle Ze48, Corn.monwe91th of VirgI •ia VDHealth Department Use se only [�Application for: ewage System ater Supply Due Date Owner ,bows, 'Pam,. Phone 7.5-7- CI 7-532,s-. Mailing Address` 2S/Si (1,ecee¢a. 404) Phone • 5;0940e Jg ,5'S10 Fax Agent o vtvo ?r,sc Phone 7s-7-4,1.7- Saes Mailing Address Z�'Sz (.5 4. r� £.J Phone .St,,,/M56191 ih4 2 V57e, . Fax Site Address - Email, •Directions to Propertyy; !�art of /,J.. 7 $/ 1.s e 1 -L___l,Za Subdivision Pr r cs Igo„.„17 - Section Block Lot / Tax l f s'in.f..4 I k" Other Property Identification -' -Di iiension/A i .e of .- :.�r:1,:: =, Property 2/L9d Aa- - .. .. - . :Y Ri`Tr:S•T_..v Inl Vey-,- �. .. Sewage System Type of Approval:Applicants for new;construction are advised to apply for a.certificatibn 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. • +-ertification Letter £onstruction Permit � olun '' iary Upgrade '�Y�ePair Permiti� ,yy,o;,ticvrew Proposed Use: Single Familyo •q ) Multi-Family Dwelling(Total Number of Bedrooms ) � Home(Number of Bedro ilk , . . . Other(describ ) - Base n o - -Wallut Basementa`" Ofsti=' Fixtures.in:Baseme o• Conditional pernut desiredlltrisagro If yes,which conditions do you want? ❑Reduced'water flow (]Limited Occupancy 0Interinittent.orseassoonal se :0 Temporary use not to exceed 1 year Do you wish to apply for a betterment loan eligibility IetteiXt o,«*There is a$50 fee for determination of eligibility. r Water Supply �h � 7 Is,il water.sup• . ( _'V'< A; . 4. 'Willfhe,mntersupp e - .''=' -,..,_. •- If proposed,is this a replacement well9.[X,es: lvo, If yes,will the old well he abandone4g4,900. Will,any buildings within 50' of the proposed well be.termite treated,Myes__ ,r o. All Applicants Is this a private sector.OSE/PE applicationgge o Ilya,is the QSE/PE:package.attached es;P3 To._ Is this property indeed,to serve as your(owners)principal place of residence? _--R in''orde,-..forVDir ;pidccess' 4W'application:for,abevvage`sysfem'youninst,atuacbed'-a:plat•oftiiievtdpe tq'and:assiteske -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*wage system. When the site evaluation is conducted•the•property lines, .-building-location-andthe-proposed well and sewage sites must-be clearly markedarid-thepropertysuffieientlyvisibie 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 Err necessaryuntil the sewage disposal system and/or private water supply has been constructed and approved_ - , S ' 7'02 0.20 Q1,v.-J✓ ,/LJ -. . Date Signature of.Owner/A eat This form contains personal information subject to disclosure under the Freedom of Information•Act. Revised 12/1/2014 vmf l Ise Only Health Department ID: Due Date Site and Soil Evaluation Report (For certiflcanon letters'and subdiVisions) General information Date: ,/.9,/2a2o 4/,4.c.,,,,,,,,,,/e County Health Department Applicant. ®nInta /4,ir,e _ Telephone Number 7677—617-532,1- Address. pZS52 Secr&F.ar�is 01 QSke',/,� a2i/&'7 ' Owner. . , ),04 ►A PiTee. Address...; ,5.c,Z y4k,,,yys 1904j,, > .A. dl LYSID Location ,61k5;J. d 4,,,,:/�. 78 ; f' „V Ads des$ dI gale: 420 . - ' Subdivision ,et. Isiwidy._ Block/Section_ Lot / _ f_ Soil,informOon'Summary. 