HomeMy WebLinkAboutSUB201300090 Approval - Agencies 2013-06-25 trived
r 111-T1
COMMONWEALTH o f VIRGINIA
In Cooperation with the Thomas Jefferson Health District ALBEMARLE-CHARLOTTESVILLE
State Department of Health FLUVANNA COUNTY(PALMYRA)
1138 Rose Hill Drive GREENE COUNTY(STANARDSVILLE)
LOUISA COUNTY(LOUISA)
Phone(434)972-6219 P. O. Box 7546 NELSON COUNTY(LOVINGSTON)
Fax (434)972-4310
Charlottesville, Virginia 22906
July 17,2013
Megan Yaniglos
Department of Community Development
Division of Zoning and Current Development
401 McIntire Road
Charlottesville, Virginia 22902-4596
RE: Review of Proposed Subdivision Plat and attached Soils Information for Individual
Onsite Sewage Systems as part of a division of Tax Map 92 Parcel 19 located in
Albemarle County,Virginia.
Dear Ms. Yaniglos:
On July 1,2013,the County of Albemarle requested the Virginia Department of Health(via the Albemarle
County Health Department)review the proposed subdivision plat identified above.This letter is to inform you
that the above referenced subdivision plat is approved for individual Onsite Sewage Systems in
accordance with the provisions of the Code of Virginia,the Sewage Handling and Disposal Regulations,
and local ordinances.
This request for subdivision review was submitted pursuant to the provisions of§ 32.1-163.5 of the Code of
Virginia which requires the Health Department to accept private soil evaluations and designs from an
Authorized Onsite Soil Evaluator(AOSE)or a Professional Engineer working in consultation with an AOSE for
residential development. This subdivision was certified as being in compliance with the Board of Health's
Regulations by: Jason Kyser; Onsite Soil Evaluator Number 1940001357. This subdivision approval is
issued in reliance upon that certification.
Pursuant to § 360 of the Regulations this approval is not an assurance that Sewage Disposal System
Construction Permits will be issued for any lot in the subdivision identified above unless that lot is specifically
identified on the above referenced plat as having an approved site for an onsite sewage disposal system, and
unless all conditions and circumstances are present at the time of application for a permit as are present at the
time of this approval. This subdivision may contain lots that to do not have approved sites for onsite sewage
systems.
This subdivision approval does pertain to the requirements of local ordinances.
Sincerely,
Josey/�
Environmental Health Technical Consultant
Onsite Sewage and Water Programs
,0Y ALA I
Awe I `
,c)
1°()
IRGINt�
COUNTY OF ALBEMARLE
Department of Community Development
401 McIntire Road,Room 227
Charlottesville,Virginia 22902-4596
Phone(434)296-5832 Fax(434)972-4126
July 1, 2013
Teresa Batten
Virginia Department of Health A a
1138 Rose Hill Drive �
Charlottesville,VA 22906
I
RE: SUB 2013-090 Roses Hill Church-2 Lot
Dear Ms. Batten:
The County of Albemarle-aas received application to develop/subdivide [Tax Map 92, Parcel 19]. This project
requires Health Departmer t approval before receiving final County approval. The applicant has provided soils
information,which is attached. Please review the proposal for suitable subsurface drainfields which comply with the
provisions of Chapter 18, Sections 4.2.2,4.2.3,4.2.4, and Chapter 14, Sections 14-309 and 14-310 of the Albemarle
County Code. Should you have any comments please feel free to contact me.
Sincerely,
Megan Yaniglos
Senior Planner
Department of Community Development
Voice: (434)296-5832 ext. 3004
Fax: (434) 972-4035
Page 1 of 10
OSE/PE Report for:
Construction Permit Certification Letter Subdivision Approval R Ad'
Property Location:
911 Address: City:
Lot ,X, Section Subdivision f�5c .'
