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HomeMy WebLinkAboutSUB202000102 Certified Engineer's Report 2020-05-27 Page ' of I OSE/PE Report for: Construction Permit n Certification Letter n Subdivision Approval�✓I/ Property Location: 911 Address: City. Lot R Section Subdivision Didee.se /fr`eAa►pn) • GPIN or Tax Map# 3/ fiirt.) SA) Health Dept ID# Latitude Longitude Applicant or Client Mailing Address: Name: �pysr 14f. /lSSe 4.� ZKr. Street: /(1(e3 Q�erkmr►r Csur City: akrtcrliv,o7/►s State VA Zip Code ZL94) Prepared by: OSE Name AVIAYof9 ,�; �'�„su �w Ltt y. -2Y9-40z97 License# I7r000/Mt7 Address 7.6. City 451.ltek State 1)13 Zip Code Z294/7 PE Name: License# Address City • State Zip Code Date of Report OS/Z7fZ02D Date of Revision#1 OSE/PE Job# Date of Revision#2 Cont ents/index of this-repo '(e.g..Site Evaluation Summary,Soil Profile Descriptions,Site Sketch,Abbreviated Design,etc.) '-2L7aj.J O Pk ISA PAO. I hIA prat S-L Drfr, eahs ,iikir•oi"�tyq fir 7 Certification Statement 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 and regulations of the Commonwealth that have been-duly issued by the applicable agency charged with licensure to perform the 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 1 recommend that a select e : ronstruction per min certification letter subdivision approval be(select one)issued denied L OSE/PE Signature • Date d.S/Z7/2CZ0 r• .7f Commonwealth of Virginia VDH Use only Health Department ID# Application for: Sewage System [Water Supply Due Date Owner &hoe el /At ,D:or ese 41 Asek,A'r c Phone Mailing Address _ 7000 CArou_se I LAne Phone • & .L 1 UA 2329(1 — Fax �f • Agent Koper A'17 s h°SSAG•1 tole Phone Y3t/-2?3-31 qf— Mailing Address / 61,3 ,Der k rim - (ear,.+ Phone CAtr'oI *sviIIe 1/R 22901 Fax Site Address II Email Directions to Property: 6oulh/ciJe of �4e 76f; 1-� •1 tl��es Ll/isf e� /Cowes -4, 3 Subdivision D;oL<Se aL escJ J Section Block Lot A Tax Map 31 p.4rc,1 S.AI Other Property Identification Dm-tens100410titige of Property Y.3.2 Ac 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 system and to apply for a construction permit(valid for 18 months)only when ready to build. neertification Letter '1-Construction Permit la-Voluntary Upgrade litepair Permit St/III/Won teivsei.J Proposed Use: • Single Family Home(Number of Bedrooms rr ) Multi-Family Dwelling(Total Number of Bedrooms ) Other(describe Base 'o Walk-out Basement` Y''esEINo. Fixtures in-Basement esEINo Conditional permit desired?[DYes re If yes,which conditions do you want? ['Reduced water flow ❑Limited Occupancy ❑Intermittent or seasonal use 0 Temporary use not to exceed I year Do you wish to apply for a betterment loan eligibility IettertYes Go *There is a$50 fee for determination of eligibility. Water Supply Will the water supplyhr ihlic Q> 'wale? - ` Is the water sup ...__. _ ?_ If proposed,is this a replacement well?DYes No If yes,will the old well abandoned?]14 [o Will any buildings within 50' of the proposed well be termite treated'1 J' eS 1Vo All Applicants Is this a private sector OSE/PE application?_DYesaNQ If yes,is the OSE/PE package h ;e1I0 Is this property indeed to serve as your(owners)principal place of residences? _ In orde.for VDH to-process your application for a sewage system you must ati ,hed-aplat of fhepropeity and a siite sketch. 