HomeMy WebLinkAboutVA200200026 Other 2002-10-12 2
Page Number ' ost-it®Fa: a 7671 Date pages►" 101 -02-0694
To / From
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Schematic drawing of sewage di: Co./Dept lC�lA /�i/ sc Co/6, �o �
Show the lot lines of the building site,sketch of pro Phone# Phone# im,including
existing and/or proposed structures and sewage dis osal system
shall show sewer lines,pretreatment unit,pump stat Fax# Fax# rig water
supply is to be permitted,show all sources of polluti
❑ The information required above h_._ ___ _ _. _ , ,
EXISTING EXISTING - 4 TRENCHES •
WELL / . WELL - 50' LONG EACH N
\ - 3' WIDE EACH
- 42" DEEP EACH
PROPOSED - 9' CENTERS
TRAILER / - INSTALL ON CONTOUR!
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MANHOLE \ /
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LEGEND
PROPERTY LINE — - - -
CONDITIONAL PERMIT: DRAINFIELD
RESERVE EAREA 1 `,
OCCUPANCY LIMITED IRON PIN FOUND
WELL AREA
FENCE x x
TO 2 PERSONS! STREAM POWER LINE --- --
SWALE
1 1.lr
This sewage disposal system and/or water supply is to be constructed as specified by this permit. ,
This sewage disposal system and/or well construction permit is null and void if(a)conditions are changed from those shown on the
application(b)conditions 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 uncovered,if necessary,upon the direction of the Department.
This Construction
Date: Issued by: Permit Valid until
Environmental Health Specialist
Date: Reviewed by: MARCH,2004
Environmental Health Supervisor
aai as,i goys,. a,/.va a L. sys ago 1. v..1 La1v 11 v11.ucua.U1 11Gvl11.11 ALL L 1UC. 11101, LEA UVL
TAG SHEET
Permit I.D.#: JO!— d R -O() 1
Owner: Q 6erM J� J& ,p/) son
Agent: ll U 1 aXx1 HOP?e s
Tax Map #: "5
Subdivision: Lot: "'
fiv‘mbination Permit 0 Repair Pe rmit {} Septic Permit {} Well Permit
Well Abandonment 0 Certification Letter
DATE INITIALS Q
Application Receives "LI0a
Assigned To: ( ojh 941 6 � f) tLA.
AOSE Submittal {}Yes '07No
Site Visit Scheduled r I?PA
00bR-
/&ooio: .
Comments: 4/1�- /6tA aneE. Z 7-5e?({01.11'4-4 -r 4li ,i ri tr i40- 44 afi.1�, 6.1L7' r. l rr�rdF e�x F �+ rclnlL�
c_ /� r,RaO..�.J.r�c }�,Y V. 1+ASSQCS Ars7IT /i.-,'r26 Nr..01e,1e.A1 nyrc_io_ .
Site Visit Rescheduled
Time:
Site Visit Made
Date Given to OSS
Data Entry
Construction Permit 0 Issued ft Denied
Certification Letter 0 Issued 0 Denied
Survey Received ft Yes ft No
Construction Permit Mailed
Construction Permit Picked-Up
Septic Maintenance
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