GPIN or Tax Map# n.^ r J ,i A" Health Dept ID#
Latitude Longitude
Applicant or Client Mailing Address:
i //
Name: 1';•J.1u ) 7 c 4c
I`
Street: 5-2.0 'ci. / IGr'i C-
p
City: C, 14,1 j,p+-es✓f t. State CA Zip Code Z2 7o
Prepared by:
OSE Name License# /7 WOO /3 S 7
Address To. x
City C,4AiL9/4ccs ua// State Vie? Zip Code Z2705
PE Name: License#
Address
City State-- Zip Code
Date of Report eir/Je/z ,i3 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.)
_ p»,7c l-Z ®3t C.,f< 5,1. r"..4 * f a
rpz- 3-9 54-, ...,..,,+a, ; .' 5 p,6= /0 Pi,,/-
rile. 5--7 ; Pori e0.4 c
r � 5ysk.,., .fpe. teertt,-o+..% 5
7 i
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 VACS-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 thork contained herein.
he 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(selectAine): construction permit certification lei' °.11 v • pI j' J
OSE/PE Signature
„. .. t1
?Ate Z a '
Commonwealth of Virginia `-°F'Use°
Health Department ID#
Application for: Sewage System `Water Supply Due Date
'
Owner 1 ;'c,i c gg 7 .-re j ear Phone L/3' -2 ” �,�f Mailing Address 5-2e 6t,^tas,%Ae.i 0/Wec, 514:it, ,ode;, Phone
C41/614 uc5v,Igt 01 ZZ`1C11 Fax
Agent /41.v cAJ Ja' S,ge/J..
,- Phone 1/3 `''rte _?Iv/cji
Mailing Address cie 1.:-e,e4te.l, 'g,^raLL j.,;.:ic, k6 Phone
( h.,rI0-fte3"oal(G lig 22 c:/ Fax
Site Address
// Email
Directions to Property: /t'a.}%1k5$j.e. ok /?o,.J ,i ; }/r •S m.je, I,gsk 'I- 4-1-c 73L
Subdivision _ Section Block Lot A
Tax Map 1, 1,4ye;�,I it Other Property Identification Dimension/Acreage of Property Z. (;I 4c_+'e$
l Sewage System(New Construction)
Construction permits are valid for 18-months. Owners are advised to apply for a construction permit if they intend to build
within 18 months of completing this application. Certification letters do not expire.may be recorded in the land records.and
transfer with a property sale. For which are you applying? ❑Certification Letter ❑Construction Permit
Sewage System(Existing Construction)
Check all that apply: ❑Repair ❑Modification ❑Expansion ❑Replacement ❑Upgrade
Do you wish to apply for a betterment loan eligibility letter? _If yes.there is a$50.00 fee for determination of eligibility.
Sewage System (New or Existing Construction)
Ingle Family Home(Number of Bedrooms 3 ) ❑Multi-Family Dwelling (Total Number of Bedrooms )
❑Other(describe)
Basement?; `o(circle one). Walk-out Basement? No (circle one) Fixtures in Basement (circle one).
Conditional permit desired? Ye (circle one). If yes,which conditions do you want?
❑Reduced water flow ❑Limited occupancy ❑ Intermittent of seasonal use ❑Seasonal or temporary use not to exceed 1 year
1
Water Supply
Will the water supply be Public or?P _rivate circle one). Is the water supply Existing o rop ose (circle one).
If proposed. is this a replacement well? Yeo circle one). Will the old well be abandoned?Ye o circle one).
Will any buildings within 50'of the proposed well be termite treated? Ye filn ircle one).
Note: For sewage systems.a plat of the property may be required and a site sketch is always expected. For water supplies.a plat of
the property is not required and a site sketch is always expected. The site sketch should show your property lines.actual and/or
proposed buildings and the desired location of your well and/or sewage system. Your property lines. building location and the
proposed well and sewage system sites must be clearly marked and sufficiently visible to see the topography.