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 swage system. When the site evaluation is conducted the property lines, building location-andthe proposed well and sewage sites must-be clearlymarkedandthe property sufficiently 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 Engineer as necessary until the sewage disposal system and/or private water supply has been constructed and approved. Signature of Owner/Agent Date This form contains personal information subject to disclosure under the Freedom of Information Act. Revised 12/12014 ?ye 3 o>I 8 VDH(Ise Only Health Department IDk Due Date Site and Soil Evaluation Report (For certification letters and subdivisions) General Information Date: 051271ZD24 /Q��i.nnwr/ County Health Department Applicant: Roemer G►1. IQ.. , 19Ssoe. n= .. Telephone Number:/ 9381-27-3-3/95- Address: L,L3 Zw_km*r Ga,.rkek.J/.hsfsi e V.4 ZL9i/ Owner:,fl L1 et fir Dpceir .J, ing.)Address:7pap ewreussf La.a..41.+ruil/I 1329Y Location: Se/4410;1 iI 4,41.. 7 y; f/ .1 dtrLs 414.1el /P.a.laz 41,s Subdivision recess Block/Section_ Lot /f Soil Inform ' Summary I.Position in landsc • ape satisfactory Yes, No! Describe: Jltev.ltLr/Ivjk rt. - 2. Slope 3. Depth to rock/impervious strata Max. 10 Min. 76 None_ 4.Free water present No ✓ Yes Range in inches 5. Depth to seasonal water table(gray mottling or gray color) A//A inches 6.Soil percolation rate estimated Yes ✓ Texture group ❑Il IV No Estimated rates'$"min/in 7. Percolation test performed Yes___ umber of percolation test holes_ No _ Depth of percolation test holes Average percolation rate_mpi • Name and title of evaluator: 346ov k. /Suet C.O.0• Signatur • �' _ . Depart Dt Use LoS'ite approved: Drainfield tre h bottoms to be t .'ced at Li,(inches)depth at site designated on permit. _ Site disapproved: Reasons for rejection:(check 1 that apply) / I. _Position in landscape subject tor'ooding or periodic saturation. 2. _Insufficient depth of suitable s.il 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) T— OSE Form G(pg 1)Revised 7/02/2009 Page V of f Date of Evaluation: pz//t120za Profile Description SOIL EVALUATION REPORT Property ID: Ttr .,A.31e.c.i S#I-Als,45e of 14.4ho,.01- 1.4•47 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 this form ✓See 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) Group i A 0-7 IONYh Nelt AirportL..,., ffi 7-s3 z.srefla Q.J, d,,,>w-6, 14mm GI". J. _ BG r3-(., VOA Ytr//inwrr ,L'd iiyAf G. L orn __ CB GI-?o Urrirt4 c-YRyig llins Yel,1d 7.fYt44LJJ,il. yeliaus I11+ u h,.r, -sac EM A 0-4 7,SIR 9/y a*.,.,..It...v, a - BA 4.22 slit J V.Ue,,e sl.El Jt A , h.,'.., -= $t zz-y? rtsh Clfs. h.. = RG y1- 7Y 7..0tV/,,S+r.,., dirt.tn L:,1}L LAMMLC C8 7y-90 /OYAW R,.._..k.I, yal..,2r jti i ,LA. 3 A 0.7 7$y,fifYin...,. Ld / a :{ 7- 2 .t. e4 G,..., .3xt- - C y2-9e 7.Sntr6tAir«78�..,..LJ�t>tiC/.�, 1..., 1111111 Mi. REMARKS OSE Torm G(pg.2)Revised7/02 2009 Page S.. of a Design Calculations nn / Property ID: Trur >� 31 wrL.I SAI - .Zkoccsc s� �f.��,,.,,�d - 44 A" 11 Flow Type of use(residential, ctc) ks;j,,,1.4e) Show Calculations Here No. of bedrooms: 1B No.of employees: OR Square Footage of building space:l$ . Daily flow(peak design) in GPD: Treatment No.of septic tanks: / Show Calculations Here' Size of septic tank(s): /ZSD Pretreatment required? _yes o If yes, specify type of treatment device: • Absorption area design Soil Texture Group: If pump system, enhanced flow, or LPD show Reserve area uired?