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HomeMy WebLinkAboutSUB201700103 Assessment - Environmental 2017-07-05 Page / of II OSE/PE Report for: Construction Permit I I Certification Letter_ Subdivision Approval -- Property Location: 911 Address: City: Lot Section Subdivision "Ay 11•44 GPIN or Tax Map# 7 2- u) 3 E Health Dept ID#r Latitude Longitude Applicant or Client Mailing Address:y Name: D✓,44 )V1 Street: Y03 prim S/rdae.J City' rt/lGSLt7G State Of Zip Code ZZ?OZ Prepared by: OSE Name Rt`Vpwrnet Co;I (r jj €01-2y4-QL9$` License# 19'boo/357 AddressP_d• 7gy' 1 City C e Sw r�k. State IM Zip Code_2Z717 PE Name. License# Address City State Zip Code Date of Report 0tr/eKI/2011 _ 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.) —2 Caih A frici.nl+yn for /1 7104 ry..31" ci-# £. ..I.7 ; Ssis rr 9-fo 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 VACS-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 the w 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 nstruction permits certification letter subdivision approval be(select one)issued enied U OSE/PE Signature .� Date 009/a/J /ye. zofi/ Commonwealth of Virginia • VDH Use only Health Department ID# Application for: ewage System ater Supply Due Dare Owner A,,,Lr Phone Mailing Address 3b33 .8,4_,n(ty Shak.,•+ LeI Phone h sila,K!'Sid/e 1l/A ZZ9L3 Fax Agent f 4(L , )(4 Phone f/ 5/-q77- Mk> Mailing Address ) q03 ,,4 i c r Phone C•A b4.i 1.4loct,dte VA 1ZZvz Fax Site Address DD Email Directions to Property: .. ,...fi.s,1 ei /�aµk 6 W 1.4" •i(5,/'es_ lied ad- L,,,,Je. 6 yQ Subdivision LIirlki d FA ow di Section Block Lot 3 Tax Map ZZ iferz) 3 E Other Property Identification Dimension/Acreage of Property 3.610 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. OCertification Letter 0 Construction Permit 0 Voluntary Upgrade 0 Repair Permit- Proposed Use: Single Family Home(Number of Bedrooms 3 ) Multi-Family Dwelling(Total Number of Bedrooms ) Other(describe Basement? es[ to Walk-out Basement 6No Fixtures in Basement 6No Conditional permit desired?DYes DKr- If yes,which conditions do you want? ❑Reduced water flow ❑Limited Occupancy ❑Intermittent or seasonal use ❑Temporary use not to exceed 1 year Do you wish to apply for a betterment loan eligibility letter` ,0Yes *There is a$50 fee for determination of eligibility. Water Supply Will the water supply beOPublic or rite? Is the water supply©Existing o oposed? If proposed,is this a replacement well?[ Yes arc If yes,will the old well be abandoned?DYes ONo Will any buildings within 50'of the proposed well be termite treated?DYes EEO Ali Applicants Is this a private sector OSE/PE application? es[ To If yes,is the OSE/PE pac a attached?lares 5No Is this property e indeed to serve as your(owners)principal place of residence? es❑No P In order for VDH to process your application for a sewage system you must attached a plat of the property 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 sewage 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 visible 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 Engineer as necessary until the sewage disposal system and/or private water supply has been constructed and approved 6/13 I/ Signature of Owner/Ag nt] Date This form contains personal information subject to disclosure under the Freedom of Infeormation Act. Revised 12/1/2014 VDH Use Only Health Department ID# Due Date Site and Soil Evaluation Report (For certification letters and subdivisions) General Information Date. (7(, cI/Zpz7 ta•mork County Health Department Applicant• ✓toe. `` Telephone Number: V 3y ,,7� - 977- l0 Address• 1103 pr4fi, Sr ce,1- l'ik/Lif.esut I(1. (/1 Z2 90L Owner: ;,11.4y L RyLi Address:%,33 Location •Codsr j,. et IN! f f1- -qc odes W 1- L k '/a Subdivision 17h4J �, i.