I give permission to the Virginia Department of Health to enter onto the property during 11,41 b h or ..
processing this application and to perform quali assura,ce checks of evaluations and d unI �. &. .��up it 4 go.0"d
Signat e of Owner/Ages t 4••••" :: i :r Pat-
'4 � ``
4vly 'gore rift 3 8
VDH Use Only
Health Department ID#
Due Date
Site and Soil Evaluation Report
(For certification letters and subdivisions)
General Information
Date : is J Ct pibernork County Health Department
� 1
c;leg)/Applicant: I',j. 1, ,9
�dfti.;
Telephone Number: hl.,? G 41, - I fcl
r /�(
Address : 5-24) t
rC4/;t 1/1 Cv r, 51„,/ lev f 170..0.50-8e :',4 ZZ`10
Owner: (`( e.41 7 J 1 Address : 5.20 -7;77,046,C., loo
Location : A/W-4 5. Pe 7h i /- .sdti.ile 45-/- Jere 73 Z
Subdivision dws d eku.,k Block/Section Lot X
Soil Inform 'on Summary
I. Position in landscape satisfactory Yes No Describe : ,s./oft,
2. Slope C %
3. Depth to rock/impervious strata Max. 470 Min. 33 None
4. Free water present No-Yes_ Range in inches
5. Depth to seasonal water table(gray mottling c9r gray color) b/il inches
6. Soil percolation rate estimated Yes Texture group f I 711 12Til DIV
No_ Estimated rate (,Amin/in
7. Percolation test performed Yes y Number of percolation test holes_
No Depth of percolation test holes
Average percolation rate mpi
Name and title of evaluator: J5uv, X.
Signature:_
� Departme Use
t4ite approved: Drain field trernich bottoms to be plat at ) ' (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 1)Revised 7/02;2009
woo' woe
Page 1 of /D
Date of Evaluation: 05/16/2013 Profile Description
SOIL EVALUATION REPORT
Property ID: Tax Map 92-19-Lot"X"
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 _ 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
1 A _0-6 7.5YR5/6 Strong Brown Clay Loam III
Bt 6-27 5YR5/6 Yellowish Red Clay Loam III
BC 27-38 5YR5/8 Yellowish Red Light Clay Loam III
R 38"+ Rock-Schist
2 A 0-6 7.5YR5/8 Strong Brown Clay Loam Ill
Bt 6-28 5YR5/6 Yellowish Red Clay Loam III
BC _28-40 7.5YR4/6 Strong Brown Light Clay Loam HI
R 40"+ Rock-Schist
3 A 0-5 7.5YR4/6 Strong Brown Clay Loam III
Bt 5-35 2.5YR5/8 Red Clay Loam III
CB 35-60"+ 5YR5/6 Yellowish Red Light Clay Loam III
REMARKS
OSE Form G(pg.2)Revised7/02/2009
Nom, Noe.
Page c Of /0
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 El primary and reserve area, C�'only the primary area, 0 only the
reserve area(check one) for mT 92 {p and /9 - " (property ID).
Design Basis
Total length of available area: Total width of available area: 25-j
Estimated Perc. Rate: ‘.)9 at 3 in. (depth) Number of bedrooms(or GPD):_381C or L/5-0 6PD
Conveyance Method: i,�,,e,o Distribution method(specify):
Dispersal system basis i&-bie S. pi 5/i OR LGMI required? 4O (Ye
Effluent quality required: Pe,'n-wAz.y rimar�i` Secondary,Advanced Secondary)
Square feet per bedroom: 4/5-2. Total trench bottom area required:_ �'35-6 .//,
Gravity.pump.siphon
Enhanced tlo�+.LPD.or Drip Dispersal
Table 5.4 of SHDR or identify the GMP used
Area Calculations
Number of trenches_ 6 (Note if a pad is used) Length of pad or trenches: C a
Width of pad or trenches: . Center to center spacing:
Reserve required? Yes Percent reserve area required: /00 la
Total width of absorption area required_ '� Total trench bottom area provided: /9 C ./44.
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 It)
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, ❑ only the primary area, 2<erily t to
reserve area(check one) for 7Z /T4f, e f '7 - Li ",yr (property ID).