_/yes no calculations here or on a separate sheet. _ 50%_.••'100%_other(check one) (dosing volume, head, pump design, etc.) Specify other Water Supply Class of well: ' CC L J411 Describe (bored,drilled):Zri pad,,, Distance between septic tank(s) and well:Sa't Distance between absorption area and well: IQo't Information and calculations required for commercial and/or conditional use applications only OSE Form I Revised 7/2/2009 Page 6 Of 8 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, 0 only the primary area, 0 only the reserve area(check one)for T. L-J2• Age,., 1 'A• (property ID). Design Basis Total length of available area: 75 Total width of available area: /31 Estimated Perc. Rate: SS at 6,4 in.(depth) Number of bedrooms(or GPD): y&/C too e� GPo 2 Conveyance Method : 4r,,,,;y Distribution method (specify): G„w eft Wends i Dispersal system basis 1 J, ,E y ofspbe LGMI required? NO (Ye AEI _(frimary)Secondary,Advanced Secondary) Effluent quality required: rfim*t Square feet per bedroom: Y. Total trench bottom area required: /t r:7..4. i Gravity,pump,siphon z Enhanced flow,LPD,or Drip Dispersal 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: 7,s- Width of pad or trenches: 3 Center to center spacing: 9 Reserve required? Percent reserve area required: /60, Total width of absorption area required_ LL Total trench bottom area provided: (fop ,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 8 System Specifications Property ID: 7ix ft2i , 3/p4acJSR/ -Abeesc i'l/f�•i,l'.,oaof /of if 4 Applicant Information Name �„ u) R.• ; ASS_. -r Phone V3Y_273-3I95- Address 4,L.3 i,,, 6.— ,4. C 4.4 i."tis...Ue 1/4 ZZgo, Location Information Tax Map No. 3//2004,/SA 1 Property address GPIN No. Directions 3'4}yillaje ,/ 41dr 74.9 Subdivision AoecS,c ,/ A I ..e.J ♦J ../044 W<si •/ ,g„.++ 643 Section Block Lot A General Information System Type Z Number of bedrooms VBR (e.g. septic tank, drainfield) Daily flow 6,49 4es (gpd) Type of property ge,1:1,440/ (e.g.commercial, residential,etc.) Conditions Sewer Line / Septic Tank—Inlet/Outlet Structure Schedule 40 PVC,4" ✓or equivalent Capacity:d /2-e gallons (add check or describe equivalent below) 2" septic tank irk gallons • Per the 2000 Sewage Handling& Disposal Regulations, Check which option ch�o m Septic tank with inspection port ✓ Septic tank with effluent filter _ Reduced maintenance septic tank Conveyance line/force main Information Distribution box Information Method 6 rift,c ly No. of boxes / (e.g. gravity, pumping, dosing siphon) No. of outlets /2 If pumping, attach Pump Spec Sheet Surge or splitter b quired: Material ,Sc{ttLL NQ Pv4 Yes_No Pipe diameter y" r____Slope of pipe G"j' (in inches) Header line Information Percolation line Information/Absorption Area 1500 pound crush strength Yes! Center to center spacing._ft. Minimum slope is 2"/100 ft. Yes ✓ Required spacing.1_ft. Installation depth ainches Aggregate depth Li inches No. of Laterals ' Lateral length 7s-ft. Lateral bottom slope,Lf inches Lateral width 34 inches OSE ._ Date 03/Ve,,,,zo OSE Form r Revised 7/2/2009 N� �780I8 \9\Tccs\ amT.M.31-4P �LOT 15, BLOCK A, THE PINES P�� m' 6G pSTEVEN B.JONES, � �JAMES C.RITZ P& JANET P.RITZ 0 \ Q 'cotV N,yOGD.B.930-512 �) V'' \`D.B.517-132 PLAT \�-" ' '� N1 .. ...._ ,c� IF AT Q 31-40 F 19.03' q A, THE PINES \cc� %��-/ _ 'HERINO, JR. F- 184-49 9�90 / c,7 cc 132 PLAT \ IRON FOUND z S39 '24'59"E 9. 