'I..Position'in landscape "satisfactory Yes. ....,'No Describe• 2.Slope 7 .% ' 3.Depth to rock/impervious strat Max..CvO Min. 37 None_ 4.Free water present No 'Yes._ Range in'Inches 5 Depth to seasonal water table(graymOttling or gray color) JU inches. �' 6.Soil percolation rate estimated Yes_t Texture group :El10.11 [7�I' QIV No Estimated rateLS min/in '7.Percolation test performed Yes___ umber of percolation'test holes_ No 'Depth.ofpercolation test holes ' Average percolation rate_mpi Name and title of evaluator if ,/� eH AM=4..„ e.a..0, Stgnatur _ _--,,, e -,,- . __.✓ Departm :eu Us !Site-approved: Drainfield trench ottoins-to be pl 661 at 19 (inches)depth at site designated on penrit. _ Site disapproved: Reasons for rejection (check all. at apply) I. _'Position in landsca subject to Boding Or periodic saturation. 2. Insufficient depth f suitable soi foyer 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. _Proposed system too close to well. 7. _Other,(Specify) OSE Form G(pg.l)Revised 7/02/2009 i C � Page y of Li I Date of Evaluation: Di/29/20.20 Profile Description SOIL EVALUATION REPORT Property ID. �x fir Ji p.sJ s- i .e -ds i/ 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 thesketch submitted with the application. If soil evaluations are conducted by a private soil scientist, location of profile holes and sketch of the area investigated includingall structural features i:e.seivage 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 tot ' form. et application sketch _ See construction permit _ Sec sketch on reverse sideor page attached to this form. Hole# Horizon Depth Description of color,texture,etc. Texture • (Inches) _ Group d A 0.7 /OY,6 D,,rk Ve//Qwrsi ifro,.ij. $ iffpa:4 • Re 7-37 ,rittrh.S•404. �rva s Si1y P.,/y Iewais 2zr Z A o-S' JOY-1 CAP ,Davk//Gm,A p+w,asf.sd#j®.v®..- •, ,: s.. . 3 A d-y- /o Y�y/� /r y./,4L,,.� ,&nt�M sk l.,r,� ,3f Y-38 S'YR r/..;Lll w,;TR.;��.�S.IfC/��+A.s _- A . a-� 1cY1e4// Y►+vk . 4 • Ee. Yz-ZQ S/R�/� pik,4 � ,2,41• A_Lath}, / ,,e4.7 /or, - Y:� • ,e . -Go Al??;2y/,? p,1 s,_l' et ,.a • REMARKS OSE Form G(pg.2)Revised7r02/2009 Page S' of 2 Design Calculations � Property ID: Tx i //S',�,4..c.i'..SP - /i•ece - hi # Flow Type of use(residential, etc) Rie5(otudtheiI Show Calculations HereI No. of bedrooms: ' sie No..of employees: i¢'//4 Square Footage.of building space:2ya74. Daily flow (peak design).in GPD: Treatment No. of septic tanks. / Show Calculations Her& Size of septic tank(s): . /2,Sp Pretreatment required? _yes If yes,.specify type of treatment device: 6, 1/ /,3174 Absorption area design Soil Texture Group: ' If pump system,enhanced flow, or LPD.show Reserve area r Mired? yes_no calculations here or on a separate sheet. _ 50% ''f 00%0_other(check one) (dosing volume; head, pump design, etc.) Specify other Water Supply Class,of well:_ Mt=e Describe•(bored, drilled):.11C4 DwItior $«d Distance between septic tank(s) and well: Distance between absorption area and well, /Dr) - t Information and calculations required for commercial and/or conditional use applications only OSE Form I Revised 7/2/2009 Page 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 - primary and reserve area, ❑only the primary area, ❑only the reserve area(check one)for X /ic/,4'a�l g' — a',? /e1 / (property ID). Design Basis Total length of available area: /25" Total width of available area: 61 Estimated Pere.Rate: 45— at /9 in.