�/y Block/Section Lot 3E Soil Informs •on Summary I Position in landscape satisfactory Yes No_ Describe:fit unc 2. Slope [ % 3. Depth to rock/impervious strata Max.SL Min. None 4. Free water present No Yes_ Range in inches 5. Depth to seasonal water table(gray mottling or gray color) 09 inches 6 Soil percolation rate estimated Yes f exture group ❑I n 1 I II nIV No Estimated rate 7o min/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: Tkso,.. K Xrk�e-d'4 Signature. i✓-- Depart t t se _ ire approved: Drainfield trenc ttoms to be ed at j (inches)depth at site designated on permit. _ Site disapproved. Reasons for rejection:(check all that apply) I _Position in landscape subject to 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 dramfield,and/or Reserve Area. 6. _Proposed system too close to well. 7. _Other(Specify) OSE Form G(pg I)Revised 7/02/2009 Sfi VDH Use Only Health Department ID# Due Date Site and Soil Evaluation Report (For certification letters and subdivisions) General Information Date•_T Zelp Al _,..,.r)„ __County Health Department Applicant: /.cc pj.Lwt Telephone Number. — 777- 7 rrff nQ Address: L0 3 PA✓k. $ / L6114,i 10l-1.0-r t&.- i/f4 21102 Owner: ;� ,�v hint j Address: 3433 1,,.,r,,� -b., i&rd �,,.�cuy(i Location . 5,,.K,s d. al- Fe,,,,k. 6 y l . 4-1- .YS,k;1.s wtsf Yo Subdivision / d fry Block/Section Lot 31 Soil Inform3tion Summary 1. Position in landscape satisfactory Yes No_ Describe: 2. Slope 5- 3 Depth to rock/impervious strata Max. 60 Min 4o None 4 Free water present No Yes_ Range in inches 5. Depth to seasonal water table(gray mottling or gray color) A//,f inches 6. Soil percolation rate estimated Yes `� Texture group ❑l ❑II 1I ❑IV No Estimated rate ry min/in 7 Percolation test performed Yes Nti nber of percolation test holes_ No ✓ Depth of percolation test holes Average percolation rate mpi Name and title of evaluator: ��„ K sU 6.4.0. Si nature: / Depart nt Use ite approved: Drainfield tren bottoms to be ced at /Z(inches)depth at site designated on permit _ Site disapproved. Reasons for rejection: (check l that apply) 1. _Position in landscape subject to ooding 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 I)Revised 7/02/2009 Page of N Date of Evaluation• 451/42,/24 j7 Profile Descnption SOIL EVALUATION REPORT Property ID: Trty inir 22_ p .g.I 3E. 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 #2 O-7 7.5171(01 13el,.w.het a LA,... RI- 7-e7 .4 - Vey,..r,;<i. G/•+y, L.,...., e B Z9- ef3 1-`!I2"/!r PoIJ.s1,yells,, t if Guy lee.ef n R 'ir4- 4E0cr -/!l"ca• S.►e.r+ 2 A d-s- 7.SY,C'1/y $gyro.,/.., C/.«�. �,,r% 20 - s 8' '-33 57 ve, v.,lfow-rs j Le Ch+j./. i 8G 33-4t 5-ye! yt;f(n,,,,sLr t 9 kE Cl.,y nw, sir 3 4 0-Y 7.5-pt trig B.-e..v► C ti.i lsr B4- Y -Z s r t silt ' Ile,..s1.L16( Y..o,,� Ls--3� 7tYILs/i, 5+.�•e.,t B ,, i eior Ljo-w, lir R1k.A/c. Id l9 D-S `Y0.N q �'e,�Gl ry Ge.twt IV lit S-3i9 Z.S ' GY� Kai 6.1i-t Cf le..w. $c 39-46 z-sYAYk Ind l ett-S 0.7 Le.�,.„ or s R a-G 7.5"YR V Y Rm..,.a (..cfkf 61,r, `sr.r, - Bf b-37 2.s1�.'