94 ' o 25'DEDICATION �� _ FROM IF AT 19.03' o ].B. 517-132 PLAT co �FjA - L2 T.M.31-5D -- (A). `" \'� ..; PARCEL 4 �pN,/ 1 �� DONNA G.KEY, PvpNS/- , 4.L tS ,T `._.. • MICHAEL C.KING LOT A © s & GWENDOLYN M.KING 4�i ; � 1, ` `.\ D.8. 3599-500 4. 32 ACRES D.8.592-412 PLAT T M.31-5C IF AT STAKE o STAKE . : `\ FREDERICKCLLHUCKSTEP E 12.28' 2STAKE 2 ::::::: & SANDY M.HUCKSTEp Pam' �`' D.B. 1311-405 6• cDi PROPOSED `:: IS D.B.592-412 PLAT ��SO �' der v `ORAAREAELD �'^ • BOUNDARY STAK0 E ,- o STAKE ) T M.31-5 0 a A oti' s� PARCEL 2 .� STAKE s. JOHN M.RIDENOUR & T. M. 31 5A1 A2 0' IF 7 BRIDGET M.RIDENOUR y �p D.8.5045-500 CZ/ STAKE/N 1 io ,,fl D.B.592-413 PLAT °' �` F 0co .n, ST4KE�,I STAKE TD \• T.M.31-58 J/'J / PARCEL 1 •S h PROPOSED 1 STAKE �o DOUGLAS E.CATON 0 �/ DRAINFI�i_D 5 / D.8. 1362-638 31-5A AREA, STAKE o`� 9• JS, �@( 80TTS SMITH IS' ,� e n�ss IF D.8.592-413 PLAT 48432PLAT s10 �� PSEPTTICD ST7KEaSTAK ��\� -143 PLAT I n DRAAREAELD 6 �� y���. / 5cq�c I = Zoo' IF `9 'Q6,9\ •moo- •y���\�F LOT B T.M. 31-78 7. 98 ACRES J JOHN E.GROSS & ( KATHLEEN W.GROSS tio IF IN D.B. 1082-640, 1' ROCK \ 643 & 644 PLAT - p0 PILE'\R' ozo ti �� cP 4 T.M.31-7 \. �ti BARRY W. WOOD ,,,-`2.'" D. B. 4957-75, 79 PLAT I F • 5� // WHTTF FOR Page / of I/ OSE/PE Report for: Construction Permit I 1 Certification Letter ' 1 Subdivision Approval Property Location: 911 Address: City: Lot Section Subdivision Prim«_c, 2 R.lie-Ad • GPM or Tax Map# 31 p,4,rc. SR I Health Dept ID# Latitude I Longitude Applicant or Client Mailing Address: Name: Rq�r __. K.ay f a� s�C. 'Ii Street: GL3 $«k,.,,,, I City:— C LAC loHwvale State (/4 Zip Code Z29o1 Prepared by: OSE Name R;VAtAr a5.; Ct &. (L[ leg-2In.bee License# r7 y¢OA as-7 Address P.O, Box 758 City ..xek State (/, Zip Code 21?Y7 PE Name: License# Address City • State Zip Code Date of Report 051ZV1020 Date of Revision#1 OSE/PE Job# Date of Revision#2 Contents/Index of this report(e.g..Site Evaluation Summary,Soil Profile Descriptions,Site Sketch,Abbreviated Design,etc.) p 1 r /-2 OSL C,44.s/.1d,t•..1 Av,�J,c./r „ µe // �i% (S:( PtairL L.iak•ws Fr3-s Si.. S.»..,.. • Skis I for 61 boy,e.�, ; • dye ?-Ip Sytt .4P1t&iine Certification Statement 1 hereby certify that the evaluations and/or designs contained herein were conducted in accordance with the Sewage Handling and Disposal Regulations(12 VACS-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 an regulations of the Commonwealth that have been duly issued by the applicable agency charged with licensure to perform tl ork contained herein The work attached to this cover gage 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(selec e): Anstruction permit❑ certification letter subdivision approval be(select one)issued denied U OSE/PE Signature Date DS Z o , 7/? Zo Commonwealth of Virginia VDH Use only Health Department rr)# Application for: ESewage System GWater Supply Due Date Owner S,.sAar ea Ph c J)tatese ei /Q;citn+erJ Phone Mailing Address 7bOo ebieat,L LAhe Phone RR`c lw ij t/A 2329,1 Fax Agent Rol W RAy t ASSoe.