(depth) Number of:bedrooms(or GPD). YBR er 60•0 GPD i 2 Conveyance Method G a4v; Distribution method (specify)' _EZ-1/Lai Dispersal system basis' `c4 ie 57.`/ of . LGMI required? da (Ye-10) Effluent quality required: (Primary)Secondary,Advanced Secondary) Square feet per bedroom:7�ir'd'yJ'" Total trench bottom:area required: F y8'e I1.. Gravity,pump.siphon Enhanced flow LPD,or Drip Dispersal s Table 5.4 of SHDR or identify the GMP used • Area Calculations Number of trenches_ ./ (Note if a pad is used) Length of pad or trenches' 1e0 Width of pad or trenches: 3 Center to.center'spacing: 9 1 Reserve required? Yes Percent reserve area required: I0p4 Total width of absorption area required O q Total trench bottom area provided: I900 .► . The required width is calculated by multiplying the center-to-center spacing by one less than the number of trenches and adding I 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 fit 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 7/2/09 Page 7 of g System Specifications Property ID. ; A /9s— Rate 14/ 7 Applicant Information Name s/)D,,,,,, Ake. Phone 757 7-5`32, - Address 28'S.Z ,- c P� Location Information Tax Map No.. //r' ,v,4.3 Property address GPIN No. Directions r4L;J di_A,,s4,e.7o8 Subdivision R,ce fI- .y '4%/ss t4/6.11 4.1,G10 Section Blodk Lot / General Information System Type ,'7" Number of bedrooms. e/8A? (e.g. septic tank, drainfield) Daily flow 40 gpt (gpd). Type of property 45,-►eokoi (e.g. commercial,residential, etc.) Conditions cilde ./3S4 Sewer Line Septic Tank-Inlet/Outlet Structure Schedule 40 PVC,4" or equivalent Capacity: /J gallons (add check or describe equivalent below) 2na septic tank A7/ 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 ance line/force main Information Distribution boxInformation Method - 6.-r,4,,,/,. No. of boxes (e.g. gravity,pumping, d�sing siphon) NO..of outlets if_ If pumping, attach Pump Spec Sheet Surge or splitter,. required: Material SA,c1.1 y® Phi Yes!No Pipe diameter - Sr Sloe ofpipe6".j (in inches) Header line Information Percolation line Information/Absorption Area 1500pound crush strength Yes ..el" Center to center spacing ft. Minimum slope is 2"/1.00 ft. Yes , Required spacing 7 ft. Installation depth /7 . inches Aggregate depth a inches No. of Laterals /0. Lateral length w ft. Lateral bottom slopeZ 3 inches Lateral widthZ inches OSE Date 05 8h,zo OSE Form J Revised 7/2/2009 UP • r•r• FRONT (INTERNAL PRIVATE ROADS) - 25' ' r I g 1: I.F. SIOE - 25' r 1�82 ,. REAR - 35' J 1 663a21 UP L. , I.F '- g RES. „I.F::DRAINFIELD 0.HOUSE L3 i �. W� „ I.F. NI DRAINFIELD L41 I;F. i I 1 TMP 115-7 20.0 I,cv � TAX MAP 115 .PA CEL 5 • L5 ► D.B.. 732 P. too + to o 8.05 ACRES �_ S .1 D.B. 384 P. 283 o I 76'34. ".1f ` D.B. 164 P. 257 TMP 115-4A - $ 76. RESIDUE ��`IF. 30 �' D.B. 115 P. 399 z .I. . 