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HomeMy WebLinkAboutSUB201800152 Certified Engineer's Report 2018-08-28 Page . L__ of S OSE/PE Report for: Construction Permit I I Certification Letter ' 1 Subdivision Approval Property Location: 911 Address: II$3 p st;11e City: tits geivi fy��/e Lot Ri.(Le Section Subdivision D _,, El GPIN or Tax Map# 9! e te_ttl II Health Dept ID# Latitude • Longitude Applicant or Client Mailing Address: Name: t i y;1i ' Ge,f Street: !7!d ��+ ____St4i —ZO/9 City:_ sv l e,- State_A,/ Zip Code ZZ?03 Prepared by: OSE Name Limn mn ik 1;1 C0,150/ L(,L �'-2Y9—OL98 License# _fi o_/3�7 Address P.O fay 75-61 J City geS,r6 - State (//1 Zip Code ZZ` Y7 PE Name: License# Address City State Zip Code Date of Report 07/2e4el e Date of Revision#1 OSE/PE Job# Date of Revision#2 Contents/Index of this report(e.g.,Site Evaluation Summary,Soil Profile Descriptio% Site Sketch,Abbreviated Design,etc.) fr-1-2_05F:C_ ._S k.....F_;_A_ppl.�_chkt'o►a_ J' >, Y Wei- -_ r,fi6 .3-Y__5�s.�_s►..r.,*,,i soi s__.-- Pstc s'L 1:)�53 a_ es �b�arev�� sl'n - — Certification Statement I hereby certify that the evaluations and/or designs contained herein were conducted in accordance with the Sewage Handling and Disposal Regulations(12 VAC5-610),the Private Well Regulations(12 VAC5-630)and all other applicable laws,regulations and policies implemented by the Virginia Department of Health. I further certify that I currently possess any professional license required by the laws and regulations of the Commonwealth that have been duly issued by the applicable agency charged with licensure to perform tl'ork contained herein. 1/The work attached to this cover page has been conducted under an exemption to the practice of engineering,specifically the exemption in Code of Virginia Section 54.1-402.A.11 I recommend that a(selec •.ne): construction permit❑ certification letter subdivision approval Q be(select one)issued© denied❑. OSE/PE Signature Date t$/Le&o / 7' . . - . Y? 2 Commonwealth of Virginia - VDH Use only ' Application for: ewa e System IJWater Supply HealthD Department ID# PP � .-�• 1 g Y �-� PP Y Due Date Owner U tA.l i Kvt. l• Nid-1^Gn J;:. Phone Mailing Address 1I10 Asiiclrr. �� �. Phone - ., t/11 11 csvi II.,. t/.? lootT Fax. Agent i c.A • cSuf .• Phone ` 39-2gs-87vy Mailing Address 17/0 /)l/PeJ c7tKe . 5u , ZAM , Phone 0414410 stille fhi 221.93 Fax . ir Site Address ' I 5~3 Se,a l3.s�+/A £o,qc &.,1' 4 1,,IJ, 1/ 227e)'Z. Email Directions0*eity:. ifs e. /C p o, 2a ; }/ .3 ns l s i 79 Subdivision Byt444 Avaly Section Block Lot /Quselle G TUX Map 1l pf+'[e I /7 Other Property Identification ° :DAuiensidn/Acie--'a of Property,.3.3XY ,gene: 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. eertificatlon Letter 'Construction Permit — olunta ry Upgrade 'pair Permit Proposed Use: C .Sub d iv i m'v►z gevAt I./ Single Family Home(Number of Bedrooms 1 ) ' Multi-Family Dwelling(Total Number of Bedrooms Other(descrtb ,,,�f Basemen o Walk BasemeattEl�c�s{ o•• -Fixtures-in asemen i�t o Conditional permit desired?DYes.: oo . If yes,which conditions do you want? , ❑Reduced water flow ❑Limited Occupancy 0 Intermittent or seaso • use 0 Temporary use not to,exceed 1 year ,Do you wish to apply for a betterment loan eligibility letter,.ts!-o *There is a$50 fee for determination of eligibility. Water Supply Will the water suPP �I'l i ? = Is the water sup• :mv i r- _ .. L- .. - . If proposed,is this a replacement well? ]Yes 13No, If yes,will the old well be abandone Will any buildings within 50'of the proposed well be termite treated?, 'Yesill•lo Alt Applicants • — Is this a private sector()SEW application? e _4 If yes,is the QSE/PE.package.attached2 ° - Is this property indeed.to serve as your(owners)principal place of residence - in ordrfor VD7 Opi5ce§s +our•applii ation:fora sewage System you must tar d=oapla 041 itv :and:mite sketp'h. For water supplies,a plat of the property is recommended and a site sketch is required: The site sketch should show your property Iines,actual and/or proposed balidings and the dashed