� inc Phone '/3t/-293-3l?r Mailing Address Lr(,.3 $e rkmnr Cewet Phone ekteleEErawy/e Y4 Z29O1 Fax • Site Address Email Directions to Property: ls:GL 76 y 4/- . I ordcs 1 kd d &az 6 - Subdivision D;ocese ei. A' A,n, J Section Block Lot 8 Tax Map 31 sin Other Property Identification Dimension/ a ofl?nopetty 7.99 Apess 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. J Certification Letter - Construction Permit -fl Voluntary Upgrade --DRtepair Permit t JugYcsien�yrs w Proposed Use: Single Family Home(Number of Bedrooms 5 ) Multi-Family Dwelling(Total Number of Bedrooms ) Other(describe). Basement es No Walk-nut Basement? Yes3No-- Fixtures in.BasementWesDi+7o Conditional permit desired?DYes( o If yes,which conditions do you want? 0 Reduced water flow 0Limited Occupancy ❑Intermittent or seasonal use ❑Temporary use not to exceed l'year Do you wish to apply for a betterment loan eligibility lettertre Go *There is a$50 fee for determination of eligibility. Water Supply Will the water supply_beErpthlic o vate? Is the water suppl 2 If proposed,is this a replacement well?QYes If yes,will the old well be abandonstiNo Will any buildings within 50' of the proposed well be termite treated?'QYes 13No - All Applicants Is this a private sector OSE/PE application?DYeSDNQ If yes,is the OSE/PE package heed es DNo Is this property indeed to serve as your(owners)principal place of residence?_ In ordee;for NDH to'processyour application for a sewage system'yStumust•;.ttarbediaplatof•the' toperty=and a site sketch. 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 atwage system. When the site evaluation is conducted-the property lines, building location and the proposed well and sewage sites must-be clearly-marked and-the property sufficiently visibleto 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 designs certified by a private sector Onsite Soil Evaluator or Professional Engineer as necessary until the sewage disposal system and/or private water supply has been constructed and approved. Signature of Owner/Agent Date This form contains personal information subject to disclosure under the Freedom of Information Act. Revised 12/12014 fy.. 3 *A// VDH Use Only Health Department IDe Due Date Site and Soil Evaluation Report (For certification letters and subdivisions) . General Information Date: 42.)/,Zo2o, ff/d„,,K/t County Health Department Applicant: .r id A f 4SSot...t_ -fte_. Telephone Number: VSY-293-3(95 Address: , Z 70 Owner:kii, id{Le Mouse se 4 ietelemaj Address: WOO eAri.ce//,,tne d'rc (4U329y Location :S,.,t.411t i, di loadte 7GY , ii- •/mils Id /iI A,uie a 443 Subdivision DeeGSe Id ivAg j Block/Section_ Lot B Soil InfornipOteii Summary I. Position in landscape satisfactory Yes No Describe: rr — — �0d_t��lrer • . 2.Slope /0 % Ti�rtti 3. Depth to rock/impervious strata Max. 40 Min.-CZ None_ 4. Free water present No ✓ Yes— Range in inches 5. Depth to seasonal water table(gray mottling gygray color) N/A inches 6. Soil percolation rate estimated Yes 1//Texture group pi Di Iv No_ Estimated rate 6-3-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: ` �s�, Ki Yrs. C .O. .- L- Signature: _ De,artmeo -'se _ i✓5 to approved: Drainfield trench i`f toms to be plac= at Zf(inches)depth at site designated on permit. _ Site disapproved: ! Reasons for rejection: (check all the apply) I. _Position in landscape subject to floe- ng or periodic saturation. 