HomeMy WebLinkAboutHS202200021 Approval - Agencies 2022-05-12'A 10NOW'Ir
Albemarle County
1138 Rose Hill Drive
Charlottesville, VA 22903
(434) 972-6219 - Office
(434) 972-4310- Fax
Fluvanna County
132 Main Street
Palmyra, VA 22963
(434) 591-1965 - Office
(434) 591-1966- Fax
VIRGINIA DEPARTMENT OF HEALTH
Thomas Jefferson Health District
ENVIRONMENTAL HEALTH SERVICES
Greene County
50 Stanards Street
Stanardsville, VA 22973
(434) 985-2262 - Office
(434) 985-4822 - Fax
Louisa County
1 Woolfolk Avenue
Louisa, VA 23093
(540) 967-3707 - Office
(540) 967-3733 - Fax
Nelson County
4038 Thomas Nelson Hwy
Arrington, VA 22922
(434) 263-4297 - Office
434) 263-4304 - Fax
Findings: Review Pursuant to VA CODE §32.1-165
Attachment 3a
Property Owner: Allison and John McNally
Home Phone: 724-561-3880 Cell Phone: 608-335-9290
Email: lohn.mcnally3141@gmail.com
Site Address: 2055 Avalon Way, Crozet, VA 22932
Parcel ID #: 39-21z4
Subdivision: Emerald Ridge Section: Lot:
Is the existing onsite sewage system safe, adequate, and proper or approvable as nonconforming
for the proposed use?
us YES Comments: Proposed one bedroom apartment is approved based on conditional
permit issuance (HDID: 101-21-0331). Basement will be renovated to one bedroom apartment, all
C NO Comments:
Other Comments: construction is interior to the house. Plumbing will tie into existing plumbing, no new
sewer line needed. Proposal was submitted in an OSE report for a conditional permit. Existing septic
system is sized to accomodate 600 gpd = 4 bedrooms. Addition will increase number of bedrooms
to 5. Bedrooms shall not exceed 5.
Please note that each evaluation is based on a case by case basis and may or may not include a Department site visit.
There is no guarantee given or implied that this sewage disposal system will continue to function properly in the
future. In the event of a sewage disposal malfunction, the owner will be responsible for any repairs or other actions
deemed necessary by the Department to correct the situation.
Page 1 of 2
See Page 2 for Site Sketch and Signature
Page 2 of 2
SITE SKETCH
Health Department
Identification Number
5chematfodrawing of sewage disposal system end.topographlo features, T ' PAGE OF
Show the tot lines of the bu0ding lot and building site, sketch of property Showing any toppgfaphfc (eaWres whtch may Impaet do the design at
the system, as OAMIng andlot proposed atrucrures tncludlng 0aw119e disposal systems and wells Within 1e0 lest of sewage disposal "Om and
reserve area 77te schemattO dtawtnp of Ifie sewage dlapoast system shall sit
OW sewer line$, prellastment unit, Pump station, convejanta rya•
Um and suttsurtace $ots absorption system, reserva area, etc. When a nonpublic drinking Water supply ii to b0 located on the same lot show all
sources of pollution whtdn too feat.
L
(] The Information required above has been drawn on the attached copy of the sketch submitted with the atpptWatton.
Attach additional sheets as, necessary to illustrate the design.
ri
ad �
.a
`7rd b ksal
146 WWaga dispo>usl eyslnnt Is to bat constructed as-specitfad by this permit sw r Attachedd ptans aMd aW49caurpti.171. t
This oawor dfspoaut tepbl* corotwcoott "Olu is suit and vow it (a) cogdlliona am s;tt"('4 from time .Uiawt oa inn WROMM (il)
udrw aw ahmw itotn ihasa shown on the p n0t ucUon potrn$,
No part of my bptadatlart shun be VOWWod of rind "Of Inspected, sp1wlaOo pt duk if nasossaly, +Ind approved; tft+Ihn foam Nallit ticpw snvd
A or "lais tapscsOV "lft"A by the 10"I til}a11h dapt, Any {tan of golhal9Ratioo vAdab hyu bnan gftwtOd prior YO Na
Mal) b„aw-pQormw
te,•C4lba/y,.4PWi Ov" cl�Lt[Ofl M IIX, Pupi3itn74l..