Design Basis
Total length of available area: Total width of available area: 75-
Estimated Perc. Rate: 600 at (5' in. (depth) Number of bedrooms (or GPD): 33,e of
,�
Conveyance Method: ,, ,, Distribution method(specify): _J f�B /11/0/
Dispersal system basis /9 0 55 /7,., ,�,t�,.� LGMI required? J//`,) (Yes6o)
Effluent quality required: 5 Gjj 1 A (Primary econd rya)Advanced Secondary)
Square feet per bedroom: ZC3 , Total trench bottom area required: 'O•
Gravity.pump.siphon
Enhanced flow. LPD.or Drip Dispersal
Table 5.4 of SHDR or identify the GMP used
Area Calculations
Number of trenches_ 3 (Note if a pad is used) Length of pad or trenches:
Width of pad or trenches:
P � Center to center spacing:
Reserve required?__ r,j Percent reserve area required: >�eV 2
Total width of absorption area required_ 2.11 Total trench bottom area provided: 72<2 � t,
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 uniforri 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
Now Nose
Page 7 of /0
Design Calculations
Property ID: �� 'dnnr, ��u !`I - L4- k"
Flow
Type of use Ir€sidenlial, etc) Re4 {, },,4 Show Calculations Here'
No. of bedrooms: 3 BR
No. of employees: /1/14
Square Footage of building space:
Daily flow (peak design) in GPD: �!5
Treatment
No. of septic tanks: 1 Show Calculations Here'
Size of septic tank(s): 1ov 70,6(1
Pretreatment required?—"les no
If yes, specify type of treatment device:
��- Roe.v'e- 9ru4 4117
Absorption area design
Soil Texture Group: IX If pump system, enhanced flow, or LPD show
Reserve area,required?ayes_no calculations here or on a separate sheet.
50%Z100% other(check one) (dosing volume, head, pump design, etc.)
Specify other
Water Sul i lv
Class of well: tom,- r6.if Describe (bored, drilled): C-P,,../4 or Etve.-ci
.
Distance between septic tank(s) and
well: 5 -
Distance between absorption area and
well: /0011-
' information and calculations required for commercial and/or conditional use applications only
OSE Form T Revised 7!2x2009
Page ff of /a
System Specifications
Property ID: TArc,Il, 9L /1,40e 1't 85(
Applicant Information
Name ki,-4,A e / /? .a4) - ——� Phone y3/- on-
Address 52a t 1 d -ryie,,,k toe
C hewi'o#1 e,14.∎ /e i44 Zito!
Location Information
Tax Map No. ''1 , rte." r Property address
GPIN No.
Directions_ 4) J,. o A 74Z Subdivision
41_ ,.►,les Ens" of £0.64c.- 732- Section Block
Lot )(
General Information
System Type Ir. Number of bedrooms 3 BR
(e.g. septic tank, drainfield) Daily flow 'lS'i (gpd)
Type of property 4es,je,,hu.
(e.g. commercial, residential, etc.)
Conditions _
Sewer Line ; Septic Tank–Inlet/Outlet Structure
Schedule 40 PVC, 4" , " or equivalent I Capacity: Joao gallons
(add check or describe equivalent below) 2nd septic tank /oov 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 1(.„, No. of boxes f
(e.g. gravity, pum ing, dosing siphon) No. of outlets 7
If pumping, attach Pump Spec Sheet Surge or splitter box required:
Material ,54).„J. /p A& Yes No
Pipe diameter Z"
Slope of pipe ii/,4 (in inches)
Header line Information Percolation line Information/Absorption
Area
1500 pound crush strength Yes ice' Center to center spacing 7 ft.
Minimum slope is 2"/100 ft. Yes Required spacing 9 ft.
Installation depth d57 inches
Aggregate depth LI inches
No. of Laterals to Lateral length O ft.
Lateral bottom slopeZ_'f inches
Lateral width 36 inches
OSE A-. _ Date t
OSE Form J Revised 7/2/2009 6
f'
Vie
a,,r� .vnr Z
S
VI
a +V
—•o 13 .r- -
Ti J
4
it
ye
•
x
1
v i
Et
ajIIOfi
07 r"fi-
1
I'1
vi
4 i-
.:L---- A
r py�1.'l
T / 7 W®®""�
N h II
'-••
I r
03 i _�
1 1 1
i nd 5
t ; N
r 1''
~`� - 1.0, \
1 v c‘..h 2
\ \\... ..'-''."'''''''.