+/&, .e -s.'I 1�,.,.., or le- 37-6o Z,5"It 1J 44 G. S G/47 Limo, _ li A 0-{t 7.nit`'1f L`hoc." Feac,4.S:JF Lem SiC 1+ 6-Y( z sr yl4 Ad. s;l G Lowrn. Icir it- 91-1 i s1-K wl` 4.t1a at, R.4 L ftf-el./ 10,70. REMARKS OSE Form G(pg 2)Itevised7/02/2009 Page G Of'2 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.a� This abbreviated design covers the 0 primary and reserve area, C�YtSnly the primary area, 0 only the reserve area(check one)for 'ram /L., 2Z pre.e1 3ir (property ID). Design Basis • Total length of available area: [pQ Total width of available area: 5-7 Estimated Perc. Rate: 70 at IS' in.(depth) Number of bedrooms(or GPD): 3 B, e,- tiro 6P9 Conveyance Method: /c,,,,T Distribution method (specify): ,tZ Dispersal system basis3 i 1 L r.y o/SH.D/t- one 135-A LGMI required? ea (Y:4 .j Effluent quality required: /;V., ! 'Prim. Secondary.Advanced Secondary) Square feet per bedroom: tiDY Total trench bottom area required: /Z2 N It, i Gravity,pump,siphon z Enhanced flow,LPD,or Dnp Dispersal s Table 5 4 of SHDR or identify the GMP used Area Calculations Number of trenches 7 (Note if a pad is used) Length of pad or trenches: fops Width of pad or trenches: 9 3 Center to center spacing: Reserve required? Yr,s Percent reserve area required: (00/o Total width of absorption area required 3-7' Total trench bottom area provided: We ,.A. 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 Ij Design Calculations Property ID: 'T.�r 4/7 2Ze ai/ 36 Flow Type of use(residential, etc)ges eJ,,,10./ Show Calculations Here' No.of bedrooms: _, No.of employees: /i Square Footage of building space:017 g. Daily flow (peak design) in GPD: 4Sa Treatment No.of septic tanks:jj Show Calculations Here' Size of septic tank(s): t000 drr/le.1 Pretreatment required? _yes If yes, specify type of treatment device: Absorption area design Soil Texture Group: li ' If pump system, enhanced flow, or LPD show Reserve area rr uired? es no calculations here or on a separate sheet. _ 50% ✓O0%_other(check one) (dosing volume, head, pump design, etc.) Specify other Water Supply Class of well: 1I lffef l Describe(bored, drilled):' I t//.j,v aialj Distance between septic tank(s) and well: SOIt- Distance between absorption area and well: /Qp'#- Information and calculations required for commercial and/or conditional use applications only OSE Form I Revised 7/2/2009 Page o 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, C�6n&the reserve area(check one)for T f/7, zL p..,ruI 3IE (property ID). Design Basis Total length of available area: Sa 1 Total width of available area: 7.5" Estimated Perc.Rate: SS" at 9L in.(depth) Number of bedrooms(or GPD): 33f o. "$2 afP Conveyance Method: /j,�,,� Distribution method (specify): o✓rnig I 7;44,4A 3 Dispersal system basis 7 ` S.'/ of. SWDIZ LGMI required? AZ (YetalD. Effluent quality required: Ary _ (Primary)Secondary,Advanced Secondary) Square feet per bedroom: VIZ t Total trench bottom area required: /Z 34 ?.4. Gravity,pump,siphon z Enhanced flow,LPD,or Drip Dispersal 3 Table 5 4 of SHDR or identify the GMP used Area Calculations Number of trenches 9 (Note if a pad is used) Length of pad or trenches: SC 1 Width of pad or trenches: 3 Center to center spacing: ? Reserve required? Yes Percent reserve area required: /Nil Total width of absorption area required 75- Total trench bottom area provided: /3s ',. . 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 y of a System Specifications Property ID: -Tv /l17) ZZ. Ip,i,.Lf 3E - �''r•R/ Applicant Information Name jjrki_e /hw,ro Phone /3y-%77- gry0 Address 9P3 Rgrk . 