location of your well and/or-sewage system. When-the site evaluation is conducted the-property lines, -building4oeation.and-the-proposed welland sewage sites must be-elearlyinarkedandihc:pmperty-sulhciently visible to-see-the-topography: I give permission to the Virginia Department of Health to enter onto the property described daring 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 I2/1/2014 for 3ofS VON Use Only Health Department IDa Due Date Site and Soil Evaluation Report (For certification letters and subdivisions) General Information Date: O9/Zo/201 g 41 brw.A rJe County Health Department Applicant: j 6 $4fderti7 .Ser✓r'te j Telephone Number:_ 534-2�1 S-S7yy____ Address: 17 t o &Atl i ej . rt4j- Sty.:;G 200 t%W 10.1.� sVN =95 / I�i�. Owner: TAINh, P �en Tr. Address: (Pig, ,ai,, ,t 4.94 ehjap#,s1t/Is YA Location : ( '$3 5ob#1s41. Ltd L'4041 jesv►lk 149 227oz Subdivision_ sApy i/ Block/Section Lot L41;;Le, Soil InforsatiTin Summary 1.Position in landscape satisfactory Yes No_ Describe: 5145 r*be 2. Slope / 3. Depth to rock/impervious strata Max. 70 Min. 70 None 4. Free water present No✓ Yes_ Range in inches— 5. Depth to seasonal water table(gray mottling or gray color) *'/p inches 6.Soil percolation rate estimated Yes_ Texture group ❑I Fill © 1 ❑IV No_ Estimated rate( min/in 7. Percolation test performed Yes umber of percolation test holes— No _ Depth of percolation test holes Average percolation+io rate mpii, Name and title of evaluator: 5111 K„ K �,e C•O. O. . Signatu . Depar/rent Use Site approved: Drainfield /(-nch bottoms to b= +laced at6p(0 (inches)depth at site designated on permit. _ Site disapproved: Reasons for rejection:(che• all that apply) 1. 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 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 7 of 8 Date of'Evaluation:_OG Profile Description SOIL EVALUATION REPORT Property ID: 714Y mmstD it totem! I t - Rat�au►v Where the local health departmentl 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 t ' form. ec 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 fl o-41 2.SYR 3/al NA Rt1d 1►lte.., Chi t.t . - t 2.S 123 f. • 4 .ly Low 3 ni el-G Z.STIR 3 Y 141.-kke f.a �•-rt.�n Cls f fwi "� q .s If REMARKS USE Form G(pg.2)Revised7/02/2009 Page Sr of v Design Calculations Property ID: I;It Air 9/ ,,,, J /9-A'esrohHe FIow Type of use(residential, ete) gl Show Calculations Here' No. of bedrooms: No.of employees: si//# • Square Footage of building space:$ev.j,,4, Daily flow (peak design) in GPD: (,eo 6Pt Treatment No. of septic tanks: / Show Calculations Here Size of septic tank(s): /Zso GS/eir, Pretreatment required? _yes If yes, specify type of treatment device: Absorption area design Soil Texture Group: ]YC If pump system, enhanced flow,or LPD show Reserve area rye uired? es 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: Exes4ihk Describe (bored, drilled):_5x sHin Distance between septi tank(s) and J well:Solt Distance between absorption area and well: 10e't 1 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 D primary and reserve area,0 only the primary area, [a'only the reserve area(check one)for 171y of 91 «J /9 - / e.5,-d a (property ID). Design Basis ' t ' Total length of available area: ffOt Total width of available area:• 7S ` Estimated Pere. Rate: 4S at 66 in. (depth) Number of bedrooms(or GPD): COO 4132) '1I Conveyance Method ti: „ti Distribution J•nutht' -fjsptri:fy _6r_timc Tzt)t J, •1 Dispersal system basis 1.bje £11 SHDR. . LGMI required? ,C4, (Ye-in r Effluent quality required: T{;wt tlati.D Secondary,Advanced Secondary) Square feetper bedroom: required: l�1' 4. q ��(o �. 6� Total trench bottom area I 1 Gravity,pump.siphon 2 Enhanced flow.LPD.or Drip Dispersal 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: $O ' Width of pad or trenches: 3- I1ELt'>f� erit�r 9 9 R2+eii 't cjitir _YCS !'ereent leo/o Tiny;iiiir3il�.rat-�ihsorpj n.Euea_reglii.r d 7s, TotaL'trealcll.