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HomeMy WebLinkAboutSUB201600249 Certified Engineer's Report 2016-12-16 Page / of 7 OSE/PE Report for: Construction Permit Fl Certification Letter Subdivision Approval Property Location: 911 Address: City: Lot X Section Subdivision Ply i fowidt GPIN or Tax Map# ZZ"!lice/3 Health Dept ID# Latitude Longitude Applicant orr Client Mailing Address: Name: `IKA,Jrl a) Street: 890 fl i4 O,-.)„ City: ICe<wi ck State ✓9 Zip Code Z27y7 Prepared by: n OSE Name R;✓,��,,,� 5 -1 Liz W_299-4245'License# /I y600/35 7 Address r0, B,X 757 City ke'Swi ck State Of Zip Code ZZ 997 PE Name: License# Address City State Zip Code Date of Report 1L //Y/Zp/4 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.) pip 1-2 OSE SdI. fialrmd.i$ ; Air1.lcNhen 1,74 9 Y/wi ;7. 3-s af_s_usf,, ; s:ls t7. 7-ft /66.0.v,;,1cd AsJ., 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 the work 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 c nstruction permits certification letter subdivision approval Ei be(select one)issued denied . OSE/PE Signature ! Date /Z//y/Zo//, ft,e z o19 Commonwealth of Virginia VDH Use only Health Department ID# Application for: ewage System ElVircter Supply Due Dale Owner �0 5 44,1hMc pp Phone 70/ -8YZ - Q�IFS$ Mailing Address QQ lip c.k 1-0w►, herd Phone kksi.);Lk (/A zz? 7 Fax Agent l3race Ai Ax 4 Phone c/3f-177 -cr?96 Mailing Address Lip 3 P4..k ci-,- ' Phone G�►krtott-e41/14, Vr L2?0Z Fax Site Address Email Directions to Property: SQ.,,f'%s;Le .0/- Rower li y l • . yS Ades West 0/ ,Qe Je lo€/O Subdivision Rol rrjy Section Block Lot Lj pgr_l X Tax Map 2 2 P.Mc�, 3 Other Property Identification Dimension/Acreage of Property (D.0(0 fl 'e5 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. ertification Letter Q Construction Permit Q Voluntary Upgrade D Repair Permit Proposed Use: Single Family Home(Number of Bedrooms 3 ) Multi-Family Dwelling(Total Number of Bedrooms ) Other(describe) �vo ,� Basement?QYesa o �lkWalk-out Basement?DYes[ < Fixtures in BasementQYesl Conditional permit desired?D'{es(„ vo If yes,which conditions do you want? Reduced water flow El Limited Occupancy ❑Intermittent or seasonalseon use ❑Temporary use not to exceed 1 year Do you wish to apply for a betterment loan eligibility letter` YesB *There is a$50 fee for determination of eligibility. Water Supply Will the water supply beOPublic ore rivate? Is the water supplyDExisting o roposed? If proposed,is this a replacement well?QYes Edo If yes,will the old well be abandoned?©Yes QNo Will any buildings within 50'of the proposed well be termite treated?QYes ! o All Applicants Is this a private sector OSE/PE application? es QNo If yes,is the OSE/PE package attached? es ONo Is this property indeed to serve as your(owners)principal place of residence? _ es❑No 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. Signature of Owner/Agent Date This form contains personal information subject to disclosure under the Freedom of Information Act. Revised 12/1/2014 far. 3s19 VDH Use Only Health Department ID# Due Date Site and Soil Evaluation Report (For certification letters and subdivisions) General Information Date: 1Z /l4/ZoIL _/¢/L,.,.„4,,lc County Health Department D Applicant: Lvt,,,, s Telephone Number:_703- y9 Z — 8 Y $ Address: VI ii9oiiow.1 2.9917 Owner: ; /mid Address: 17Q Aijs►Gl/e,,,)" 4,4 d� 4'/.