34'26" . 21.07 ACRES 2 O \' ' ,; 7 2.96. 2 96 ' 32'00'-29" E D.B. 29.0 P. 277 r,. I.S. o L. -' , --- Et; 4.„ e 798.63' 25.00' 1 ' 1S I:F.' 36.2` cV .IPRIMARY do a:4 1 \ N. \ ' 'ry. 'RESERVE ` I.F. ` \� \ DRAINFIELD � `I L6 ` 1 `a _ \ \\!O Ole 111" 1 1 1 • \\ \ \o� HOUSE SITE * \L7I 1 c \ • \els 1 1 1 1\ r. \ e \ in q •\ • 7 N. \\ ` \ LO1 1 RESIDUE ;� .t-.` \ \ 21.01 ACRES 21.07 ACRES °p r , z `\ \ CS OA:LS 25.00 : •1 . PIPE FOUND _ `\ \ 13.02 ACRES 14 N \, . \\ 5:69. \; 8.05 ACRES- a \\ \ \ y2 HOUSE SITE 21:07 ACRES 0 • • TMP 115-4B \ \ PRIMARY $ _ TMP 115-8 • D.B. 1049 P. 514 . o, qp \ _ D.B. 13 • 65 P. 395 D.B. 680 P. 553 Z 66O' \ \ \\ In DRAINF1ELD _ _ CO D.B. 244 P. 365 N \ .` , k D.B. 181 P. 356 \\ \ \. o I.F.. \\ ••\ \\ LOT 2 >:• :1 N al \ '•\ \ 15.27 ACRES �L101 `EXISTING 30' PRIVATE ®. 7S'45 24" w\ \\ ACCESS �.EASEMENT i. ` ALONG EXISTING ROAD '. '\ 30:00' - D.B. 741!P. 738 oQ tt ' \� \ 15�2.24' L1.1 4(1 f r- _r I.S. O -"I i MOO' TMP 115-9 TO STATE ROUTE 708 D.B. 1.480 P. 110 • D.B. 290 P. 278 013..,5.1 'P. 118 Page I of ir OSE/PE Report for: Construction Permit Certification Letter Subdivision Approval E Property Location: 911 Address: City- Lot 2. Section Subdivision ,•ee 4-4m,,y GPTN or Tax Map# /IS q.../ S`- Health Dept ID# Latitude Longitude Applicant or Client Mailing Address: Name: .!/A►1/1/a l't e _ Street: 412S2 t.ct`rel,oryi 1 4J City•_ 540.0..50 . J .. State 144 Zip Code• 2/.57O Prepared by: OSE Name ��vat�+�;a �;�' G�,ts�1F;M{ /Lc '/3y ZN7az9g License# I9ytdD/55'7 Address O 8,X 75.8 City tsir.a�,� State .(J4 Zip Code Z2?if7 PE Name: License# Address , City State•__ Zip Code Date of Report OS r am Date of Revision#1. OSE/PE.Job.# . , Date of Revision#2 Contents/Index}of,/t�his report(e.g.,Site Evaluation Summary,Soil Profile Descripti/ons,'Sitte Sketch,OAbbreviated Design,;etc.) O.1-2 S ecti,.73N1 sMen�} , /t 11�i0/f- a f P/44 �-r1►it Pea //laltokos lloft, 5-4 .11 s- � gni /i J f9d7AJaJies4tr� CJo ": Ab 7 575L.., Certification Statement T 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 work contained herein. t. 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(selectee)• construction permit certification letter subdivision approval CI be(select one)issued!: denied 0 OSE/PE Signature Date OSld� i®,:?,p f • Commonwealth of Virg] a VDH Use only Health Department lD# Application for: p��wage System ater Supply Die Date Owner ,1)ga,^a Ittic.e Phone 757-6,/7...17, 73- MailingAddres Z%IS'Z Se,re;Ries 4 Phone . 5e 04..stle lk V4 ,?.`/3-010 Fax Agent 2)pw.,p ?fete Phone 757-(,/7-5-3.23" Mailing Address 2515-2 s«re ilLi Phone . :co44 ,;/f,. MI 79-20 Fax . Site Address �/ Email Directions to Property: O'(/orf ci J. of rpr�E.a� 70$ 4 '47':..V,�ii/s lf/,c� e� .�iw 6 d Subdivision Pei le As+;1 Section Block Lot 2 Tax Map //S' „ „/S Other Property Identification 'Q_P inoirsion/;Mceage ofPioperty I5.27*res 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 18 months)only when ready to build. .9(ertifcation Letter -Construction.Permit 1TYoluntary tipgrade '- 11Cdpair Fermit dy&it,(1�vgw Proposed Use: ins -.5Manlier Multi-Family Dwelling(Total. er of Bedrooms ) Single Family Home(Number of Bedroo Other(descri•e)) Base.. a .