1,r�,s1- let ka7/41C Ott ZZ9oZ Location Information Tax Map No. ZZ pfru( 3E Property address GPIN No. Di rections $„�„�� l (/tions � ���t; SectionSubdivision R� Block �/0 / • IS^/Ls Lot 3 General Information System Type Number of bedrooms 3P,L (e.g. septic tank, drainfield) Daily flow ysaGPD (gpd) Type of property 'es; K.1i (e.g. commercial,residential,etc.) Conditions Sewer Line Septic Tank-Inlet/Outlet Structure Schedule 40 PVC,4" equivalent Capacity: taw gallons (add check or describe equivalent below) 2r' septic tank la000 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 Conveyance line/force main Information Distribution box Information Method No. of boxes (e.g. gravity,pum ing, dosing siphon) No. of outlets /Z If pumping, attach Pump Spec Sheet Surge or splitter box required: Material S,,L J J y0 PVC Yes_No Pipe diameter Z" Slope of pipe d/IMF (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 18' inches Aggregate depth a inches No. of Laterals 7 Lateral length [go ft. Lateral bottom slopel-Zinches Lateral width 34 inches OSE Date 04/09/2017 OSE Form J Revised 7/2/200 Page /41 of // System Specifications Property ID:__ Z2 nr. 3E ` eseevL Applicant Information Name g r �i4y,q. Phone 'Y39-9 7 7 - EM6 Address go; ,+,,k Sh..,4- 614,420,441I a c4! 22`I0 Location Information Tax Map No. ZZ ,,,,,, Property address GPIN No. Directions St�� d /QBd1C OP Subdivision 4 /,,..,Ilift„ly 41- •ys r/4s Glcs1 L9D Section / Block Lot 3E General Information System Type IC Number of bedrooms 38XC (e.g. septic tank, drainfield) Daily flow tfSp Pb4 (gpd) Type of property I (e.g. commercial,residential, etc.) Conditions Sewer Line Septic Tank-Inlet/Outlet Structure Schedule 40 PVC,4" - or equivalent Caacity: moo gallons (add check or describe equivalent below) 2'septic tank l OOo 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 Conveyance line/force main Information Distribution box Information Method No. of boxes / (e.g. gravity,pump' ,dosing siphon) No. of outlets /if If pumping, attach Pump Spec Sheet Surge or splitter box required: Material 5614,i JAG y0 TVG Yes No Pipe diameter 1` —Slope of pipe M (in inches) Header line Information Percolation line Information/Absorption Area 1500 pound crush strength Yes ✓ / Center to center spacing 1 ft. Minimum slope is 2"/100 ft. Yes ✓ Required spacing q ft. Installation depth YL inches Aggregate depth a inches No. of Laterals 7 Lateral length SD ft. Lateral bottom slope 1-Zinches Lateral width 34 inches OSE Date !xi/01Ati 7 OSE Form J Revised 7,2,2009 i vc r7 1-1.,1. \u/ - __.vv na.1 ....J lr. i P. v) . • Lots (A) and (B) are to be / \s< �' P� ,�a�2 2`� combined to create a 3.00 Ac. � ' 10' (B) %`���' o� parcel to be known as Parcel 3E. TAP 22-3C �2 , Well Esmmt. �A� Per 0. Finley C. Ragland, etals / existing / I,A 5a 0.8.4875 Pg.498 • / dwelling 0�/ A^7 CD 0� /<0 ./ ` i.. \ (C) /`, ,�b / \fir / Iron . 4i / Parcel 3D ,sso / Fd. • q ` �°� 0 / tih / 00 h,�o rf9,\` PDF .. N. a, / New 25' Wide cop /� 110% , RDF �,�� Pti /Access Easement / do \ oo�,�e5 12^ // ti$ /_ (0 hO x.a1 .� `ti0J c�a / 10� G42 / �0 TAP 22-4A2 r 0 C / ffr�ey L. Shifflett, etux/ \ \ea�ay�� \\ / y /•_ a �`.`. c -7e 0 / A Q / Ohl 0.8.891 Pg.630 ?h f / / .\cJ\// 0,�\ / 2ti / ,�, /?r 4 (A / 1 N I`-‘APFr 100 Years >'->./40 W* •/ o,� ' 100' Stream` Flood Zone ` r�1 /! Buffer '� �fr R � PDF� /;'pO�� / / \ ' (1) N44'52'55"W 149.65' - OLD LINE I.w / Iron \\ (2) N44'57'57"W 149.67' - NEW LINE X___.. ---- - .. •s1 Fd. \ denotes building site creek 1_ / 22 ` )/ /0 /` Dam Break // off/ /245 Oj/ `� Indunation / Or°cr \; Zone / / Lot / 0 \ TAP 22-4A / / / / Samuel Meade Harris, etals / / (B) / h> 0.8.4602 Pg.99 / / / / .per / / / / ah - / / / co _ - IF/ 35`ps // 5 120icv 4ti�/ 3927.3 1'tO a�,4 4��) Mon onth Ed P90' Fd. t 1) - o 4 RECEIVED IJ 5 COMMUNITY DEVELOPMENT