(w+ - Location : S0,4,}14,slJ. !f£ /� .9 /hi/r5 W / of iC j 61/4, Subdivision Rn.Sif,A1 .4ni13, Block/Section Lot }( Soil Informs ion Summary 1. Position in landscape satisfactory Yes t/No Describe: 1145 a Ain is-7 2. Slope g % 3. Depth to rock/impervious strata Max. Ls Min. Co None 4. Free water present No `�Yes Range in inches 5. Depth to seasonal water table(gray mottlingng or gray color) /i///g inch« 6. Soil percolation rate estimated Yes +� Texture group ❑I n I I rF I\' No Estimated rate (Dmin/in 7. Percolation test performed Yes_ inber of percolation test holes No ✓Depth of percolation test holes Average percolation rate mpi Name and title of evaluator: G.O.D. Signature: Depart t Use 'Site approved: Drainfield tre bottoms to be •rimed at S/L (inches)depth at site designated on permit. _ Site disapproved: Reasons for rejection: (check ll 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 drainfield,and/or Reserve Area. 6. _Proposed system too close to well. 7. —Other(Specify) OSE Form G(pg 1)Revised 7/02/2009 VDH Use Only Health Department ID# Due Date Site and Soil Evaluation Report (For certification letters and subdivisions) General Information Date : /Z/iy/Zai(o /9444n,4 le. County Health Department Applicant: `�"'�$ /H7/ d l-elephone Number: 703 - g?z - ?Mr Address : eye j49.A} ,�.� I£Q,r J Pets w+`c K 01 22 At 7 Owner: /0,4 5 R7/rn c✓ Address: Location : A y/ ' / . is 6 y0 Subdivision /`y/t / 3n, / Block/Section Lot X Soil InforTation Summary I.Position in landscape satisfactory Yes✓ No Describe: 2. Slope ,j % 3. Depth to rock/impervious strata Max. (gyp Min. LI S one 4. Free water present No(Yes_ Range in inches__ 5. Depth to seasonal water table(gray mottling or gray color) _ /(//fr inches 6. Soil percolation rate estimated Yes '' Texture group ❑I Ti I I r II No— Estimated rate Co min/in 7. Percolation test performed Yes dumber of percolation test holes No /Depth of percolation test holes Average percolation rate mpi Name and title of evaluator: �145 K. .O. O. Signature: Depart; ent Use ite approved: Drainfield tr ch bottoms to b- ced at 2.,7(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 drainfield,and/or Reserve Area. 6. _Proposed system too close to well. 7. _Other(Specify) OSE Form G(pg.l)Revised 7/02/2009 Page 5 of 1 Date of Evaluation. Qz/IL/ZoIL Profile Description SOIL EVALUATION REPORT Property ID ftml/fie__411904,4,13 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 _"rSee 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 A o-S 7.s'YR r/Y Beaus. Le5,4r4. "Zr 131- r-3s Z.97 yli. 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Inc • REMARKS OSE Form G(pg 2)Revised7/02/2009 Page W of 1 Design Calculations Property ID: Tex /n, , Z2 ar«I 3 - R�I � "%�y `'�/''°"l Flow Type of use(residential, etc) Resj..h Show Calculations Here' No. of bedrooms: 3 gk No. of employees: ()/f! Square Footage of building space: /?cbsrk Daily flow(peak design) in GPD: 'ISoGPD Treatment _ No. of septic tanks: l Show Calculations Here' Size of septic tank(s): loco L.►llon. Pretreatment required? _yes-tfo If yes, specify type of treatment device: Absorption area design Soil Texture Group: 1:Er If pump system, enhanced flow, or LPD show Reserve area required?✓es_no calculations here or on a separate sheet. 50% --ilk_other(check one) (dosing volume, head, pump design, etc.) Specify other Water Supply Class of well: 704 (A/di Describe (bored, drilled):1drilled):ilk led/..J $o+� Distance between septic tank(s) and well: So`4- Distance between absorption area and well: /co t information and calculations required for commercial and/or conditional use applications only OSE Form I Revised 7/2/2009 Page 7 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, Piedy the primary area, ❑ only the reserve area(check one)for��� 2 _,_,./ 3— „ "yc"(property ID). Design Basis Total length of available area: (10 Total width of available area: G(pt Estimated Perc.Rate: tea at yZ in.(depth) Number of bedrooms(or GPD): 3F>ie or 95—a GfD 2 Conveyance Method : 6✓rtvi}y Distribution method (specify): �.