- -=:e! a -Walk-out Basement` sDNl) Fixtures-in•Baseme o Conditional,permit desire �DY'es L:''a If yes,which conditions do you want? (]Reduced water flow []Limited Occupancy Q Intermittent,or seaso e ❑Temporary"use not to exceed 1 year Do you wish to apply for a betterment loan eligibility lettg ',, ,;.There is a$50 fee for determination of eligibility. Water Supply - .egr., ,:erl`�.ee ate? . ...lathe:water p`-r^ Imo:' �~ c;".�?1k•!eo.,....'.� ,-_-:..„ . will tliesvafer supp ..., .„ � �, . If proposed,is this a replacement well?DYes__ 'o If yes,will the old well a abandoned?DXes J10 Will any buildings within 50'of the proposed well be'termite treated'f tYes:', o A Applicants ���/� Is this a private sector OSE/PE applisationi; es; Q If yes,is the QSElPE:package hedrDYfes f lo..- Is this property indeed-to serve as your(owners)principal place of residence... .:: . ... . ,,. ICAi Tasys yo ;?PP. it f'Qua sere YOditilt*i;st�i ' =PTa;df ierP Y-a a' Forand/or supplies,,opli ar' of _the ovr min en. a plat property is recommended and a site sketch is required.The site sketch should showyourproperty , proposed buildings•and the desired location.of.your well and/or sewage system. When the site evaluation is condupted-thePmPertY lines, •-building-location-and-the-proposed wetland sewage sites must be clearly-marked-andthe propertysu€ficientlyvisible-to-seethetopography- 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/or pri a watified byr a has privat ee sn e torn Ozucted'nsite Soil Evaluator or Professional Engineer as necessary until the sewage disposalsystem and approveS% 7':�.a s2.0, Q Date Signature of Owner/A ent This form contains personal information subject to disclosure under the Freedom of Information•Act. Revised 12/1/2014 Olt/ 3 a g VDH Use Only Health Department ID# , Due Date Site and Soil Evaluation. Report (For certification letters and subdivisions) General Information Date pS�ogfzoza. 04,•1414i. County Health Department Applicant .Pnv►tn Prc,.e Telephone Number .57-617-S3224- Address. 25:5-2 Scce.e4i.,rys :land Si t4sw.4 29..s90 Owner 2)[2v►,,,,qaye Address:2 cz Secvet-ay.s�iaod ffse+ t/4 z1/s9D Location /141L,<de. .£ 74? ; V ,v,0 s iife,/ I Lir 424 Subdivision l e fKwoti/N .. Block/Section_ Lot 2. / 'Soil InformAtitth Summary 1 Position in landscape satisfactory Yes *C No Describe•ei �� �s stik _ — e K er ag/i�e 2.:Slope % 3 Depth to rock/impervious strata Max. /$ Min. `if.9 None_ 4.Free water present No r�' Yes_ Range in inches 5 Depth to seasonal water.table(gray mottling or gray color) AO/ inches 6.Soil percolation rate estimated Yes._ Texture group 0.1 011 ® 11 I EIV No_ Estimated rate 76 minim '7 Percolation test performed Yes___ ,mber of percolation test holes No .. Depth of percolation test holes Average percolation rate mpi Name-and title ofevaluator: �i � 4r. Signature` r! � • De ar Kent Use ✓Site approved: Drainfield trenc'bottoms to b placed at 17 '(inches)depth at site designated on