a dA
Albemarle County
VIRGINIA DEPARTMENT OF HEALTH
Louisa County
1138 Ross Hia Drive
Thomas Jefferson Health District
1 Woellelk Avenue
Charronwvhlo, VA 22903
Louisa, VA 23083
(434)972L2t9.OI6ae
ENVIRONMENTAL HEALTH SERVICES
(540)a67-3702.ptroe
(434) 972-4310- Fax
(640) 967-3733 - Fax
Flwanna County
Greene County
Nelson County
102 Main SV601
60 8tanaNe Svaot
4030 Thomas Nelson hMry
Parmrro• VA 22963
Stanardsville, VA 22973
Arringion, VA 22922
(434) 591.1965. Office
(434)985-2M-Office
(434) 2834207 - Wee
(434) 591.1966. Fax -
(434) 985d822 - Fax
434) 2634304 • Fax
Request for Health Department Review
Property owner, Aflison& John McNally
Maiiing Address: 2055 Avalon Way, Crozet, VA. 22932
Agent Name: NA
Mailing Address:
Site Address: 2055 Avalon Way, Crozet, VA. 22932
Subdivision: Emerald Ridge
Parcel Hl M 39.21 Z4
Home Phone: 724-561-3880
Coll Phone: 808-335-9290
Email: John.menally3141 ftrnail,com
I lame Phone;
Cell Phune:
Email:
Section: NA Lot, 30
Curn.•nt Use (include number of Mrdruunis); 4 bedrooms
Proposed Construction (include number ofbedroomx)• Adding 1bedroom Apt. With conditions
Has property been occupied during the previous 30-day penod? QYh$ or QNO
Septic tunk and distribution box lids will be uncovered for inspection by. NA (Date)
• To prevent potential damage to thesystem VnH recommends homeowners first contact Miss Utility for marking any
underground utilities. The septic tank and distribution box should be carefully excavated by baud.
Uncovering the septic tank and distribution box lids would cause undue hardship: 21YES or[JNO
Reusonsfor Httrdship: accurate records exist
(examples orhardshlp: system was installed Icss than 5 yews age, teuently ptunpod, *"units records exist. excavation would likely
danwgu components)
PLEASE Rf AD CAREFULLY:
This report Is only intended to address the above referenced request and does not address evoluotion procedures for sewage systems
being sold through real estate transfers, or systems and water supplies being reused as pan of a subdivision process. This document
specifically addresses VDH's implementation of § 32.1.165 of the Code of Virginia and is not to he used for any unauthorized use.
Ilse pwperty uuwidaries and building locations arc clexrfy marked or idenniled at the property. 1 give permisetun to VDll m vnlur nu
property described, it necessary, for thu purpose of processing this application. An accurate xketch of the property, existing structures.
wells, sewage dispnsai xynemx, and proposed ctute(s). is attachedlapse also attach any recent war& orxepde system (septic
wnk pump -outs, operation Rc maintenance
Owner/Agcrit Signutun:: Dare: Li f i (g,�,
Form 2
C'onD,trpn+l
Construction �i Repair
Permit E( Permit
OSE/PE Report For:
11 Voluntary Upgrade
Permit
❑ Cenification
Letter
Page i of (0
13 Subdivision
Approval
Property Location:
911 Address: 2055 Avalon Way, Crozet, VA. 22932 City: Crozet
30 Lot Section NA Subdivision Emerald Ridge
GPIN or Tax Map If Health Dept 10 # 101- 21 - 0331
Latitude NA longitude NA
Applicant or Client Mailing Address:
Name:
Allison & John McNally
Street: 209 Avalon Way
City. Crozet State A Zip Code 22932
Prepared by:
OSE Name William Craun license # 1940001013
Address 124 Georgetown Green
City Ch ottesville State VA Zip Code 22901
PE Name !:A License #
Address
City state Zip Code
Date of Report Date of Revision #1
OSE/PE Job # Date of Revision #2
1 eotneena/IndeeRof this report (e.g., SRO Evaluation summary, Sell profile Oesatptions, site sketch, Abbreviated Design: am)
CA (Site t 6.