-,we/ 7e„cj 3 /'I / Dispersal system basis /NrJ/c S.q ,/ 5HP/2 LGMI required? A (Ye lap Effluent quality required: Pf;r„..,,,y mar)Secondary,Advanced Secondary) Square feet per bedroom: 102 74/4.- Total trench bottom area required: 1356 s,. Gravity,pump,siphon 2 Enhanced flow,LPD,or Drip Dispersal 3 Table 5.4 of SHDR or identify the GMP used Area Calculations Number of trenches b (Note if a pad is used) Length of pad or trenches: G O' Width of pad or trenches: 3 Center to center spacing: 9 Reserve required? Ye, Percent reserve area required: /et)2 Total width of absorption area required (PEP Total trench bottom area provided: /We 5y, " , 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 g Of 7 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, E only the primary area, C3K6nly the reserve area(check one)for/1, ZJ - t,.1 ,;� 4X"(property ID). Design Basis Total length of available area: fo' Total width of available area: yg Estimated Perc. Rate: SQ at Z7 in.(depth) Number of bedrooms(or GPD): .3 BR o. 9c 4PD 1 2 Conveyance Method : 6640)-7 _ Distribution method (specify): f-2 'jtia,i./ Dispersal system basis a, Cy 0I s///P - b./It/3571 LGMI required? /VO (Y. Effluent quality required: Tri`.1„.„/ (rimary)Secondary,Advanced Secondary) Square feet per bedroom: Z$Z fir,A /I 7 Total trench bottom area required: 9t Gravity,pump,siphon z Enhanced flow,LPD,or Drip Dispersal s Table 5.4 of SHDR or identify the GMP used Area Calculations Number of trenches (Note if a pad is used) Length of pad or trenches: Sd Width of pad or trenches: 3 Center to center spacing: 7 Reserve required? Yes Percent reserve area required: /00 Total width of absorption area required 7 U Total trench bottom area provided: 700 ,'.h. 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 0 100 200 400 GPS COORDINATES: IS = Iron Set (A) 3951790.E / 11519707.1 DF = Drain Field (B) 39514151.4 / 11520126.2 UP = Utility Pole f 0 SCALE IN FEET (C) 3950169.2 / 11519234.0 BSL = Building Setback Line • (D) 3950279.8 / 11518581.0 L a —irk_ New property corners are to u m be set with iron rebar. L • Om U • 00 a \\ \\ (A) Fd n L=104.07' 51(9^�1(°y /\ > S47'10'32"E �,�Se // \S 147.00' 90.90 �0") ��(JP' IS @ 90 / existing/ ,, 6 d0" / driveway f ) // S47'10'32"E R/ / S44'S7'49"W UP�, DF 241.09 / / // \ ��541 0��/ • \�S� UP R=5749.58' 4. ' New 10'�' L=47.46' /,' / 90�\, 2�/ �`L� c N�, Well Esmt. . •(B) / 0� •DF � / / NO0'17'01"W, i TMP 22-34 �j existing ck John A. Haas / 881 / / dwelling 40.55' 0j 0.8.4624 Pg.664 / Bldg. / /0�' / // ADF Site / / // ,'Iron / /�`88 ;2�`O / / Fd. \ 1 / / 2� // \.\� , Nf / cb / 00p / / /\�. / -creek / 2,����9 / '2 2 P !� �ti� �� 100' Stream /C ' // �P�,ee P9 / TMP 22-442 ,' �, -Buffer / / .p� �1e�010 Jeffrey L. Shifflett, etux 0.8.891 Pg.630 �� S \\, / // /0a FP O' /\ /��\ ch /,/ \ ,�` // / /. e /// 100' Stream . / FloodYZa��` �24? / ` \ Buffer / Pp, 0� / , 0 0• ,' // Parcel "X„ / / v . ti /c., 10.010 Ac. / j ___ __ Iron 0 / =- of Fd. / . / 100' Stream` _ / _creek _� / Buffer // ✓ / / // / / g /•' / / Tax Map 22 / �c3 / / Parcel 3 0i / (00 TAP 22-44 / 22.032 Ac.(Field Run) / / Samuel Meade Harris, etals / / 0.84602 Pg.9B / / -10.010 Ac. (Parcel "X") / h°' ` D) _38' 8SL / // 12.022 Acres (New Total) / c Iron 70 Op / / Residue - Lot 4 / kph 3g / Nag 3g 48 W `39?BSL 66231, •31' ,/ Mon. Fd. 0.90' (C) North of Pipe Fd. / \TMP 21-408 i ` Lost Gander LLC / \ 0.8.460E Pg.716 ll IMP 22-5C \ 'Hope" 5.8802 Pg.544 '\ , �PuTH op. For Drain Field 9 Approval , z. Z O , U D Robert W. Coleman, Jr. -., No. 2007 PLAT SHOAI \G —., q�o E��� DIVISION SURVEY ON t. ,SUav TAX `/AP PARCEL 22 — 5 KNOWN AS LOT 4 RESIDENTIAL 3591 BURNLEY STATION ROAD SURVEYING SERVICES RIVANNA DISTRICT (434) 245 - 8744 ALBEMARLE COUNTY, VIRGINIA 17CHARLLOTTTESVILLE, VEET. SUITE 7 IRGINIA, 22903 SHEET 2 OF 2 DECEMBER 8, 2016 1"= 200' 16-015 thy