-liutt�+»z:area provided:: ZIGO_ . , 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_4 of_3 System Specifications Property ID: 7wx Alr,9/f,,,,.t,1 19 - Rcs:Jgc, Applicant Information Name Re_i:aE.4-(19 I .Sy.ru..76Se mes Phone Lin 2 qs r s7'/ Address 1710 Axed Shrub- sou 2014 C.1�,�,rJO+a es„rll� ✓a 22903 Location Information Tax Map No. 7/ /mei•J t9 Property address Ia3 fitasdYlc e0,1 GPIN No.. _ . --.-- -- a h,theiet)r.su;/le UN 2210'7 Directions sf ; ,,,,k� �, Subdivision ,o n 6,„# }/" .3 �.•l.S �/ � �., 7 y2 Section Block Lot P.,,s,'vl „ General Information System Type " .! Number of bedrooms of '• (e.g. septic tank, drainfield) Daily flow600 is.,D (gpd) Type of property Res; 4,1 ,J (e.g.commercial,residential,etc.) Conditions Sewer Line Septic Tank—Inlet/Outlet Structure Schedule 40 PVC,4" equivalent Capacity:d /ZS'4 gallons (add check or describe equivalent below) 2° septic tank /Pro 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,pumpin , dosing siphon) No. of outlets /Z If pumping, attach Pump Spec Sheet Surge or splitter box required: Material se.h,.du je tjf 1 vc Yes_No ✓� Pipe diameter 2" Slope of pipe NM (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 deptheo& inches Aggregate depth 11 inches No. of Laterals q Lateral length To ft. Lateral bottom slope23inches Lateral width 34 inches OSE f Date (200/2,01.$ OSE Form J Revised 7/2/2009 �� o Q Q- ti/ / �0 2�02 t. TAP 90 21H ;,Q,�o,- m , Christopher Black, etux w(0 cc,° J © D.B.4942 Pg.316 , o° 2 R , ��7 / TMP 90 21H1 0• Ql 24h•. \ co u� / Kristen L. Hunt ���� \� ° o �` 0.8.4929 Pg.9 �`Z 2� 'UP A�,�� Lp� \ 4) I S IMP 91-18 <� s.>, Wendell W. Wood VDOT Mon. ►y �tYP•) ;` A . �\ \ �� k9 y9, 0.B.1727 Pg.674 2.23'cornerNE of ��'/ O�'`b IF S \ • 3° "�O ` S S STc� ,°�, © ' .,\.�D well �'on.Nb\\ ..0:P, �h c�• tir���° ,'P cc� `� \ ,,ED 9\. 9- F •2°'ti6 e%/-_�. 550 Mon: x\" �o �° • : v shed --0 �� 43'00. r _ 0 B5 Fd. \ s �� ,' ° 1 �° Residue ��° IF — 99� �',�fig, , .>ir 9'�\ ADF. ro0 P 100\\ -� —Primarve& 6- Sf 9a_QAh !' ss °a\ `� a h�� VSr Ne J r?� �\ ,�Z, 0 tic Draxnfield Parcel B �', � � +. 3 epr a° `� c 9. eiv �' �05 0 0,2e e 2�9 �cckz-e IF \\ 9 93 W Ine \Is �Q QapQ�' °�`� , 9e e 3 \ Parcel "A" ?1e- o� 6e°0�� 6;Z�/ \\ / \ 202 \ �2 °r' \ � Primary & \ ' Reserve "� 4 y \ //��o % Drainfield I.`�o,�a S°. \\\ ` \\ 0P0 T. \" °` ^1 6� \\ \'\ Bs ;'} ,9A�Oo A ti TAP 90 21G °T�• \\ ��\, %i� �0.��� �Q 9e QA6 Rectors 6 Visitor's \ 'v P 3 '� 1e 2 '�j of the INA \ �a�0 to 0.8.1110 Pg.279 \ Q• P CI 41 IF 01 ' o 06 Page !of 8 OSE/PE Report for: Construction Permit El Certification Letter n Subdivision Approval Property Location: 911 Address: City; Lot R Section Subdivision 3414—ev►. !ilv1;1/1 GPTN or Tax Map#__V ,,,`', tejM Health Dept 1D# Latitude � Longitude Applicant or Client Mailing Address: Name: teS;c Ltpa__ S_r_y.cy Street: /7!/0 Ig��Pe eel ,jt�.44 Zeg . City: GKW { r 10HeSUuI!e State 1.7, Zip Code Z2703 _ Prepared by:OSE Name R,/14t r ;1_eoAi,,1si hj �/jy 21/`J-O278 License# l7,400/�3s7 Address—( a XI 757 J City gESurt'Cie State V/7 Zip Code ZZ?V7 PE Name: License# Address City State Zip Code Date of Report 08/Zo114// 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.) lei. 3 75...V -.st~wtm y_ ; 11s____.-.._ _Pig 3"-���s� .,_.eril6S__- AbbrevAT5LA4sljn 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 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 work contained herein. nThe 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(sele,,eV construction permit❑ certification letter subdivision approval i f] be(select one)issued© denied❑. OSE/PE Signature Date 05' /Zoj ___ Commonwealth of Virginia VDHUseonly Application for: System' ater SupplyHealth Depar merit ID# PP ewa a g Due Date • Owner T;,r,I joitAI 2 Ftfivr, J. - Phone Mailing Address !G i s 4•ArJLr foe„(- Phone ei kThrlo} Svil f� Cf/q ZZ901 Fax Agent Ped S, ...,,n3q �efvt'4cS Phone V3y-Z?S —/T /. Mailing Address /7ID Vol 5*. ec..4 .�IA:k ZM Phone kw(644444 (/t9 ZZ?o 3 Fax Site Address Email Directions to Property: EFIO L of L}G Zo ; f/ .3 rn:Ls ,(lla✓fj< .07 leQu}o 7'/Z Subdivision SA fin, Fri,*.;ly • Section Block Lot p Tax Map I/ (24.st.) )7 Other Property Identification of Property 7 Z3 4r.. 