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Home My WebLink AboutSUB202100173 Review Comments Final Plat 2022-02-24401 McIntire Road, North Wing o� rnv.7r Count of Albemarle Charlottesville, VA 22902-4579 Y Telephone:434-296-5832 o m COMMUNITY DEVELOPMENT DEPARTMENT WWW.ALBEMARLE.ORG `�8GIN1N Memorandum To: Gwen Lacy (Gwen&raysurveyine.com) From: Kevin McCollum, Senior Planner I Division: Planning Date: February 24, 2022 Subject: SUB202100173 Collins Engineering - Two Lot Division Revised TMP 69-19D The County of Albemarle Planning Division will grant or recommend approval of the plat referenced above once the following comments have been addressed: [Each comment is preceded by the applicable reference, which is to the Subdivision/Zoning Ordinances unless otherwise specified.] 1. [14-308.1] A Tier H Groundwater Assessment has been initiated for this application. Results of the assessment will be forwarded to the applicant once it is completed. Please see the attached Tier Il Groundwater Assessment. 2. [14-302(A)(11)] Final plat approval is pending the approval and recordation of application SUB202100176 Collins Engineering BLA. Once that plat has been approved and recorded please update all applicable notes and labels on the plat accordingly. Comment addressed. 3. [14-309 & 14-3101 Soil evaluations & Health director approval of septic systems. Please provide the soils evaluations for the proposed lots for Health Department review. Health Director approval is required prior to final plat approval. Comment stands. Soils evaluations were provided for Lot 3 as a whole with application SUB202100176 (Attached) but do not include evaluations for Lots 3A and 3B individually. Please provide this additional information for Health Department review. 4. [14-306 & 14-3171 Provide a private street maintenance agreement for review by the County Attorney. A private street maintenance agreement template is attached below. Comment addressed. 5. [14-316] Prior to plat approval, VDOT must approve all proposed entrances onto public streets. Comment addressed. 6. [14-302(B)(1)] Include a date of revision. Comment addressed. Please contact Kevin McCollum in the Planning Division by using kmccollumkalbemarle.org or 434-296-5832 ext.3141 for further information. Comments from Other Reviewers: Virginia Department of Health (VDH) — Alan Mazurowski - alan.mazurowski@vdh.vir inia.gov, review pending a soils evaluation report. Virginia Department of Transportation (VDOT) —Adam Moore, adam.moorekvdot.vir ig nia.gov No objection. TIER II GROUNDWATER ASSESSMENT County of Albemarle x Department of Community Development £ 401 McIntire Road, North Wing Charlottesville, Virginia 22902 434-296-5832 1 www.albemarle.org/cdd DATE: 11/04/2021 APPLICATION: SUB 2021-00173 PROJECT NAME: COLLINS ENGINEERING - FINAL - DIGITAL TMP: 06900-00-00-019DO The pending development on the property affected by the above referenced application number meets criteria outlined in Albemarle County Code Article IV - Groundwater Assessments to warrant a Tier 2 Groundwater Assessment. The following assessment uses the best available sources to outline the various groundwater conditions that could have an impact on this property. Water Quantity # of Wells within .5 Miles of Parcel: 18 Range of Depth of those wells: None to 605.0 feet Range of Yield of those wells: None to 60.0 gallons per minute (gpm) Median Yield for Wells in County: 6.0 gpm Water Quality # of Leaking Underground Storage Tanks (LUSTs) within 2000 Feet of Parcel: 1 # of Superfund sites within .5 miles: 0 # of Landfills within .5 miles: 0 Hydroaraohy % of Parcel that Contains Required Stream Buffers: 0.0% Watershed of Parcel (Y/N'): Mechums River -Stockton Creek (Y) 67.9% North Fork Rockfish River (N) 32.1% Geology Bedrock: Blue Ridge basement complex(my) - mylonitic schist and cataclastic rocks, undivided 100.0% Hydrogeologic Units*: Foothills -II 100.0% If you should have any questions, please contact the Community Development Department at 434-296-5832. ' A "Y" indicates that the