2. _Insufficient depth of suitable soil a er hard rock. 3. _Insufficient depth of suitable soil o 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 rya VII # VDH Use Only Health Department IDe Due Date Site and Soil Evaluation Report .. (For certification letters and subdivisions) • . General Information Date: 65 17 202 , /14...w.r/e County Health Department Applicant: tier W 'icy i 15oL j Znu Telephone Number: f31i-2Z?-3/9s— Address: 663 Lim.- 1"4„.. 4 1k/aE/nsry✓e Wei L290/ Owner:B, a.tie D:ofass Address:J800tivoKstJL s,. Atisw,j I% Z32,7? Location :Ja.4k3id.c eI /...k 76Y ; It .1 has W.s4 it Zrfg LL3 Subdivision pirgAskAilkinasj Block/Section_ Lot Soil Informs ' ummary 1. Position in landscape satisfactory Yes No Describe: as — — - vfkati. 2.Slope /0 % / • 3. Depth to rock/impervious strata Max. (.0 Min. None_ 4. Free water present No ✓ Yes_ Range in inches 5.Depth to seasonal water table(gray mottling or ray color) 0/4inches 6.Soil percolation rate estimated Yes �,/TTeext_ure group p I Ell Offi QTV No_ Estimated rate Ssmin/in 7. Percolation test performed Yes mber of percolation test holes_ No _ Depth of percolation test holes_ Average percolation rate—mpi Name and title of evaluator: Tg. I. 4y er c.o.d. r, -Signature. �, De ar eat Use —1 tte approved: Drainfield tren,% bottoms to be • aced at,?/. (inches)depth at site designated on permit. _ Site disapproved: Reasons for rejection:(check . that apply) I. _Position in landscape subject •/ ooding or periodic saturation. 2. _Insufficient depth of suitable oil 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.])Revised 7/022009 r - Page $ of // Date of Evaluation' 0.,T 14 JzoSO Profile Description SOIL EVALUATION REPORT Property ID:'�x .31 rye/ SN/ - D:pt ese di /CaGA -].e>< 48 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 this form • _See 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) Group / 1 .- lorry/i ►tIek &in.>r, k. '3C �11111 ;1' 11111 2. f s Mr. o-4 /cva y/ .Dn k Rt...1r. lasso► am. i'� • y ,ji arc. rarAgnillg L7 i!/ .4em ME 3 R 0-11 _4 7.cIR i k.�o,.a,lames -/i.,,..s�.Li /.y As"a MIIMIIIM oric"a . . a = ti 6 .is T.syay4ILI Chsii,..,.. ME is - I...S2 7SYI!YLSron,R4 J1.L.jii8Ci►y 44. INIS2"; Arg, Reje per, -naur,rfs i- J. 111- A.. 7= W ' M _ 27-lr0 Z.sits-, 1 t 1714 d j,..— Ilt 11111111.1 REMARKS OSE Form G(pg 2)Revised7/02/2009 Page of II Design Calculations Property ID: Tx Aar 3/�rul SA/ - D,Ot� i/AtAMa+d - �ol k 8 Flow 11 Type of use(residential, etc) Show Calculations Here' No. of bedrooms: '1$ No. of employees: 4/9A Square Footage of building space:1g001A . Daily flow (peak design) in GPD: 4,10 Treatment No. of septic tanks: Show Calculations Here' Size of septic tank(s): h./6n Pretreatment required? _yes If yes, specify type of treatment device: Absorption area design Soil Texture Group: 21:c� If pump system, enhanced flow, or LPD show Reserve area ired?_yes_ no calculations here or on a separate sheet. 50%_ 100%_other(check one) (dosing volume, head, pump design, etc.) Specify other Water Supply • Class of well: Mr Describe (bored, drilled):]:1[t D„164 v 8,4 • Distance between septic tank(s) and well: S"p't Distance between absorption area and ( well: / frd{ Information and calculations required for commercial and/or conditional use applications only OSE Form 1 Revised 7/2/2009 Page 7 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, oCnly the primary area, 0 only the reserve area(check one)for 7' 3/ l ,o,,,.