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. -13Gertification Letter --13:Construction Permit zi3ooluntary Upgrade repair Permit Proposed Use: $u 6J ivp sro,,, Rs✓a'e w Single Family Home(Number of Bedrooms tl ) Multi-Family Dwelling(Total Number of Bedrooms ) Other(descnb / Basemen t;� � 6 Walk-o t Basemeati ' ss1Ta; - Faxtures.in Basemen Conditional permit desired?airds • If yes,which conditions do you want? ❑Reduced water flow ['Limited Occupancy ['Intermittent or seasonal use Temporary use not to exceed I year Do you wish to apply for a betterment loan eligibility lette ,e„ here is a$50 fee for determination of eligibility. Water Supply Will the water supP i 1i.c o e2. • - . Is tba:watersup L. If proposed,is this a replacement well?DYes pNp. If yes,will the old well be abandoneii?p Y.ea. jNo Will any buildings within 50'of the proposed well be termite treated2 ]Yes )NO All Applicants Is this a private sector OSE/PE applieatiog? 1 If yes,.is the.OSE/PE kage.attached2. !c E':cs~,j3 To, . Is this property indeed-to serve as yout(owners)principal place of residence? In'order:for VDU io pi c s your applicat]on;for•a sewage system you musvattabbi•d.aplat"9ftbeTifoperviida•Asite sleet l .-For water supplies,a plat of the property is recommended and a site sketch is required: The site sketch should show your property lines,actual and/or proposedbuiidings and the desired location of your well and/or sewage system. When.the site evaluation is conducted the-property lines, building locationand-theproposedweilandsewagesitesmustbeclearly-marked•andtheproperty cientlyvIsrbieto-seethetopogcaphy: I give permission to the Virginia Department of Health to enter onto the property described during normal business hours for the purpose of processing this application and to perform quality assurance checks of evaluations and designs certified by a private sector Onsite Soil Evaluator or Professional Engineer as necessary until the sewage disposal system and/or private water supply has been constructed and approved Signature of Owner/Agent Date This form contains personal information subject to disclosure under the Freedom of Information•Act. Revised 12/1/2014 Pr 3odS Y•DH Use Only Health Department IDA Due Date Site and Soil Evaluation Report (For certification letters and subdivisions) General Information Date:68/ze / .0 I$ Apier,"„ele. County Health Department Applicant: Re.s.aowti'rq 1 si��ru�cjrr'n� Telephone Number: ILV Address: Jil10 /glliec ic.,e_ t%h4o vdi it . 03 Owner:Tohviv. Address:,16-q-$-44 -you_ �tJ k k---i�I17 Location :4 SIGGgri /t•aw.k Zo "/ • 4.x/s , 44 42 I 7yZ Subdivision ljgban_A ;1,, Block/Section Lot Soil Informa: n Summary 1. Position in landscape satisfactory Yes ✓No Describe '-'11"4.1cler 7.5;lciesipe_ 2. Slope 13 % 3. Depth to rock/impervious strata Max.7Z Min.7Z None 4. Free water present No✓ Yes— Range in inches 5. Depth to seasonal water table(gray mottling or gray color) /I//)M inches 6.Soil percolation rate estimated Yes Texture group Ell rill I DIV No— Estimated rate Ip$'min/in 7. Percolation test performed Yes .N'umber of percolation test holes No — Depth of percolation test holes Average percolation rate mpi 1' Name and title of evaluator: / S so,„ K. �yser �•�fJ Signature: _ _ ff De-pa r enb t Use _ ite approved: Drainfield�,ench bottoms to -laced at y8 (inches)depth at site designated on permit. Site disapproved: Reasons for rejection: (c •ck all that appl . _Position in landscape subject o 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) OSF.Form U(pg.l)Revised 7/02/2009 Page y of i Date of Evaluation: 0b/11/2e9I$ Profile Description SOIL EVALUATION REPORT Property ID:_Tpsy_itintf/l•,rt.1 19 - �M{t e j "du 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 l00 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 th' m. ee application sketch See construction permit See sketch on reverse side or page attached to this form. Hole 4 Horizon Depth Description of color,texture,etc. Texture (Inches) Group l b-7 VI( ILI £eJd+al. &t, a S£} 'worn, Tr 7- 4N . '� �G.