watershed is a water supply watershed. An "N" means that it is not. 1 69-19 E 69-19 D 69-6G 69-19A7 69-19C Tier II Groundwater Assessment Site Map 0 60 1 20 1 80Feel p8 APP#• SUB 2021-00173 O Subject Parcel - LUSTs u � TMP: 06900-00-00-019D0 O Known Water Wells A Superfund Sites Map Created by CDD on: 11/04/2021 Water Protection ■ Landfills Aerial Imagery from Y2018MM` Ordinance Buffers tr� 2 *Hydrogeologic Units Defined Taken from the 1213012003 Albemarle County Hydrogeologic Assessment Phase ii — Groundwater Availability and Sensitivity Assessment with Proposed Groundwater Assessment Standards. Prepared by ENSAT Corporation, Culpeper, VA. The process of investigating groundwater availability at the County -wide scale involved identifying distinct hydrogeologic units and comparing the units based on groundwater availability characteristics for which data could be obtained. Each hydrogeologic unit shares some common characteristics with regard to geology, soils, and topography, although there is quite a bit of variability within each unit. Nine hydrogeologic units were identified across the County, as follows, and as shown on the Albemarle County Hydrogeologic Unit Map (Figure 2). 1. 2. 3. Figure 2 - Albemarle County Hydrogeologic Unit Map Blue Ridge West-IW: This unit lies primarily on the steep eastern slopes of the Blue Ridge Mountains and is dominated by the Myersville and Parker Soils, and to a lesser extent the Chester. Slopes range from 2-60%. These soils are residual in nature. The Myersville soils are derived from weathered volcanic metamorphic rocks (greenstone) and Parker and Chester soil series are derived from weathered granite and granite gneiss. These soils are considered to be relatively deep and well drained. Blue Ridge East-IE: The Blue Ridge East unit overlies volcanic greenstone rock and represents the eastern limb of the Blue Ridge Anticlinorium. The area is characterized by the presence of a prominent ridge and trends generally northeast within the otherwise rolling piedmont landscape. Portions of this ridge are known locally as Green Mountain, Carters Mountain, and the Southwest Mountains. This area is dominated by the Rabun and Myersville soils and to a lesser extent, the Catoctin. The Rabun soil series is deep and well drained and like the Myersville soil series is formed from weathered greenstone. The Catoctin soil series is considered to be moderately deep and well drained and is also formed from weathered greenstone. Colluvial Fans -II: The Colluvial Fan unit lies at the base of the eastern slopes of the Blue Ridge Mountain and is characterized by relatively steep drainage swales that extend to more gradual sloping conditions. The area includes a series of intermittent drainages that include ephemeral drainage ways. Many of the intermittent drainages become perennial streams as this area includes stream bottom valleys. A significant portion of the unit area consists of transported soils including the Braddock and Thurmont. These soils are formed in colluvial and alluvial materials found on colluvial fans and terraces and are the product of weathered granite, granodiorite, granite gneiss, and greenstone. Both of these soil series are deep and well drained with slopes ranging from 2-25%. Residual soils including the Hayesville and the Chester are also abundant. These soils are also deep and well drained and are formed on upland slopes from weathered products of granite and granite gneiss. Slopes of these soils typically range from 2-45%. Bedrock geology consists largely of metagranitic rock of the Blue Ridge Basement Complex and metasedimentary, metaconglomerate and phyllite of the Swift Run Formation. The accumulation of transported soils (colluvial and alluvial) can form "cappings" over residual soils and parent material, which can add to the overall thickness of the overburden. 