\ \ eir,\\*,
1111 ,
i 1 1 \ ILIL-'...---- --....m".•"C" .1 , t
tirtived
......
*ore owe /0 Di. /0
p ate,
I inates:
35670.6 E11505829.4
35480.6 E11506281.1
35107.4 E11506030.8
35280.3 E11505565.5
- •--_. - G1
Iron • TMP 92-18
Set Willie (5 Hilda Pillow
5.8.843 Pg.204
24S 100'
Water Protection
TAP 92-16 0'. S6 Stream
Thomas Jefferson �� 2 40 0 I Buffer
Val Foundation, Inc. ■��� O F ,
D.B.2894 Pg.76 PARCEL "X" •4 Iron • y �� -
0�r), 2.806 Acres Set 90
o � ■�� 7 2�s 03
. K� ������ G2
��„ wy�v(T. o well •ii!���4 ``�`\
house \ GL
;:'a c, •2 T.M.P. 92-19 T�SS
pea%' Dila Dilapidated �ti
,1
coal�'-' stucco oct et; RESIDUE k''/#v o
old' House '''', 2.736 Acres
a''' Including Parcel "Y" „50/�'
`'�G4 DF --1(i)'
` Iron Set 30,000 S.F. 0,
`•-N@ 15.06'," 1 � To Buildable co / //4)
, N`. \N , \ o Area ,f-30,000 S.F- ,'
P
e. �.` �`� ' •' Buildable - TMP 92—�
,4 Area v, Gerald L. SE
� .�•�� DF h '` D.B.1876 Pc
'SS. `.\ ' .: ',+ DF' `90 DF ��cG4/0.
3 „ ���Ss`-749'• , `'. - - 4 ,'ex .o2Q 2.89 Acres (Rec
o- C o -6 D <, ,•ti$4 „�o, .� Less Parcel "Y'
A„ ,6,p, Se ','3% k , old F' j 0 2.88 Acres (New
ose Ch �`� `�, @ S39*15'00',W .
c 1,0, : ; is1z: :ssc::.25.0' ,\2F ` `..- o-- -
3 Adjusted Area)
��h�J i�„�' R,QS @r,16,84' } New Corner
v 06 �N77 � . •
Iron Set
(t• 1�0 _@ 25.0' G3
8.45'1 .. 2'00,;
82.10, -__TMP 92-16
84.10 ,-;_----:-.. -----z--
1pe - -
F:
9nas Jefferson New o ~ ..
r' I
91 Foundation, Inc. tat r : w
Tp 4.
.8.2894 Pg.76 ' ', , tv,a,
Page i of f
OSE/PE Report for:
Construction Permit l l Certification Letter Subdivision Approval
Property Location:
911 Address: City:
Lot fli,,,',,,,f, Section Subdivision Esc ✓liJl ,eYtur
GPIN or Tax Map# fL 19,}, e 19 Res Health Dept ID#
Latitude Longitude
Applicant or Client Mailing Address:
t
Name: fl10.344/ 7, 5Jac
Street: 5 2C ,..re..-An ''ea 4 ,..
'tAtt 5:24.4 icc
City: C.Ataiitivt4e4one. State L/A Zip Code 2Z t 1
Prepared by: in
OSE Name iVAwnR Sat .9n a #t License# i/ t100 0 1357
Address P-0.
gvx 5ZZ1
City Ja#'e I IJe. State tis4 Zip Code Z2-1 o5-
PE Name: License#
Address
City State_ Zip Code
Date of Report D�j/fO zol 3 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.)
a 1- as, .e t ' „ ,s i,'vn C 1 st%}c
r , 3"'Y 54.c. SA.-.»,msy ; S f s pr I ?
11.,.aez T--tii J+b_cyiO4,1 poor!„ ; P. -,... Cork-
pal t 7 5y3k n e,"4;r , 4,a f
Certification Statement
1 hereby,certify that the evaluations and/or designs contained herein were con' n . a na `t Se r in in ii •
Disposal Regulations(12 VAC5-610),the Private Well Regulations(12 VA• 631 roc a e c.. - a la P. '' la s a'4*
policies implemented by the Virginia Department of Health. I further certi ''r at I c r, „ os ` ay ofes; ice V rea ire
by the laws and regulations of the Commonwealth that have been duly issued by the apicable --ncy charged ices:re to° , ..'
perform the work contained herein.