�1 ll.Kvi_dit.riD 31r -7x Zrs*a IS M t7k4 t I,.r `goyim _ Z A O.4 5'Y12 bl 3 4 14-l t`sh 8re LA. s if icy 7:t �- 1 2.5'yh 143 O...41_. , tt� yL-7Z Z.S)R I/7 /€.& C' (r� 1..1+w, 3 A Y 1Ly t_ -65,10 p GMY iwAr . �3} S-3! Z4-40 4 Dark 114 f key 0,!fietN BG ' 39-7Z s�yt<S,L�►rlr �� • REMARKS OSF.Form G(pg.2)Revised7r02/2009 Page_s of 8 _ Design Calculations flit? 11 Property ID: 'rt r ,�/'�e."/ l9 -parc�I 9 Flow Type of use (residential, e,c)J ate_4igj Show Calculations Here' No. of bedrooms: Or No.of employees: N/19 Square Footage of building space:/v . Daily flow(peak design) in GPD:4004Po Treatment No. of septic tanks: / Show Calculations Here' Size of septic tank(s): /zrn d llo z Pretreatment required? _yes'-rr6-' If yes, specify type of treatment device: Absorption area design Soil Texture Group: '3ir If pump system, enhanced flow, or LPD show Reserve area reQuired? _ no calculations here or on a separate sheet. _ 50% ./100%_other(check one) (dosing volume, head, pump design, etc.) Specify other s . Water Supply Class of well: lift (Eli/J Describe(bored, drilled): 13re Pr_ J orrom,c Distance between septic tank(s) and weII: 50'+ Distance between absorption area and well:Jo Information and calculations required for commercial and/or conditional use applications only OSE Form I Revised 7/2/2009 Page G Of g' 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 certificationt letter or subdivision approval. This abbreviated design covers the i3"primary and reserve area,0 only the primary area,❑ only the reserve area(check one) for i /JL,,, 24 ,4 1 19,p (& (property ID). ���TT - • Design Basis - --- - ------ - ---- Total length of available area: 75" Total width of available area: 15 — Estimated Pere. Rate: (ds at qr in.(depth) Number of bedrooms(or GPD): y$/e or GDO1. (LPD 2 Conveyance Method r*mai Distribution method (specify): trrivel Very ' Dispersal system basis ' Fe 5:It of SOIL_ LGMI required? No (Y;42) Effluent quality required: rims Secondary,Advanced Secondary) i ' Square feet per bedroom: (if ,�}, Total trench bottom area required:j ei ri Gravity.pump.siphon 1 Enhanced flow.LPD.or Drip Dispersal Table 5.4 of SHDR or identify the GMP used Area Calculations Number of trenches 7 (Note if a pad is used) Length of pad or trenches:..-_7S i Width of pad or trenches: .' Center to center spacing: Reserve required? YcS Percent reserve area required: 100 t Total width of absorption area required 7S" Total trench bottom area provided: Z025 ff.4., The required width is calculated by multiplying the center-to-center spacing by one less than the number of trenches and adding I trench width plus any required reserve area. If the topography is not uniform across the length of the site the trenches will need to flare apart on one end to maintain contour. When this occurs it is necessary to use a center-to-center spacing that accounts for the flair or the installer will not be able to fit the system within the approved area. It is perfectly acceptable to have more area available, especially up and down • the slope,than is required. OSE Form E Revised 7/2/09 e• Page_7 of S System Specifications ,, le ID: 7 i i - Bred A Applicant Information Name eesd.e i}ia 1 ..CLIrdcyi'hl .ft.rurct4 Phone `/39 21C-87 1Y Address Inv A/1.4 .A+k,,f sale, 2.oA Location Information Tax Map No. J 1 /q Property address GPIN No. _ _ / _ Directions ►Asa, id Ramie, zo ; Subdivision &I.j 't/- •3 h,; aifla f_gosfi 7y2 Section Block / Lot A General Information System Type Number of bedrooms y$� (e.g. septic tank, drainfield) Daily flow( 6PD (gpd) Type of property ec5 ..,4,n1 (e.g. commercial,residential, etc.) Conditions Sewer Line Septic Tank-Inlet/Outlet Structure Schedule 40 PVC,4" ✓or equivalent Capacity: /L50 gallons • (add check or describe equivalent below) 2T' septic tank 0//4- gallons Per the 2000 Sewage Handling&Disposal Regulations, Check which option chosen: ✓Septic tank with inspection port ohs. Septic tank with'effluent filter Reduced maintenance septic tank Conveyance line/force main Information Distribution box Information _ Method _/,,� /}�� No. of boxes /- (e.g. gravity,plimpingf dosing siphon) No. of outlets /2.