4. Piedmont Foothills -III: The Piedmont Foothills unit is characterized by rolling upland to relatively steep topography. Soils within this area dominated by the Hayesville, Ashe and Chester soil series which are moderately deep to deep, and generally well drained. These soils are found on the piedmont upland and foothills of the Blue Ridge Mountain on slopes ranging from 2-45%. These soils are formed from weathered granites and meta -granites of the Blue Ridge Basement complex. The Piedmont Foothills area is bifurcated by Hydrogeologic Unit IV (Lynchburg). 5. Lynchburg -IV: The Lynchburg unit is characterized by a relatively narrow band that trends in a northeast direction and includes a relatively long segment of the Mechums River valley. Soils within this unit are dominated by the Hazel and to a lesser extent by the Elioak and Glenelg soils. The Hazel soil series are moderately deep and well drained and are formed in the weathered products of metagraywacke sandstone and mica schist. Hazel soils lie on uplands and their slopes range from 7- 45%. The Elioak soil series are deep and well drained and are formed in the products of weathered micaeous metamorphic rock. Slopes of the Elioak range from 2-25%. The Glenelg soils are also deep and well drained and are formed in the weathered products of quartz mica schist. Slopes of the Glenelg range from 2-45%. The area is underlain primarily by the Lynchburg Formation and/or the Mechums River Formation which consists largely of metagraywacke, meta sandstone, and graphitic schist. 6. Ragged Mountain-V: The Ragged Mountain unit is characterized by mountainous terrain located in the southwestern portion of the County and is underlain by the metagranitic rocks of the Blue Ridge Basement Complex. The soils in the area are dominated by the Chester, Hayesville, Ashe, and Parker soil series. These soils are derived from weathered granite and granite gneiss and are deep and excessively well drained. These soils range in slope from 2-45% with some slopes up to 60 percent in the Parker soils. 7. Candler -VI: The Candler unit is underlain primarily by the Candler formation. Bedrock geology includes phyllites and to a lesser degree laminated metasiltstone. Soils underlying the unit area are dominated by the Manteo and Nason series. Manteo soils are shallow and somewhat excessively drained. The Manteo soils are formed in the weathered products of sericitic schist/phyllite on uplands and range in slope from 2-45%. The Nason soil series are deep and well drained and are also formed in the weathered products of sericitic schist/phyllite. The Nason soils are formed on uplands and range in slope from 2-25%. 8. Newark Basin-VII: The Newark Basin unit is characterized by low relief topography, which exists over Mesozoic basin geology. The unit is underlain by the Newark Supergroup which consists of sandstones, siltstones, and shales. Soils within this area are dominated by the Totier, Rapidan, and Penn series. The Totier soil series are deep and well drained and are formed from weathered Triassic red shale. These soils are found on uplands and range in slope from 2-15% deep to moderately deep and well drained. Slopes range from 2-25%. The Rapidan soil series are also deep and well drained and are formed in weathered products of Triassic conglomerate. The Rapidan, like the Totier, are found on uplands and range in slope from 2-25%. The Penn series are moderately deep and well drained and are formed from the weathered products of Triassic red shale. The Newark Basin hydrogeologic unit includes the Scottsville Basin located in the southern portion of the County and much smaller area of the Barboursville Basin located in the northern portion of the County. 9. Piedmont Proper-VIII: The Piedmont Proper unit is characterized by gently rolling piedmont topography. The bedrock geology underlying the unit is mapped as Metagraywacke, quartoze schist, and melange. Soils in the unit area are dominated by the Nason and the Manteo in nearly equal percentages. Although these same soils also dominated the Candler unit, it should be noted that the Manteo soils were nearly twice as prevalent as compared to the Nason. Manteo soils are shallow and somewhat excessively drained. The Manteo soils are formed in the weathered products of sericitic schists/phyllites on uplands and range in slope from 2-45%. The Nason soil series are deep and well drained and are also formed in the weathered products of sericitic schist. The Nason soils are formed on uplands and range in slope from 2-25%. 