permit. Site disapproved. Reasons for rejection•(check al that apply) ' I. _Position in landscape subject tp 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. _Proposed system too close to well. 7. Other(Specify) OSE Form G(pg.1)Revised 7/02/2009 i Page V of 8 a Date of Evaluation. d23A11 J,Zo20 Profile Description f SOIL.EVALUAATION REPORT Property ID• l rfX i els Arco J.c- �irxe- A � 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 and attached to is form. Sec 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) g J /- y 1 1 r� t) Group .4 . s! Io t /� {rl Y/ie,t+lEfh dlfiA wl/1 ,7,/f�nAM �f. . . ...£ -Yr 7,31P''RSNa:,, f:1k¢Shy/:fray 7rr - - - O 6 ,MfR%1)q,k j 4 i.... 7 - fif - 7.75?, '7.-ya y// t 1 S/l, it ley ...wa Mar / r Zit WI.. SYi Y 71�,,.f{�, ,P,1 C,Jr�.S,Ay /.'& .4,iw, 3 fit o-sr le viz s/V V.. ie„itA 104 , 84 y- Yt®1 .gib.4,1 S'Ih• • • • REMARKS OSE Donn G(pg.2)Reviscd7/02/2009 gam-- ----- -- — -- - • Page of 3 Design Calculations Property ID: //j 1�.,.J S - kee-Li #2. Flow Type of use(residential, etc) 4/4641,46,( Show Calculations Here' No. of bedrooms: ER No. of employees: yf/A Square Footage of building space:ZY0 h.' . Daily flow (peak design) in GPD: Treatment No..of septic tanks: / Show Calculations Here' Size of septic tank(s): /&Se f, Pretreatment required? _yes If yes,,specify type of treatment device:, 6/"p13s'9 Absorption area design. _ Soil Texture Group: if pump system, enhanced flow, or LPD show Reserve area rguired? es_no. calculations here or on a separate sheet. 50% ifO0%_other(check one) (dosing volume, head, pump design, etc.) Specify other_ _ Water Supply ' Class of well. G Well Describe (bored, drilled). Me;1In//„d or Add' Distance between septic tank(s) and well:S0'4 Distance between absorption area and well:/oi' ' Information and calculations required for commercial and/or conditional use applicatiibns only OSE Form I Revised 7/2/2009 _ Page 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 rimary and reserve area, 0 only the primary area, 0 only the reserve area(check one)for Tx I)7 //_,p41../S' - ��. . - �ds if (property ID). Design Basis Total length of available area: Total width of available area: 12ff Estimated Pere. Rate: 70 at I9 in.(depth) Number of bedrooms(or GPD): o,. goo2 Conveyance Method : �� ; _ . Distribution.method (specify). 17Z- 'fo,,U Dispersal system basis 7jj s.9 et 611,k LGMI required? , (Yee) Effluent quality required. Ap„nriry (attimarD Secondary,Advanced Secondary) Square feet per bedroom: Total trench bottom area required:. , Gravity,pump.siphon Enhanced flow,LPD,or Drip Dispersal 3 Table 5•4 of SHDR or identify the GMP used Area Calculations f Number of trenches_ 7 (Note if a pad is used) Length of pad or trenches. 