- If pumping, attach Pump Spec Sheet Surge or splitter box required: Material SGied u,le„ 'to /VG Yes_No Pipe diameter In Slope of pipe(''-1co' (in inches) Header line Information Percolation line Information/Absorption Area 1500 pound crush strength Yes ✓ Center to center spacing-7_ft. Minimum slope is 2"/l 00 ft. Yes Required spacing 9 ft. Installation depth ye inches Aggregate depth 13 inches No. of Laterals VLateral length 7S-ft. Lateral bottom slopez-3inches Lateral width 36 inches OSE Date 0 r/2o/2p i h OSE Form I Revised M/2009 s: 6 A. o6 0 N r" 2 �2 ry / IMP 90 21H ., ' �ti \2 Christopher Black, etux tea'.QQ�' '� © 0.9,4942 Pg.316 ,'' c. O p , '`� °� 2 ' `r / IMP 90 21H1 �(0 0?' �� IF �'�� Kristen L. Hunt O �,0 2 • \� cS 0.8.4929 Pg.9 ti2 I TMP 91-18 'v� '�' • \9p•F `�� �'y Wendell W. Wood rL'� 'UP ;R�.� �� `°, �< ,q D.B.1727 Pg.674 VDOT Mon. .tic (typ.) e. ,o,'` N` r O� ,90 �S. 2.23' NE of '\ �.�� IF \ `� •S •1+ corner ?'- �` `SS0 ‘�jti �, Q,L Q '�\l�D well ``1 A�f`04,., `ASS j 49 Ali IF __ o 'N ? < . `\ SD %C35�� 9• F 9'• - ~590J Mon: tiiOow• ,'p, �c� `;.\ ,i qa�� ,�O• ,,. BS \ Fd. �' Q o° ti`: !�rshed dp `�\ �� tip' 600 _ 1 \`5�9. / a� q�: 'o� Residue h a S1 _ _ \� F Z�' ,r 0 q\ RDF� h� �0��\ Primary & fin\ 1F,�2,01 / /r 4,\ / ,? PP 0• Reserve �r u 0 , �S /�d� h / SSA QB\ .,�/' h�o Dra�nfield Parcel B '`P\4. Jss, iv J°ye • �6i '21Ae�09 occ11c0 IF \N 9 93 w�n9 \Is �� 1�0 e, c, ` 2� ,9 0`; AQ� kco�o� , \ Parcel "A" 1 �2 6 c6• o`O?� \ �\Primary & 0 y2 °,' \ 44. sts� Reserve 6 \ f% DrainfieldI, o'`'4 DSO \\ co° • ' \ h0`x. c3, , \ \ ,f# �O O� 9.. \ \`° � N�' Ooa P, 1 � �\ � ,' / Rectorsin \..4). / 0) q, 6 M16 �� N N ,/ t9). 45 "\go' lb e 1 Visitors0 of of the UVA \\ t!`4� D.B,1110 Pg.279 N if \ 4 IF O /,�o h; (<a /�Z4pQyQ2 /' Page ! of 3' • OSE/PE Report for: Construction Permit F7 Certification Letter l l Subdivision Approval Property Location: 911 Address: City: Lot 13, Section Subdivision ;_zd ,.„ lo ;1„----- - -----— ---- —__ _ GM or Tax Map# ) P, �e f q Health Dept ID# r Latitude Longitude Applicant or Client Mailing Address: Name: Re5i4.4ta1 snVeytJ4 seev,,,es Street: �f)i' `l,y o .��tJJsJ19 City: CAN•116 Salt JjG State lb/ Zip Code ZZ7D3 Prepared by: OSE Name Lybhift SI1 suf LI Y3Y 2Y9-OZ $ License# I?%'Ool35'7 Address F.D. Box 7SV City I,eSwWC, State V4 Zip Code ZZ9y7 PE Name: License# Address City State Zip Code Date of Report 01/ZoAVIV 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.) _ r 3 —5- Skzr,m4 ; o,J5 —r - - 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 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 tl ork 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(selec ne): construction permit❑ certification letterill subdivision approval Er be(select one)issued denied❑. • OSE/PE Signature f Date_ 40 z0_ p7e, 2 o1 Commonweal h of Virg'ia VDH Use only Application for: evvage stem mate Health Department TD# S`Y r Supply Due Date Owner 1;3`.yay, 9 er 3. _ Phone Mailing Address !tilt' 44444. eo Phone - C 1% 10 csvi ik (fig ZZ7d I Fax Agent Re6i3 er 44k 1 544*v ,t,J .fie ryit4S Phone I/3y z Kr-.R7$I Mailing Address 171 b Snivel i e-o4 S't,.;le ZOA Phone CA4-1/61-0svale. UA 22103 Fax Site Address Email Directions to Property: Ei45siL Jat.•4 ZO i 4/ •3 nmks 144 oi•'£ Mfe;'7yZ Subdivision o44-eN Fes.;iv Section Block Lot B Tax Map 71 pNrcc.I 19 Other Property Identification ''-1?iaiension/z�•''°-. .eofPro _. : r. e1'�g PAY 7.G1'Y Ids 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. 