10. Barboursville -IX: This unit exists in only a small portion of the County at the area where Route 20 enters Orange County. Evidently this hydrogeologic unit was small enough that it did not factor into the ENSAT report and therefore does not have a description like the other units. You can see an unlabeled delineation of this unit in the map (Figure 2) along the northern County boundary near the right-hand side. 0 COMMONWEALTH OF VIRGINIA Application for: EJ Sewage System 0 Water Supply Owner: Mountain View Land Trust Mailing Address: 3209 Clarke Lane Charlottesville. VA 22901 Agent: Stockton Creek LLC c/o JeseP44kimpeerr r3I0.r, Iftw Mailing Address: 455 2nd Street SE, Suite 201 Charlottesville, VA 22902 Site Address: TBD Afton, VA 22920 Directions to Property: Subdivision: Tax Map: Corner of Route 250 & Route 151 69-19D Section: Other Property Info: Phone: Fax: Phone: Phone: 2 45 VDH USE ONLY Health Dept. ID# Due Date: 540-331-0037 Fax: Email: as�onatroetirmmenegmLOrent:zom Block: Lot: Acreage: 4.56 Sewage System Type of Approval: Applicants for new construction are advised to apply for a certification letter to determine if the land is suitable for a sewage system and to apply for a construction permit (valid for 18 months) only when ready to build. ❑ Certification Letter ❑ Construction Permit F] Subdivison Approval ❑ Repair Proposed Use: Single Family Home (Number of Bedrooms) 5 Multifamily Home (Total # of Bedrooms) Other (Describe): Basement Yes Walk -Out Basement? F1 Yes Fixtures in Basement? Yes ❑ No ❑ No ❑ No Conditional Permit Desired? ❑ Yes Ej No If yes, what type of conditions are desired? ❑ Reduced Water Flow ❑ Limited Occupancy ❑ Intermittent or seasonal use ❑ Temporary Use (1 yr. maximum) Do you wish to apply for a betterment loan eligibility letter? ❑ Yes" 0 No "There is a $50 fee for determination of eligibility. Water Supply Will the water supply be ❑ Public or 0 Private Is the water supply ❑ Existing or 0 Proposed If proposed, is this a replacement well? ❑ Yes 71 No If yes, will the old well be abandoned? ❑ Yes ❑ No Will any buildings within 50' of the well be termite treated? ❑ Yes [21 No All Applicants Is this a private sector OSE/PE application? 0 Yes ❑ No If yes, is the OSE package attached? 2 Yes ❑ No Is the property intended to serve as your (the owners') principal place of residence? ❑ Yes F] No In order for VDH of process your application for a sewage system, you must attach a plat of the property and a site sketch. a plat of the property is recommenced 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 setter Onsite Soil Evaluator or Professional Engineer as necessary until the sewage disposal system and/or private water supply has been constructed and approved. 0i C L, 1-5 LI Signature of Owner/Agent Date TbYMomAwj %%M"M ftVW%Cbd�%"WMArt VA-UMYMON = U-" Only Dsfa Eruered: Date Doz FmS HDR) # Fltwww No 0 Faytllsm l pVcka # MHD 0 Rewipt li Page I of 10 ❑ Construction Permit ❑ Repair Permit OSE/PE Report For: ❑ Voluntary Upgrade ❑ Certification Permit Letter 0 Subdivision Approval Property Location: 911 Address: TBD City, State, Zip: Afton, VA 22920 Lot: Section: Subdivision: GPIN or Tax Map #: 69-19D Health Dept. ID #: Latitude: Longitude: Owner: Name: Mountain View Land Trust Address: 3209 Clarke Lane Charlottesville, VA 22901 Prepared by: OSE Name: Chris Heltzel License # 1940-001460 Address: PO Box 554, Woodstock, VA 22664 PE Name: License # Address: Date of Report: 1211012021 Date of Revision #1: Date of Revision #2: iContents/Index of this report: I 'I1. Cover Sheet 7-8. Well Specifications �2. Soil Evaluations 9. Site Sketch & Sanitary Survey 3-4. Profiles 10. Site Location 5-6. Abbreviated Designs Certification Statement I hereby certify that the evaluations and/or designs contain herein were conducted in accordance with the applicable provisions of the Sewage Handling & Disposal Regulations (12VAC5-610), the Private Well Regulations (12VAC5-630), the Regulations for Alternative Onsite Systems (12VAC5-613) and all other applicable laws, regulations, and policies implemented by the Virginia Department of Health. I further certify that I currently posses 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. The potential for both conventional and alternative onsite sewage systems has been discussed with the ownertapplicant. 