1 "fhe 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 one): construction permits certification letter subdivision approval P.
be(select one) issueddenied❑.
i
OSE/PE Signature � . _v _- 2,.w Date Lit°/014--='.3
1
Ps le D4
VDH Use Only
Commonwealth of Virginia Health Department 1D#
Application for: I ewage System []'`Water Supply Due Date Owner /r'i zA,f P 7 A '<r' Phone .3 "2 94, -?II
Mailing Address 5-20 e e'{ T cr.gce. u * JO Phone
C 4490-es vr/ , Z2`7o 9 Fax
A j r� )
Agent /�, 'c Aurtl T• �4 ,sr Phone 139' -Zip -9/Icl
Mailing Address -->?t? 6►r4.-c.-,it,41, ,r z j;, :fie /00 Phone
''haf LL!-)?e✓+/fa j'q ?L Yo i Fax
Site Address
� / Email
/
Directions to Property: ,v 1t j.d e e:� i re !, 7t,z . 4d- • `— 41,45 6-+yss 73z--
Subdivision Iasi , 1 at Section Block _ Lot
Tax Map ®rqr f l Other Property Identification Dimension/Acreage of Property Z•73!9¢cres
Sewage System (New Construction)
Construction permits are valid for 18-months. Owners are advised to apply for a construction permit if they intend to build
within 18 months of completing this application. Certification letters do not expire.may be recorded in the land records. and
transfer with a property sale. For which are you applying? ❑Certification Letter ❑Construction Permit
Sewage System(Existing Construction)
Check all that apply: ❑Repair ❑Modification ❑Expansion ❑Replacement ❑Upgrade
Do you wish to apply for a betterment loan eligibility letter? If yes.there is a 550.00 fee for determination of eligibility.
Sewage System (New or Existing Construction)
['Single Family Home(Number of Bedrooms 3) ❑Multi-Family Dwelling (Total Number of Bedrooms )
❑Other(describe)
Basement? es. o(circle one). Walk-out Basement? . es o (circle one) Fixtures in Basement`. Yes .'o(circle one).
Conditional permit desired? Yes/No(circle one). If yes.which conditions do you want?
❑Reduced water flow ❑Limited occupancy ❑ Intermittent of seasonal use ❑Seasonal or temporary use not to exceed I year
Water Supply
Will the water supply be Public or,Pricale'3X ircle one). Is the water supply Existing orropose ,(circle one).
If proposed. is this a replacement well? Yes Ocircle one). Will the old well be abandoned? Yes�'o,(circle one).
Will any buildings within 50'of the proposed well be termite treated? Ye /No(circle one).
Note: For sewage systems.a plat of the property may be required and a site sketch is always expected. For water supplies_a plat of
the property is not required and a site sketch is always expected. The site sketch should show-your property lines.actual and/or
proposed buildings and the desired location of your well and/or sewage system. Y■'.: property lines.building location and the
proposed well and sewage system sites must be clearly marked and sufficiently vi ;#-.` to • t• c,: .ph
I give permission to the Virginia Department of Health to enter onto the ert '
ro
p p y -� n i lou o o .
processing this application and to perform quay ass a e checks of evaluatio . and s•:, j .1e `tion is No d.
11111P..6.6 :_
Signature .f Owner/Agent 1r Date .1111.,10116-
Or'
P' 3 of
VDH Use Only
Health Department 1D5
Due Date
Site and Soil Evaluation Report
(For certification letters and subdivisicns)
General Information
Date : 05"", >,®zCi3 Albe,,.vrde, County Health Department
p
Applicant: Alt era P$ lil e
Telephone Number : `13 L/-2 r' 8
Address : 5-20 ;fete ‘e 5,4e lot) {odor-ic-5., e VA'
9
Owner: `fin . per Address:Sjr� r�.v, s� .i r�g�c 5.01a /00
Location : e1 4„,i-v- 74z, E454. JQv 7 3 L
jJ r
Subdivision ese. 14J it CLi i Re;Block/Section Lot ,1“..e.