13Certification Letter -'=Construction Permit 13Voluntary Upgrade pair Pemdt Proposed Use: C S..bd evt5i On e,vpeto Single Family Home(Number of Bedrooms ) Multi-Family Dwelling(Total Number of Bedrooms Other(describe Basement' (.To . Walk-out Baseme �s nt 1No. - - Fixtures in Basemerrliq Conditional permit desired?fYe`s�= o If yes,which conditions do you want? OReduced water flow ❑Limited Occupancy ['Intermittent or seasonal use QTemporary use not to exceed 1 year Do you wish-to apply for a betterment loan eligibility lettertitehere is a$50 fee for determination of eligibility. Water Supply Will-the water supplx �hlwo e?. Is.the.watersup • s • If proposed,is this a replacement well?DYesfNo If yes,will the old well be abandoned? _ YVs,Qi!To. Will any buildings within 50' of the proposed well be termite treated? yes Alt Applicants Is this a private sector OSE/PE applicatiorf q If yes,,is the..OSB/PB:papkage attach e2 d e o . Is this property indeed to serve as your(owners)principal place o idence? �a�" I�► z In ordo;.;for.VDI fo'giiOceis:Yett '.aPphi atiiM:forasewage ysfcn you;uus'l sdo` lat"9f-.. supplies,a plat of the �: .. �"P �iii's_site sketch. For water PP P property is recommended and a site sketch is required. The site sketch should show your property lines,actual and/or proposedbactingc and the desired location ofyour well and/or swage system. When the site evaluation is conducted-the-property lines, --building-location•and-the proposed-welland sewage sites must-be cle ly-marked-and4h4froperty-su cientiyvisibleto-seethe-tapegraphy. I give permission to the Virginia.Department of Health to enter onto the property described during normal business hours for the purpose of processing this application and to perform quality assurance checks of evaluations and designs certified by a private sector Onsite Soil Evaluator or Professional Engineer as necessary until the sewage disposal system and/or private water supply has been constructed and approved. Signature of Owner/Agent Date This form contains personal information subject to disclosure under the Freedom of Information-Act. Revised 12/1/2014 77- 3 ed- 8 VDn Use Only Health Department IDA Due Date Site and Soil Evaluation Report (For certification letters and subdivisions) � � General Information Date: o_fy zp Zo 1$ _ ,Q)b,ernsirk County Health Department Applicantrvelps41 Ser a 5t Telephone Number: 93 q-Zys"- S*7'Pi Address: /7J0 4/Ited 5j Owner uii'y.v. 1 BISh 'Sr Address: Jltt zcA„Let,kj j b ct'i t Location :14.54;J tit A0w4 Z07 "/ .3 M 10. /U4A, el oufc 7yZ Subdivision 1j - BIock/Section Lot Soil Informs ' n Summary 1. Position in landscape satisfactory Yes No Describe: s.l / L 2. Slope r 7 % 3. Depth to rock/impervious strata Max. 60 Min. 5 3 None_ 4.Free water present No Yes Range in inches 5. Depth to seasonal water table(gray mottling or gray color) filM inches 6. Soil percolation rate estimated Yes✓in Texture group ❑I n1I II DIV No Estimated rate (nsmin/in 7. Percolation test performed Yes lumber of percolation test holes No Depth of percolation test holes Average percolation rate_mpi Name and title of evaluator: '�ag h K � �i.t2 d. _ Signature: i r_ - — De'of tmen>� t Use ite approved: Drainfiel rench bottoms p ee placed at Z3 (inches)depth at site designated on permit. Site disapproved: Reasons for rejection: (c ck all that apt) I. _Position in landscape subje t 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 drain field,and/or Reserve Area. 6. _Proposed system too close to well. 7. _Other(Specify) OSE Form(i(pg.')Revised 7/02/2009 Page ! of Date of Evaluation: 124. 2tolg— Profile Description SOIL EVALUATION REPORT Property ID:'7{qy iehrre /q — ii " �M! Ewe.) 8 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 thjc 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 0 S •' 3 . . it :�: L �RtME to 7,sy sc. ; .. . 4 M. . Mir A 'MCC • r. :r. £I Lrttri► UIC 3 n-S y.y . • . . REMARKS • OSE Form G(pg.2)Revised7/02/2009 Page 5- of Design Calculations , se Property ID: `j:= PArc4 Flow Type of use(residential, etc) ese`a ni,,Ad Show Calculations Here' No.of bedrooms: / BR No.of employees: /1///4 Square Footage of building space:/Soo Daily flow(peak design) in GPD:(eej4pp Treatment No. of septic tanks: 'lt Show Calculations Here' Size of septic tank(s): /ZSD 4r,/lvn Pretreatment required? _yes If yes, specify type of treatment device: Absorption area design Soil Texture Group: i= If pump system, enhanced flow, or LPD show Reserve area rewired?_ no calculations here or on a separate sheet. 