0 The work attac r page has been conducted under an exemption to the practice of engineering, specifically the exemption ir%,d, "to ii L 'on 54.1-402.A.11 I recommend that a: ��OonS4r ikp i?f 0 Subdivision Approval be: ❑ Issued C Ce pgiplBA rs, > e rmit ❑ Voluntary Upgrade ❑ Denied HELTZEL Lic No. 1940001460 v., 11oiyna.wc. J Date: }P qT��F �NSITBS�� hp Mn rnntains nprcnnal ininrmatinn rnhmnt in rrisrrncuro nnrlpr the Frnprrnm of Infnrmatinn Art PAVk.II 19/n1114 Page e7— of ko SOIL SUMMARY REPORT GENERAL INFORMATION Date: 9/8/2021 Submitted to: Albemarle County Health Department Owner: Mountain View Land Trust Telephone Number: 540-331-0037 Address: 3209 Clarke Lane Charlottesville, VA 22901 Agent: Stockton Creek LLC Go Joseph Simpson Address: 455 2nd Street SE, Suite 201 Charlottesville, VA 22902 Property Location: TBD Tax Map/GPIN: 69-19D Subdivision: Blk/Sec: Site: 13-1 1. Position in Landscape Satisfactory: El Yes ❑ No Describe: Convex Upland Sideslo e 2. Slope: 11 % 3. Depth to Rock or Impervious Strata: Max. 73"+ Min. None 21 4. Depth to seasonal water table (gray mottling or gray color): Not Observed Yes ❑ 5. Free Water Present? 21 No ❑ Yes Range: inches 6. Soil Percolation rate estimated: Yes Texture Group: I ❑ II 0 111 ❑ Iv ❑ ❑ No Estimated rate: 50 mpi @ 40" 7. Permeability Test Performed? E1 No ❑ Yes If yes, note type of test performed and attached results. Test Type: NA Site Approved. Drainfield to be placed at 40 " depth at site designated on permit. ❑ Site Disapproved. See reasons for rejection. Reasons for rejection: 1 ❑ Position in Landscape subject to flooding or periodic saturation. 2 ❑ Insufficient depth of suibable soil over hard rock. 3 ❑ Insufficient depth of suitable soil to seasonal water table. 4 ❑ Rates of absorption too slow. 5 ❑ Insufficient area of suitable soil for drainfield and/or reserve area. 6 ❑ Proposed system to close to well. 7 ❑ Other (Specify Below. Add additional pages if necessary) Additional Notes: Page'of to Heltzel Soil Consulting Property Address: 250/151 Site: 13-1 Tax Map Number: 69-19D Date of Evaluation: 9/8/2021 Profile Horizon Depth Description Texture Class IOYR 4/3 silt loam, weak fine subangular blocky P1 A 0-9 structure, friable, many roots III 5YR 6/6 & 7.5YR 5/8 loam, weak medium subangular Bt 9 28 blocky structure, friable, common roots II 5YR 5/6 & 7.5YR 7/6 light loam, weak coarse BCt 28-35 subangular blocky structure, friable, common roots, II few 10YR 8/1 lithochromic mottles 5YR 5/6 & IOYR 6/6 light loam, very friable, few C 35-70 roots, common IOYR 8/1 lithochromic mottles II IOYR 4/3 silt loam, weak fine subangular blocky P2 A 0-10 structure, friable, many roots III SYR 6/6 & 7.5YR 5/8 loam, weak medium subangular Bt 10-30 blocky structure, friable, common roots II SYR 5/6 & 7.5YR 7/6 light loam, weak coarse BCt 30-39 subangular blocky structure, friable, common roots, II few 10YR 8/1 lithochromic mottles SYR 5/6 & 10YR 6/6 light loam, very friable, few C 39-69 roots, common 10YR 8/1 lithochromic mottles II IOYR 4/3 silt loam, weak fine subangular blocky P3 A 0-9 structure, friable, many roots III SYR 6/6 & 7.5YR 5/8 silty clay loam, moderate Bt 9-28 medium subangular blocky structure, friable, III common roots SYR 5/6 & 7.5YR 7/6 silt loam, weak medium BCt 28-35 subangular blocky structure, friable, common roots, III few 10YR 8/1 lithochromic mottles SYR 5/6 & 10YR 6/6 silt loam, very friable, few roots, C 35-70 common IOYR 8/1 lithochromic