�„/SAI-D.or�olI/j•J.r�� 8 (Property ID). Design Basis Total length of available area: 7Q. Total width of available area: yye Estimated Perc. Rate: SS at �8 in.(depth) Number of bedrooms(or GPD): 4' i, (o 4PD 2 Conveyance Method : Pa Distribution method (specify): E2.11o44 Dispersal system basis Tjls•s yoi SNDR - GAY/3S-11 LGMI required? No (ye ga Effluent quality required: � * / 1MM Secondary,Advanced Secondary) Square feet per bedroom: 09 . 6i Total trench bottom area required: / .?t .ht zGravity,pump.siphon Enhanced flow,LPD,or Drip Dispersal Table 5.4 of SHDR or identify the GMP used Area Calculations Number of trenches_ G (Note if a pad is used) Length of pad or trenches: 7.01 Width of pad or trenches: 3 Center to center spacing: • Reserve required? yes Percent reserve area required: /D .) Total width of absorption area required_ V' Total trench bottom area provided: 12(074, 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 IT 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 0 primary and reserve area, 0 only the primary area, the reserve area(check one)for-1 3J/44,LSA/-D;ecesc e(ta6rmon.) 'B' (property ID). Design Basis Total length of available area: 7D' Total width of available area: S31 Estimated Perc. Rate: SS at 3L in.(depth) Number of bedrooms(or GPD):SMac_sego 1 2 Conveyance Method : RA Mt Distribution method (specify): EZ-flow Dispersal system basis table S.'/ I S//DR-(,AIf/35-4 LGMI required? 4 (YetL) Effluent quality required: As„ncallMi Secondary,Advanced Secondary) Square feet per bedroom: p Total trench bottom area required: /Zu Gravity,pump.siphon 3 Enhanced flow,LPD,or Drip Dispersal 3 Table 5.4 of SHDR or identify the GMP used Area Calculations Number of trenches_ V (Note if a pad is used) Length of pad or trenches: 701 Width of pad or trenches: 3 Center to center spacing: 9 Reserve required? 11CS Percent reserve area required: too,. Total width of absorption area required Yi Total trench bottom area provided:/Z f p S,h. 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 9 of // System Specifications l 9 Property ID: 7 3/e/44p4,g/ i/ -.DisoteJ. aIlecir.,o.id ' 4 • RtinA Applicant Informaation Name---K r W a � Phone t/� ,�y-Z, _3/9S Address G/ L3 &h.,A- Glir,r�r��sr.;I/c ✓/4 2220/ Location Information Tax Map No. 31 ,....4 _0/ Property address GPIN No. Directions�,,,��,,� 4 4,,4 74 y Subdivision .1"Wks Wail s Q.t. 413 Section Block Lot $ General Information System Type Number of bedrooms 9 (e.g. septic tank, drainfield) Dailyflowd) Type of property Goa LPG (gpd) (e.g. commercial, residential, etc.) Conditions (J/, /3st Sewer Line ,. Septic Tank—Inlet/Outlet Structure Schedule 40 PVC,4" ✓or equivalent Cadpacity: /2S0 gallons (add check or describe equivalent below) 2" septic tank jz.5'o 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 box Information Method No. of boxes / (e.g. gravity, pumping, d sing siphon) No. of outlets /Z. If pumping,attach Pump Spec Sheet Surge or splitter box required: Material 5..L.JJ€ YO ?