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MO94 wJ rNrwor l/+WN SDrne11EY6G 165�r 7-579 Es�/'-'r-V Ep CAI T-, V14-- ZZ�l37 IZf�3—�?z VIDHOF HEALTH DEPARTMENT Protecting You and Your Environment Page 1 of 3 Albemarle County Health Department 1138 Rose Hill Drive Charlottesville, VA 22903 (434) 972-6219 Voice (434) 972-43 10 Fax OSE Construction Permit — Minor Modification December 8, 2020 Steven and Emily Beydler APPROVED 7519 Esmont Road Esmont, VA 23229 RE: Site Description: Existing three bedroom home + new accessory structure with one (1) bathroom Site Address: 7519 Esmont Road, Esmont, VA 23229 Tax Map #: 12813-32 HDID #: 101-20-0398 System Description: Minor modification to an existing approved SDS. Three (3) bedroom residential home + accessory structure w/ one bath (No change to OP) To be installed: New Gravity Sewer Line (4", SCH 40 PVC) and I Clean Out (4", SCH 40 PVC) every 50' Dear Steven and Emily Beydler: This letter and the attached drawings, specifications, and calculations (7 pages) dated October 13. 2020 constitute your permit to modify an existing sewage disposal system on the property referenced above. Your application for a permit was submitted pursuant to §32.1-163.5 of the Code of Virginia, which requires the Health Department to accept private soil evaluations and designs from an Onsite Soil Evaluator (OSE) or a Professional Engineer working in consultation with an OSE for residential development. VDH is not required to perform afield check to verify the private evaluations ofOSEs or PEs and such a field check may not have been conducted for the issuance of this permit. The sewage system design was certified by Stephen Vargo, OSE as substantially complying with the Board of Health's regulations (and local ordinances if the locality has authorized the local health department to accept private evaluations for compliance with local ordinances). This permit is issued in reliance upon that certification. VDH hereby recognizes that the soil and site conditions acknowledged by this permit are suitable for the installation of an onsite sewage system. The attached plat shows the approved area for the sewage disposal system; there are additional records on file with the Albemarle County Health Department pertaining to this permit, including the Site and Soil Evaluation Report. This construction permit is null and void if any substantial physical change in the soil or site conditions occurs where a sewage disposal system is to be located. If modifications or revisions are necessary between now and when you construct your dwelling, please contact the OSE/PE who performed the evaluation and design on which this permit is based. Should revisions be necessary during construction, your contractor should consult with the OSE/PE that submitted the site evaluation or site evaluation and design. The OSE/PE is authorized to make minor adjustments in the location or design of the system at the time of construction provided adequate documentation is provided to the Albemarle County Health Department. Construction Permit: Property Location: 911 Address: OSETE Report for: Certification Letter: Subdivision: *MINOR MODIFICATION PERMIT* 7519 Esmont Road City: Esmont, VA 23229 Lot: Section: GPIN or Tax Map #: 128B - 32 Latitude: Applicant/Client Mailing Address: Name: Steve & Emily Bey Address: 7519 Esmont Road City: Prepared By: OSE Name: Address: City: Esmont, VA Stephen B. Vargo P.O. Box 187 Scottsville PE Name: n/a Address: n/a City: n/a Date of Report: Oct. 13, 2020 OSE/PE Job #: n/a Subdivision: Health Dept. ID #: Longitude: State: VA Zip Code: License #: 1940-0001113 VA Zip Code: License #: State: n/a Zip Code: n/a Date of Revision #1: Date of Revision #2: Contents/Index of this report (e.g. Site Evaluation Summary, Soil Profile Descriptions, Site Sketch etc.) APPLICATION (I) PLAT (6) CONSTRUCTION SPECS (2) CERT. STMNT. (7) INSPECTION NOTICE (3) CONSTRUCTION DWG (4) SANITARY SURVEY (5) Certification Statement: hereby certify that the evaluations and/or designs contained herein were conducted in accordance with the Sewage Handling and Disposal regulations (12VAC5-610), the Private Well Regulations (12 VAC5-630) and all other applicable laws, regulations and policies implemented )y the Virginia Department of Health. I further certify that I currently possess any professional