mottles III Page A of 10 P4 A 0 8 10YR 4/3 silt loam, weak fine subangular blocky III structure, friable, many roots 5YR 5/6 silty clay loam, moderate medium Bt 8 27 subangular blocky structure, friable, common roots III 5YR 5/6 heavy loam, weak medium subangular BCt 27-41 blocky structure, friable, common roots, few 10YR II 8/1 lithochromic mottles C 7.5YR 5/6 & 10YR 8/2 silt loam, very friable, few 41-73 roots III PS A 0-8 10YR 4/3 silt loam, weak fine subangular blocky III structure, friable, many roots 5YR 6/6 & 7.5YR 5/8 silty clay loam, moderate Bt 8-35 medium subangular blocky structure, friable, III common roots 5YR 5/6 & 7.5YR 7/6 light silty clay loam, weak BCt 35-47 medium subangular blocky structure, friable, III common roots, few 10YR 8/1 lithochromic mottles 5YR 5/6 & 10YR 6/6 silt loam, very friable, few roots, C 47-73 common 10YR 8/1 lithochromic mottles III Heltzel Soil Consulting Abbreviated Design - Conventional Site 13-1 PRIMARY DESIGN Page Z� of lO A. a. Estimated percolation rate. (minutes per inch) so b. Recommended trench bottom. inches 40 c. Depth to impervious strata/ or water table/ or limit of evaluation. (inches) 73 73 73 d. Minimum separation distance required. (inches) 19 18 24 e. Separation distances in inches provided in design. 33 33 33 f. Sloe (percentage) 11 g. Minimum trench bottom due to slope. inches 19.5 h. Is the sloe greater than orequal to 10%? Yes i. If Ai is Yes, does 24 inches or greater to rock/impervious strata exist below Ab? Yes j. If yes to Aj, add 1 ft. to the minimum center -to -center spacing beginning at 20% slope and continue for each 10% slope increase above 20%. If no to Aj, add 1 ft. to the minimum center -to -center spacing beginning at 10% slope and continue for each 10% slope increase above 10%. (Report the value, in feet, of the increase in center -to -center spacing above the minimum). 0 s. ITrench bottomsquare feet required per bedroom Table 5.4 376 C. a. Number of bedrooms. 5 b. Gallons per day in design 750 D. a. Length of trench. feet 100 b. Length of available area. (feet) 100 E. Width of trench. (feet) 3 F. Number of trenches. 7 G. Center-to-centerspacing. feet 9 H. a. Width required. (feet) 57 b. Width of available area. (feet) 57 I. Trench bottomsquare footage required. 1880 J. Trench bottomsquare footage in design. 2100 K Is a reserve area required? Yes X INo a. Percent required? 100% b. Percent available: 100% Notes: 'See attached abbreviated design form for reserve" Heltzel Soil Consulting, LLC Page ` of td Abbreviated Design - TL3 Effluent with Trenches Site 13-1 RESERVE DESIGN A. a. Estimated percolation rate. minutes per inch) 50 b. Recommended trench bottom. (inches) 40 c. Depth to impervious strata/ or water table/ or limit of evaluation. inches 73 73 73 d. Minimum separation distance required. (inches) 18 12 24 e. Separation distances in inches provided in design. 33 33 33 f. Sloe (percentage) 11 g. Minimum trench bottom due to slope . (inches) 11.5 i. Is the sloe greater than orequal to 10%? Yes j. If Ai is Yes, does 24 inches or greater to rock/impervious strata exist below Ab? Yes k. If yes to Aj, add 1 ft. to the minimum center -to -center spacing beginning at 20% slope and continue for each 10% slope increase above 20%. If no to Aj, add 1 ft. to the minimum center -to -center spacing beginning at 10% slope and continue for each 10% slope increase above 10%. (Report the value, in feet, of the increase in center -to - center spacing above the minimum). 0 B. a. Design Type? TL3 b.Trench bottom square feet required loading rate, gpd1ft2 0.89 c. a. Number of bedrooms. 5 b. Gallons per day in design 750 D. a. Length of trench. feet 100 b. Length of available area. (feet) 100 E. Width of trench. (feet) 3 F. Number of trenches. 3 G. Center-to-centerspacing. feet 9 H. a. Width required. (feet) 21 b. Width of available area. (feet) 21 I. Trench bottomsquare footage required. 843 J. Trench bottomsquare footage in design. 