Owr —
ApplICaTIOn
4-5 y or existing Sepild a ml
ta+rtlRcadon Satemem
I herebycenify that the avatuations and/or designs contained herein were conducted in accordance with the opplicoble prowslons Of
the Sewage Handling and Olsposal Regulations (12 VACS-610), the Private Weft Regulations (12 VA54%1l, the Regulations for
Alternative omite sewage Systerm (12VAC5413) and all other applicable laws, regulations and policies Implemented by the VfrgMI*
Department os Mnarth. s further certify that i ainamty oosseseanv omfmidbetal license required by the laws and re1N(atlom of the
Commonwealth that have been duly Issued by the applicable agency ebarged with i(censure to perform the work contained herein.
The potential for both conventional and aherrg*a onsne sewage systems has been discvssed with the owner/applicant
te work attached to this cover page has been conducted under an exemption to the practioe of engineering, specificallye hexemption in Code of virginls %06n 54.1+W2.A.11
e'aw O.P. o4
I recommend that 8(S@lt one):c wamM
pal( pe voluntary upgrade ❑ Denled ❑
Oe 8/14/2021
OSE/PE Signature , Date
v
This form contains personal information subject to disclosure under the Freedom of Information Act. Revised 9/ l,701 7
Commonwealth of Virginia
Application fortmSewage SystemQWater Supply
Owner Allison & John McNally _
Mailfng Address 206S Avalon Way
Crozet, VA, 22932
Agent William Craun, OSE
Mailing Address 124 Georgetown Green
Charlottesville, Va.22901
Silt; Address 2055 Avalon Way, Crozet, VA, 22932
Dirccaons to Property_ _
subdivision Emerald Ridge section
Tax Map 039-2124 Other Property Identification NA
0$12oIzi-¢200'0O AW4tf wvt-ZOI7b501
it 00(o87L
3 opG
VDH Lae an
Health Depitunrnt ]Do �-21�Ct1j
Mw Dow
Phone 724.661
Phone 808 33$-9290
Fax
Phone 434-326.6485
Phone —
I"
-
Email
Bloek Lot30
Dimertsion/AcMage of Property NA
Type of Approval: Applicants fbr new construction are advised to apply for a ccrtirli Won letter to detention if land is
suitable-fbr a sewage system and tu upply for a consuuedon permit (valid for 18 months) only when ready to build.
OCeltiliieation f.ed"o Construction Permit O Voluntary Upgrade O Repoir Permit a Mirror Modification
Proposed Vast
Singto Family Home (Number of Hec rooms 5 ) Mulli-Family Dwelling (rotas Numbcr of Bedrooms _)
Other(desctibe) existing 46R house, adding IBR apartment with condition of 8 people
Basoment7QYcOia Walk -out BasewateYctii�, (o Fixtures In Bascmeat0Ycs)No
Conditional purtnitdahcd(DYc<)No ifyca,which conditions doyou want.
accluaed wuh r flow ®Lgnited Oocupancy Qlntcmtittcat or seasonal use QTemporgiy use not to "coed 1 year
Do you wish to apply fbr a betterment lean eligibility letter eeNo `There is a M fee for determination of elWVdity.
Will the water supply beQRabiic or&dvate? Is the water supply ousting ord'mposcdf
Ifpropostd, is this a replacement wcll?(>cx0No 1(yes, will the old well be abandnne'royesoNo
Will any buildings within 50' ofthe proposed well bu termite trratee! QYes QNo
Wen Type (e.g. doalestic tuc, agricultural, irrigation, etc.)