Soil Inform tion Summary
1. Position in landscape satisfactory Yes No Describe :
2. Slope 7 %
3. Depth to rock/impervious strata, Max.(19 Min.3Y None
4. Free water present Noi-` Yes Range in inches
5. Depth to seasonal water table(gray mottling or gray color) )4,1A inches
6. Soil percolation rate estimated Yes 4 Texture group ❑I ❑II ❑'III ❑1V
No_ Estimated rate 4,0 min/in
7. Percolation test performed Yes Number of percolation test holes
No Depth of percolation test holes
- Average percolation rate mpi
Name and title of evaluator: �1et + c," v)• :� .
Signature:_
Depart nt Use
Site approved: Drainfield trench bottoms to be placed at 1 (inches)depth at site designated on permit.
_ Site disapproved:
Reasons for rejection: (check 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 7/02/3009
Page �i of
Date of Evaluation: 05/16/2013 Profile Description
SOIL EVALUATION REPORT
Property ID: Tax Map 92-19-Residue
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 _ 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
1 A 0-6 7.5YR5/6 Strong Brown Clay Loam III
Bt 6-29 5YR5/6 Yellowish Red Clay Loam III
BC 29-38 5YR5/8 Yellowish Red Light Clay Loam III
R 38"+ Rock-Schist•
2 A 0-7 7.5YR5/8 Strong Brown Clay Loam III
Bt 7-26 5YR5/6 Yellowish Red Clay Loam III
BC 26-38 5YR4/6 Yellowish Red Light Clay Loam III
R 38"+ Rock-Schist
3 A 0-6 7.5YR4/6 Strong Brown Clay Loam III
Bt _6-34 5YR5/8 Yellowish Red Clay Loam III
CB 34-44 5YR4/6 Yellowish Red Light Clay Loam III
R 44"+ Rock-Schist
REMARKS
OSE Form G(pg.2)Revised7/02!2009
*we
Page 5 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 C�primary and reserve area, ❑ only the primary area, ❑ only the
reserve area(check one)for_ i p..rs,J 19 — e (property ID).
Design Basis
Total length of available area: Total width of available area: 9
Estimated Perc. Rate: O at 15 in. (depth) Number of bedrooms(or GPD): 3 j�r,,,- 95' 6.7'
Conveyance Method': Lii/Ay,' Distribution method (specify):
� �
Dispersal system basis �J�e 9 ,o� .51,PpR LGMI required? / ; (YesC5())
Effluent quality required: v- mRQ PrimaDSecondary,Advanced Secondary)
Square feet per bedroom: 5-2 „ift, Total trench bottom area required: / 35-
Gravity.pump.siphon
Enhanced flow. LPD.or Drip Dispersal
Table 5.4 of SHDR or identify the GMP used
Area Calculations
Number of trenches C.
(Note if a pad is used) Length of pad or trenches: 47a
Width of pad or trenches: 3 Center to center spacing: ? ,
Reserve required? Yes Percent reserve area required: Iva,,%%
Total width of absorption area required ' Total trench bottom area provided: 1155-c
. ,
The required width is calculated by multiplying the center-to-center spacing by one less than the number of
trenches and adding l 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
Design Calculations
Property ID: rib, #1Yr-
� e1? -�e51�e
Flow
Type of use (rL,sidennal etc) fei,jcy,I, I Show Calculations Here
No. of bedrooms: 3 9R
No. of employees: !L1/4
Square Footage of building space:
Daily flow (peak design) in GPD:
Treatment
No. of septic tanks: / Show Calculations Here—
Size of septic tank(s): /000 ptileel
Pretreatment required? _yeso
If yes, specify type of treatment device:
Absorption area design _
Soil Texture Group: If pump system, enhanced flow, or LPD show
Reserve area required? :.- yes_no calculations here or on a separate sheet.
50% -""(00% other (check one) (dosing volume, head, pump design, etc.)