license required by the laws and regulations of he Commonwealth that have been duly issued by the applicable agency charged with licensure to perform the work contained herein. X The work attached to this cover page has been conducted under an exemption to the practice of engineering, specifically the exemption in the Code of Virginia Section 54.1-402, 11 1 recommend that a: construction permit subdivision approval OSE/PE Signature: certification letter be: issued 0 denied Date: Oct. 13, 2020 � m, (n VS 5P 0\",�Gr) I - flPpn Yck-009A Iz/I4I2() 1 pl Z0 a3Q 1of7 Commonwealth of Virginia Application for a Sewage Disposal and/or Water Supply Permit *MINOR MODIFICATION PERMIT* Type of System: X New _Repair Exp. _Conditional Owner: Steve & Errvly Beydler Addr: 7519 Esmont Road Tel: (760) 792-8207 Esmont, VA 23229 Agent: Addr: Directions to Property: Residence at 7519 Esniont Road, Esmont. VA 23229 Subdivision: Section: Block: Lot/Site#: Other Property Identification: Tax Map Reference: 128E - 32 Dimension/Sim of LOUProperty: 0.96 acres Building/Facility: X New _Existing Residential Use: YES X NO Termite Treatment: YES X NO Single Family Number of Bedrooms: r✓e Basement: _ YES X NO Fixtures in Basement: YES NO Tel: *PROPOSED ACCESORY BUILDING WITH PL UMBING Multi -Family Number of Units: PROPOSED SEWAGE DISPOSAL METHOD: Onsite Sewage Disposal System: X Septic Tank D/F LPD Other: WATER SUPPLY: _Public New Existing _Private New X Existing Describe: EXISTING IIIC WELL Mound The property lines, building location and sewage disposal system site are clearly marked and the property is sufficiently visible to see the topography. I give permission to the Department to enter onto the property described for the purpose of processing this application and to perform quality assurance checks as necessary until the sewage disposal system has been constructed and approved. cJlclLu2 8¢. Signature of wner/Agent 9 Dec, 2020 Date 2 of Sewage Disposal System Construction Specifications General Information *MINOR MODIFICATION PERMIT* Owner. Sieve & Emily Beydler Telephone: (760) 792-8207 Address: 7519 Fsmont Road Psmoni, VA Fora Type I Sewage Disposal system which is to be constructed ordal Tax Map: 128E - 32 Subdivision: Section: Block: Lot/Site#: Actual or Estimated water use: DESIGN NOTES Water Supply, misting:(describe) ExisdnglllC well To be installed: Class: Cased: Grouted: Building Scv,= * permit for running building 4" I.D. PVC 40, equivalent sewer from proposed c per in (minimum). accessory building with �Slo her. o Odter. No Bends Over 45 degrees, cleanouts to be installed every 50' in new run of sewer line plumbing to existing building sewer for house Septic Tank: Capacity: 1000 gallons (minimum) *EXISTING TANK �X Other. Tanks to comply with 1000 regitiadon& Tanks must be watertight. Inlet -Outlet Structure: *EXISTING INLET -OUTLET STRUCTURE PVC 40, 4" tees equivalent. Other: Pum and Pump Station: No XX Y"00f yes, see design on later pages) GravityMains: 3"or larger LD., minimum 6"fall per l00', 1500 lb. Crush strength or equivalent 7 Other: *EXISTING 4" SCH 40 PVC GRAVITY MAIN Distribution Box: Precast Concrete: 10 ports �X Other. *EXISTING CONCRETE DISTRIBUTION BOX, TIMED WITH SPEED LEVELS Header Lines: Material: 4"1.D. 1500 lb. Crush strength or equivalentfrom distribution box to Tinto absorption trench. Slope 2" minimum per 100'. �X Other. *EXISTING HEADER LINES Percolation Lines: Gravity 4"plastic 1000 lb. Crash strength or equivalent, slope 2"m 4" (mbt. max) per 100'. :❑Other. *EXISTING PERCOLATION LINES *EXISTING ABSORPTION TRENCHES Absorption Trenches (slope 2" min. to 4" max. per 100; stone to be .5" to 1.5" in size): Square IL required: Inches from ground surface to trench bottom Trench Width: Cantor Spacing: Depth of Aggregate: Num. Of Trenches: Trench Length: yo a ��-- _b o O- � •�7 b � O k G w �� b b, O S$ 1r M Certification Statement County: Albemarle Property Identification: 128E - 32 Submitted by: Stephen B. Vargo, OSE M 1940-0001113 This is to certify according to subsection 32.1-163.5 of the Code of Virginia that work submitted for the referred property is in accordance to and complies with the Sewage Handling and Disposal Regulations of the Virginia Department of Health. Minor Modification I recommend a Permit ba approved. J Date: Oct. 13. 2020 Stephen B. Vargo, VA OSE r6 1940 0001113 7 of