All Applicants
Is this property intended to serve as your (owners) principal place of rcmdence70Y<)No
AD applications just be umcimp inicd by private s^ r eva,*lfons and designs, unless a petition for VDH services is
the property is recommended and a sue akawh is "Ire& The site sketch should show ytwrproperty Itnct actual MWor
s sari the desired lataalioq oPyaur well entree samage system. When the sire evaluation is condoquf the property lines,
uW the proposed went and sewvye sites must be Orally marked and the property wliklenily visible to see the tppolpepby
to the Virginia Depanme:it of Health to enter ento the property dc=bed during nam al business hours for time purpose of
pi�d w perform quit. checks of evaluations and demsra ccrtificd by a private seater thisita Soft
Sthect' ace I the sewage disposal cyarem ar dbr private waterZ
$iy has bcca ronstructed and
?7 6Z r
Signature of Owner/ Agent to
This forty eoataias personut tofarmadon subject to dhetosure tinder the Freedom of tuformation Act. Revised 7/1/2019
Sewage Disposal System Construction Permit PAGE 1 of Z
Commonwealth of Ytrglnts /�rgt'�� Health Department
Dopatta19 !1 'allh [ f.. .Il identification Number
'i _1 Health Department Ktnn gnrn.nn�n
� • Ganerallnlomtealon - -
Now Repair p Expanded C] Conditions] ❑ FHA ❑ VA ❑ Case No.
Based on the application for a sewage disposal.systam conatruclfon permit filed in accordance with Section
s.13.01, a c netruction hermit ishereby iee� to,
Owner l �uv rn >r.. 1C Telephone
Address
For a Type =_ Se wa a disposal system which Is to be constructed on%at'
Subdivtsl =nnkotA ei UA SeCtlon/Block
Actual or eat , • �ti r -�-�
OE81aN 1
NOTE: INSPECTION RESULTS
Water supply; exie8ngf (describe}
ear supp Satisfactory yea 0 no
Comments
0• W. 2 Received: yes ❑ no Q not applicable p,
Building newer yes p no O comments
Satisfactory
To be Installed: class -
eased �f7 route
Sulldlrig ss+ower.
41 I.O. PVC 40, or equivalent.
Slope 126• per sty (minimum).
Q. Other '
SapOc tank: Capacity / gala. (minimum).
PrOtmahnentunfl: yes ❑ no 0 comments
Othaf
inlet ?
r a
Satisfactory
PROWMW
IMatwWltil" of
PVC 40, 4" lessor equivalent.
4 Other
Pump !gd•pump eta"". '
No D Yes [] describe and show design.
Pump & pumA'statbn:� i ryas
-Sallatactory f f
It s:
Convoyangemeshed: yes 1comawmOs
Gravity Maine:,ia t larger t,D., mtntmum S" fell par
100', 1600 lb, crush strength or equivalellL
Satialactory
0 Other
OietrlbaUon boK:we411iuUen
Precealconcrete with /n. ports
4osf yes
Sathfaclory
Other
He"" ""oe:
Malarial: 40 LO,1000lb, crush alrengih plastic or equiva-
ilesdarllnoer yea C9 no q comments
8attalactory
fond from dletribu0an bqK to 2' into absorption trench.
Slope 2" minimum,
ri Other
PsroaialMn goes:
Gravity 41 plastic 1fi00 lb, per fact beating toad or
Perratalisb litu:s; Yes t~i no ❑ Comments
SsdiaterAcry
aqutvatent, elope 2" 4" (mtn, max,) per in0',
L1 Other
AboorptlDntranchDai
Square & required / •1 depth from. ground Su" Sp
Ahaprptian yam n0 [j Cpmmanfa
Satisfactory
N
_•1 'Whom of tronch aggr le ails i
7_.
Trench bottom bottom elope . 4 v S!tt' Y
comet tb carver spaclpo , L ; nanab width �
? r'
gapthot aggrogdto V'f ,
Trurwh long8f'lionthas �
Oats
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