900 K. a. Is a reserve area required? Yes X No b. Percent reauired 100% c. Percent available 100% Notes: ieltzel Soil Consulting Page? of VDH USE ONLY SYSTEM SPECIFICATIONS HDIN: Application Information Name: Mountain View Land Trust Address: 3209 Clarke Lane Phone: 540-331-0037 Charlottesville, VA 22901 Location Information Tax Map/GPIN #: 69-19D Property Address: TBD Subdivision: Section: Block: Lot: Directions: Corner of Route 250 & Route 151 General Information Well Purpose (select all that apply): 0 Domestic Drinking Water ❑ Agricultural ❑ Irrigiation ❑ Industrial/Commerical ❑ Geothermal Well Class: 3B Minimum Casing Depth: 50 ft. Estimated Water Usage: 750 gpd Minimum Grout Depth: 50 ft. Horizontal Setbacks Distance from Building Sewer: 50 ft., min. Distance from Pretreatment Unit(s) 50 ft.. min. Distance Conveyance System: 50 ft., min. Distance to Absoprtion Area: 50 ft., min. Distance from Property Line: 50 ft Distance from Foundations: 50 ft., min. Distance from other source(s) of contamination: 50 ft., min List other sources: NA Notes: This form contains personal information subject to disclosure under the Freedom of Information Act. Addendum to AOSE/PE Certification Statement For Private Well Construction Permit Page � of 10 The proposed well site shown herein, x— 1. Is located a minimum of 50 feet from all property lines. 0 2. Is located within 50 feet of the adjacent property line(s) but I have determined that the adjacent property is not used for an agricultural operation. 0 i. Written affirmation from the adjacent property owner(s) that their property is not used for an agricultural operation. ii. Other confirmation that land use is not an agricultural operation, please describe. 0 3. Is located within 50 feet of the adjacent property line where the property is used for an agricultural operation. For confirmation, I have attached the appropriate documentation pursuant to § 32.1-176.5:2 of the Code of Virginia. (check one below) 0 i. Written permission from the adjacent property owner's) for the well construction. 0 ii. I certify that no other site on the property complies with the Board's Regulations for the construction of a private well. Proposed Well Site is located within 50 feet of an Adjacent Property Line(s) Property is not used for an Agricultural Operation Statement for Adjacent Property Owner(s): I affirm that my property is not used for an Agricultural Operation as defined in § 3.1-22.29 of the Code of Virginia. Signature of Property Owner Date Proposed Well Site is located within 50 feet of an Adjacent Property Line Property is used for an Agricultural Operation Appropriate documentation to comply with § 32. i-176.5:2 of the Code of Virginia: Written Permission I grant permission for the construction of the proposed private well described herein which is within 50 feet of my property line. Signature of Property Owner Date Heltzel Soil Consultinq, LLC PO Box 554, Woodstock VA 22664 c:(540) 331-0037 ® BORE# F7 PIT# —m SLOPE DIRECTION PROPOSED WELL Site Sketch & Sanitary Survey TM# 69-19D Albemarle County, VA PROPOSED SEPTIC IDRAINFIELD I AREA Page I of Iv ALL KNOWN WELLS & DRAINFIELD SITES WITHIN 200' OF THE PROPOSED DRAINFIELDS ARE SHOWN. T.M.69-19D REVISED LOT 3 4.56 ACRES / A 5 54.03' —#y P2� Opt ---- - - - - -- / Z Ie----------y5 ,� �A I I P4 �Ite I �— I December 10, 2021 DRAWN BY: CH Heltzel foil Consulting, LLPaged of C Site Location PO Box 554, Woodstock, VA 22664 200' 400 � .. / L CAT ON IS REAM -. \ �pM BUFFER (5.04+ 1 SEPW III Site 11—1 f�PROAREA POSED ORAIINNFIELD VIEDiiRESo6 2.63 ACRES Site 1-2 PROPOSED SEPTIC DRAEA IR� Site 18-1 PRO SEPn ED DRAINFIELD '>$ ARE T.M.69-19E REVISED46CRES4 Site 16-1 PROPOSED SEPTIG DRAIT.E1.69-19D AREA R�56 ACRES3 9�6 91y Site 13-1 I OVERHEAD UTILITY POL LINE (6.56+/— ACRES) I I �e m I I 1Site 8-2 PROPOSED / T.M.69-19B R ,,, SEPTICDRAINFIELD OSED AREASite ACRES \LOT 111-1 904900--RE596I' _ - - 7.CRES1 / R�UjE0 B�EW019 &f 211i �� P D g.4� 2p9 SNRU \A'w .6 3 NU I r UK KLUUKUA I IUN (J '%C' Ro rv�/e� 915 � Np� 5Z,, R'. F OVERHEAD UTILITY LINES PROPOSED - SEPT C DRAINFIELD AREA �\ 86 Site 6-1 REVISED ` / OL 8.736ACRES wµ M