50% ✓fO0%_other(check one) (dosing volume, head, pump design, etc.) Specify other Water Supply Class of well: C eihi/ Describe(bored, drilled):.c,Drdieder aged Distance between septic tank(s) and well: 5b'+- Distance between absorption area and well:L0'f ' information and calculations required for commercial and/or conditional use applications only OSI:Form I Revised 7/2/2009 Page k Of,I _ 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 ary and reserve area, CI only the primary area, 0 only the reserve area(check one)for 1 ,,,„r 71 „..I 1 f -px�rz�I "8" (property ID). ,I Design Basis Total length of available area: r D 0' Total width of available area:• .-/Z D'- - ; Estimated Pere. Rate: ( 5 at Z. in.(depth) Number of bedrooms(or GPD):18R o,,,(od0 (afro i Conveyance Method:_4r,,tv;4.y Distribution method (specify): l Ten44 Dispersal system basis3_b __Sy.a�-S1�y LGMI required? A/p (Ye' e.j 1;I Effluent quality required: recork.A7 411MIecondary,Advanced Secondary) Square feet per bedroom: Lot 1.14. 4, Total trench bottom area required:j 7s y- h, j , I Gravity,pump,siphon i% Enhanced Clow,LPD.or Drip Dispersal ;j 3 Table 5.4 of SHDR or identify the GMP used 1 Area Calculations Number of trenches _ (Note if a pad is used) Length of pad or trenches:-- _.- � 1 t a Width of pad or trenches: 3 Center to center spacing: 7 Reserve required? YeS Percent reserve area required: IOO,o Total width of absorption area required 57' Total trench bottom area provided: 2100 I,lik 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 F System 'Specifications fl Property ID: Tax 91 0ars,119 - Pored I B Applicant Information Name �� •des Phone Y3'/- Zys':-$7'/'/ Address-710 ,¢//Nee) Slr�� �.$. 204 atielvtifoSmti VII 22?o3 Location Information Tax Map No. 9/ p,}, ,1 17 Property address GPIN No. Directions k• ,Zo, Subdivision ik,,,, ;/v 'F- •3 ;e 741Z Section Block Lot R General Information System Type z' Number of bedrooms '/8iZ (e.g. septic tank, drainfield) Daily flow4,op OD (gpd) Type of property g.5.41....1 (e.g. commercial,residential, etc.) Conditions Sewer Line Septic Tank—Inlet/Outlet Structure Schedule 40 PVC,4" for equivalent Capacity: /2.3-0 gallons (add check or describe equivalent below) 2" septic tank ,//q 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 _______s(4,U No, of boxes l (e.g. gravity,pumping, dosing siphon) No. of outlets /,Z If pumping, attach Pump Spec Sheet Surge or splitter box required: Material 3'4 14,,,4 %% ?tic, Yes_No ✓- Pipe diameter_y°-- Slope of piper-/oo' (in inches) Header line Information Percolation line Information/Absorption Area 1500 pound crush strength Yes � Center to center spacing 9 ft. Minimum slope is 2"/1 00 ft. Yes -� Required spacing 9 ft. Installation depthZ9 inches Aggregate depth 13 inches No. of Laterals 7 Lateral length IDO ft. Lateral bottom slopez-4 inches Lateral width X inches OSE A Date b$/o/Zolg' OSE Form 7 Revised 7/2/2009 , 0 2�p`Z �/ TIP 9021H Christopher Black, etux yati�Q°' J,4{U Q 0.6.4942 Pg.316 /,' ��°��`�`?o'��0 hP�IF `ref o TMP 90 21H1 ,• N Kristen L. Hunt 0' 0 2 • \ 'OS'oo ! D.B.4929 Pg.9 0 I �,�,a kr • \\ \Y y',,, • ye. S, TMP 91-18 2^ •' P. \ F • �: vj Wendell H. Wood VDOT Men. tieb i(typ.) a'. A•��� r`� �jro� �� '7� D.B.1727 Pg.674 2.23' NE of '� ',.��.._b IF .30 D S corner '�,�d \\ SSO �ojti 5•�.1� ,.P2 Q ,.- D well 'o^'? 04,`\ `�S6'7 '4 IF ,,,_-- 1 .. 1 ��o°• ^ ,�a coc ��\ ,QED °�0c�S�• �6�<� 2°'0 ��9'rj9U \ Non. 9 j SS Fd. x\/x. /�o °°� 2':;�\ As shed �d0 `\ ���ti90 600 1 `599. /� Q o a so Y.�T•- 'o� ltesYdue hm° `IF ��-- ' \ 9�S 1a Z�' O,rY q\ RDF •• ` (0- r�1p0�� Primary 6 �1^ F n1�,Le 01 - �'\ �� , pP Reserve " a `�� pS o�' Ud��� SSc,de\ • .,��,ti h�° Drainfield Parcel B 'e 'rb` da . 1 '.<3\ `o .*0v 0'' S, .cp JoyeP�� ,iee',0° °��q c0,F \\ 39 93 Wlne \Is 90aceQc�' °�� I ` 92 ���ee�a ����' \N Parcel "A" `�e•• ° �. oc q' ' '. �Z 0' \\ ' , \'pReserve& N. ati �� \ j��O ,�/'% Dra hfield IS \ 0 .9' \ \ '�c)‘/ 1. i h IMP 90 21G 0.7c)" \\ ` \,` ,r PO� ��2 \e e e21 e9 e Rectors & visitors \\ " c9 a�1 0 - of the [1t�4 \ ��0 y D.B.1110 Pg.279 \ pQ O \ w-. IF ® 0