90 Width of pad or trenches: 3 Center to center,spacing: 9 Reserve required? Ye:i Percent reserve area required: /eo Total width of absorption area required_ S 7+ Total trench bottom area provided, Q 4. The required width is calculated by multiplying the center-to-center spacing by one'less than the number of trenches and adding I 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 fit 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 7/2/09 1 - Page 7 of r System Specifications Property ID: 7777, !Ile,. //s' J.c • ;c� - 4E2 Applicant Information Name_ �AMAA� • Phone .7 7-c/7-;,, 2s Address Sr-iisV,/// I/4 2 fS72) Location Information Tax Map No: r/°',araQ/.S ' Property address GPIN No. �,,�, Directions ll/n44-ile i 4,4 7�8 Subdivision 7,�, ..`�/044 ( si ae 67p Section Block _ Lot .Z General Information System Type . Number of bedrooms Yht (e.g.septic tank, drai field) Daily flow( p gpp (gpd) Type of property 5,4.,„.7/ (e.g. commercial,residential, etc.) Conditions 4.41p psv Sewer Line . Septic Tank—Inlet/Outlet Structure Schedule 40 PVC,4" or equivalent Capacity:. /Z'5Q gallons (add check or describe equivalent below) 2"d septic tank sj/gyp gallons Per the 2000 Sewage Handling&Disposal Regulations, Check which option cho�s n: Septic tank,with inspection port Septic tank with effluent filter Reduced maintenance septic tank Conve ance line/force Main Information_ Distribution box Information Method 6,.4,,,,-4y No.of boxes I (e.g. gravity,pumping!, dosing siphon) No. of outlets /Z: If pumping,attach Pump Spec Sheet eet Surge or splitter lax required: Material 54.11e ,0 l// Yes No_✓� Pipe diameter I' Sloe of pipe(e /0' (in inches) Header line Information Percolation line Information/Absorption Area -71 1500 pound crush strength Yes � Center to center spacing. ft. Minimum slope is.2"/100 ft. Yes ' Required spacing 1_ft. Installation depth 1? inches Aggregate depth i3 inches No. of Laterals 7 Lateral length to ft. Lateral bottom slopeJ•�6 inches Lateral width 36__ inches OSE J Date OS"I08 ��z0 / r OSE Form.'Revised 7/2/200• � A 1 : i.r• FRONT (INTERNAL PRIVATE ROADS) - 25' " �-'� sit L1 I.F. SIDE 25' I 1.5 ' , REAR-— 35' ' t I ,2"1p E, UP 1-2 I N 66 RES. „I.F. \ I.F ,DRAINFIELD 0,HousE L3 I . - . w, I.F: \ N. :. DRAINFIELD� L4� I.F. 1' 1 1 TMP 115-7 co o• TAX MAP 115 PARCEL 5 L5 20.06' I j D.B.. 732 P. 100 / I \ D.B: 384 P. 283 o 'N 8.05 ACRES ,= S 763L�3Oa1 `- D.B. 164 P. 257 TMP 115-4A z I . S 76.34'26. 21.0 RESIDUE ACRES III I.F. 2 E 7 D.B. 'S22, P,: 399 ' 2z .. 02,9`` S 32'00'29 E D.B. 290. P. 277 - i.l 7 . 1•.• O l 36.29' ,- in- 1," -0.63.. 25:00'• 1 1 l4 I.F.',, _' q PRIMARY do °:► l I.F. \ h \ ' ' s. RESERVE 1!° V'A J, \ DRAINFIELD /J L6 ; '% `�, - .� \ 11 \\ \ , O \ 1 1 \ \00. HOUSE SITE \ • 1 c \\ \ \\,per 1 1 1 \ LOT 1 2RESIDUE ;•i -t'-4, \ \ 21.01 ACRES . 21.07 ACRES °�°. ; \ AT \. \ \\ Ls. O,;�•'L8 �`• PIPE \ \• \ 13:02 ACRES FOUND \\ \ \ 6g 8.05 ACRES, M W \ \\ 1 1'� Q014+ HOUSE SITE 21:07 ACRES of 6 \ \ \ }d O •-- t \ \ \. L9 3 • TMP 115-4B TMP 1.158 D.B. 1049 P. 514 0. RO. \ \ RESERVE N \ u� D.B. 1365. P. 395 D.B. 680 P. 553 Z N 660� • \\ \ \.` DRAINFIELD _ . 0. D.B. 244 P. 365 D.B: 181 P. 356 I \ \ \ • o I:F.• \\ \ LOT• 2 \\ ' \ \ 15.27 ACRES - .\ -EXISTING 30' PRIVATE L10 N 75'4524.,. W ; \ \ ACCESS EASEMENT \ I'` ALONG EXISTING ROAD - 30.00' -..D.B. 741:/P. 738 .1+ r. \\ \ 1522.24' L1,1 I _' Ls. O -' 25.00' TMP 115-9 , TO STATE ROUTE 708 D.B. 1480 P. 110 . D.B: 290 P. 278 - D:B. ,51 P. 118,