Specify other_
Water Supply
Class of well: 1X.C- :.ve;d' Describe (bored, drilled): ar„l1ed 0-80.--al
Distance between septic tank(s) and
well: ' I-
Distance between absorption area and
I well: /00.1”
Information and calculations required for commercial and/or conditional use applications only
OSE Form I Revised 7'2,2009
wrw .w
Page -7 of
System Specifications
Property ID: 7` Mir ".L p,°to) 9 iesr,A c
Applicant Information
Name /f,,heAJ ), 5..,J1er Phone /3 /-.2r — 9//
'
Address 5-2,a $A; too
CA,004 u //d- v4 ZZ*o/
Location Information
Tax Map No. � ,,,, s' i 9 - ri es. ,.,e, Property address
GPIN No.
Directions Ndr}l,K,,,, „l. ko,..to 74.2. Subdivision Rose. 1),Il
f- Ew• /- o ko,tte 73z_ Section Block
Lot ![e A u t
General Information
System Type Number of bedrooms 3 FR
(e.g. septic tank, drainfield) Daily flow VS-0 (gpd)
Type of property Rc3,denh*1
(e.g. commercial, residential, etc.)
Conditions
Sewer Line Septic Tank—Inlet/Outlet Structure
Schedule 40 PVC, 4" -" or equivalent Capacity: /ooG gallons
(add check or describe equivalent below) 2nd septic tank /7q 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_ 04,,, No. of boxes I
(e.g. gravity, pumping, dosing siphon) No. of outlets 4,
If pumping, attach Pump Spec Sheet Surge or splitter box required:
Material 561444e, ' a Yes_No L./-
Pipe diameter '/"
Slope of pipe fyr„.,- '(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 .7 Required spacing y_ft.
Installation depth .15 inches
Aggregate depth 13 inches
No. of Laterals S Lateral length Y ft.
Lateral bottom slope.?°l inches
I Lateral width 31.- inches
OSE / �.: .,. � Date 04," o /;te r '
OSE Form J Revised 7/2/2009
ap' p Ai ir 44 ,
. .....
......_ _ 0 — -
4.•1 r — —
— — —
....--
.....----' .._
—
___ —
....,-"! • :114 '..-•"" I 1.....----
..,
&,-5 iole" „,.. • , ,,
71,, oP
.... i \7z,■,„'
,
,
, \ ,
. ‘ z
9 ---.;.) c ft., ,.
.... i
...., .
la {
•
m—.....------_,__
CAS 1 ri 55.4‘.4 1
..= 1
I
I I_
,z,
---i,
t....... „--- ..... e..„. '
t --
5 ,
'''..-
.....--
-------.
in
. "
„.,
4
;(4
CA
. CIL_ 0 ,
0 .
a
tu, ,
cs. ...3—
7
,
. ) ,.
i .
‘,,711 :.:1- ..:,.i .,,,,.
, _. 4,,,,
.
-4
, -4 id : :.,,I ''''..i :,:I ,■1:'''''..'° :':,''' 0
a ';4 -,,', ,i, 'I.i # '''.i....* '!'•. $:- -: 1
IV”....4;''' I.-:4..,, ,,' r'. 4'4' 44- k,-,-, '-!•*-^;...‘14,
,
. 4i'
.
,.,
—,—
-I- --.. ,, I'
--„.
*/ -......
s,.
IN
Gt
Wile e' 9
9e
1 /
iinates:
35670.6 E11505829.4
35480.6 E11506281.1
35107.4 E11506030.8
35280.3 E11505566.5
- - G1
Iron • TMP 92-15
Set Willie 6' Hilda Pillow
5.8.843 Pg.204
24s 100'
TMP 92-16 •0�, S62. dater Stream
ction
rhomas Jefferson ,
Vol Foundation, Inc. "X" ►:�:� p0 Buffer
D.8.2894 Pg.76 .� Iron
PARCEL X Set 490` \
`$ 2.806 Acres Os,
A/ -... ,24s
0
.tip well +-�4.4 G2
�
� \ 1E
0, 0 house •�
ea = •Cs ej, T.M.P. 92-19 '�SS1
b,%' Dilapidated ti
goa-- �'' Stucco oc� �titi RESIDUE �cc� ..0.
1d