✓e_ Yes No Pipe diameter gv Slope of pipeiq (in inches) Header line Information Percolation line Information/Absorption • Area 1500 pound crush strength Yes Center to center spacing 2..ft. Minimum slope is 2"/100 ft. Yes ./ Required spacing ft. Installation depth Zg inches Aggregate depth 13 inches No. of Laterals G Lateral length 70 ft. Lateral bottom slope inches Lateral width 3 inches OSE Date Ds,7/2o2e OSE Form 1 Revised 7/2/2009 Page /0 of // System Specifications Property ID:an /)(731 „„1.sag/ - el 41,...,1 I.4 *8-1es ne Applicant Information Name 1Q� W. gel ;Asy z.secK Phone 5'3'/-293-3/9s Address (,G3 227., Location Information Tax Map No. 31 p,.,,./ SA/ Property address GPIN No. Directions $�,,,�,-Jd J/Q, 1g Z Subdivision awe/6,441 1 t'/ .1 aas 1✓.-*E4,1 L 4 3 Section Block Lot E General Information System Type Number of bedrooms S/ae (e.g. septic tank, drainfield) Daily flow 4w£pD (gpd) Type of property t4_1,1.r,tiei (e.g. commercial, residential, etc.) Conditions 11l4P /3SA Sewer Line ,� Septic Tank—Inlet/Outlet Structure Schedule 40 PVC,4" ./ or equivalent Capacity: /1So gallons (add check or describe equivalent below) 2 septic tank /lse gallons Per the 2000 Sewage Handling& Disposal Regulations, Check which option chos�a: Septic tank with inspection port ✓ Septic tank with effluent filter _ Reduced maintenance septic tank Conve ance line/force main Information Distribution box Information Method p„ No. of boxes / (e.g. gravity, pumping, dosing siphon) No. of outlets /Z If pumping, attach Pump Spec Sheet Surge or splitter required: Material .5a411. 4o Puc Yes No_ Pipe diameter 2. Sloe of pipe 0/A (in inches) Header line Information Percolation line Information/Absorption • Area 1500 pound crush strength Yes / Center to center spacing ft. Minimum slope is 2"/100 ft. Yes ./ Required spacing ft. Installation depth 36 inches Aggregate depth a inches No. of Laterals . Lateral length 7o ft. Lateral bottom slope?-3 inches Lateral width inches OSE / _ _ Date 05727 sezo OSE Form 1 Revised 7/2/2009 ._ ' . No,N r7, „ _ , .4,.. .\:o ,,,, -,:,k,,,, T.M.31-4P \� m LOT 15, BLOCK A, THE PINES \ STEVEN B.JONES, P�� ' .. JAMES C.RITZ Ci & JANET P.RITZ QC\�.�•QA'P�\ A c� a D.8.930-512 <� 'Q; Z1`°/ N,i>\ 0.8.517-132 PLAT ���.- `'O,D. J,`!�/' `\,q j4 ,c� IF AT Q �0 ,' ©I� 31-40 �\ 19.03' .',QZ 9�q� A, THE PINES \t<• , ' 'HERINO, JR. 9 ,' . P ' m 184-49 . IRON FOUND �4 z 1'2 PLAT \ S39 2 59 E 9.94 ' 0 25'DEDICATION ‘‘ FROM IF AT 19.03' 3.8.517-132 PLAT m �FjA , - �LZ T.M. 31-50 �1� 10Ix �' \.. ,3.:;:\ DONNACGLKEY, C\� 5 \' ' �.� s" ��""< MICHAEL C.KING �� �NPN� LOT A GWENDOLYN M.KING 4. 32 ACRES \�� D. D.8.3599-500 00AT T.M.31-5C IF AT ::::: PARCEL 3 STAKE o STAKE \ FREDERICK L.HUCKSTEP E 12.28 2�se z <:`.. 6 SANDY M.HUCKSTEP D.B. 1311-405 ,r5NS 21 � "'` PROPOSED �`:(;:. IS 0.6.592-412 PLAT �YlAP s. 2D8\ \ `� `DRAINFIELD • BOUGN DARY / °�" STAKE \ /�STAKE `y ' ) T M.31-5 cJ° 4 3 oni 61 / PARCEL 2 JOHN M.RIDENOUR & a STAKE d`. BRIDGET M. RIDENOUR T. M. 31 5A 1 2 °��I� / D.B.5045-500 '� STTKEji T'� v��F D.B.592-413 PLAT cs •�� P STAKE �37aKE J° T.M.31-58 • / PARCEL 1 S h ?� SEPOICD 1 STAKE,�° \ DOUGLAS E.CATON °. ti��" DRAINFIi�O� aD.B. 1362-638 31-5A AREA, Z TAKEo`co • ..70. s �� BOTTS SMITH IS .� • 8,........,n�ms \ D.B.592-413 PLAT 463-210 s� PROPTIED STAKE 8s AK OG�' -1-243 PLAT43 PLAT DRAIREIELD 6 ���2��9• laic )• : zoo' I F AREA 9s / LOT B T.M. 31-7B 7. 98 ACRES JOHN E.GROSS & ( \ KATHLEEN W.GROSS ti0 IF IN D.B. 1082-640, 1' ROCK 643 644 PLAT ^2 PILE O20 A, .Phi^ � G� �h O�� `t\ T.M.31-7 \. Oti BARRY W.W00D •t D.B. 4957-75, 79 PLAT eI F / 4 42" FOR WHTTP