HomeMy WebLinkAboutSUB202200207 Approval - Agencies 2022-12-09COMMONWEALTH OF VIRGINIA
VIRGINIA DEPARTMENT OF HEALTH
Albemarle County Health Department
PO Box 7546
Charlottesville, VA 22906
(434)972-6219
AOSE Construction Permit Approval Letter — Level 1 Review
October 13, 2010
Murcielago, LLC
600 Loring Avenue
Salem, MA 01970
Subject: Sewage Disposal System Construction Permit
Health Department I.D. # 101-10-0319
TMP # 123-34C8
Farms at Jefferson Mill, lot # 8
Dear Murcielago, LLC:
This letter, in conjunction with the approved plans (10 pages) dated October 5, 2010, which are
attached, constitutes your permit to install a sewage disposal system . The 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 fiom an Authorized Onsite Soil
Evaluator (AOSE) or a Professional Engineer working in consultation with an AOSE for
residential development. The permitted site was certified as being in compliance 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) by: (Stephen
P,Gooch, # 1940 000278 ,). This letter is issued in reliance upon that certification.
The Board of Health hereby recognizes that the soil and site conditions acknowledged by this
correspondence, and documented by additional records on file at the local health department, are
suitable for the installation of onsite sewage disposal systems. The attached plat (or plats) shows
the approved areas for the sewage disposal systems. This letter is void if there is any substantial
physical change in the soil or site conditions 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 Authorized Onsite Soil Evaluator (AOSE) or Professional Engineer (PE) who
performed the evaluation and design on which this permit is based. The name, address, and
phone number of the AOSE/PE appears on the certification form attached to this permit. Should
revisions be necessary during construction, your contractor should consult with the AOSE/PE
that submitted the site evaluation or site evaluation and design. The AOSE or 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.
This authorization is null and void if conditions are changed from those shown on the application
or conditions are changed from those shown on the attached construction drawings, plans and
specifications. No part of any installation shall be covered or used until inspected, corrections
made if necessary, and approved by the Albemarle County Health Department or unless
expressly authorized by the Albemarle County Health Department . Any part of any installation
which has been covered prior to approval shall be uncovered if necessary; upon the direction of
the Department.
This authorization to construct a sewage disposal system expires: April 13, 2012,
Sincerely,
Travis Davis
Env. Health Specialist
cc: Stephen P. Gooch - 1940 000278
1821 Broadway Street
Charlottesville, Virginia 22902
suitable for the installation of onsite sewage disposal systems. The attached plat (or plats) shows
the approved areas for the sewage disposal systems. This letter is void if there is any substantial
physical change in the soil or site conditions 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 Authorized Onsite Soil Evaluator (AOSE) or Professional Engineer (PE) who
performed the evaluation and design on which this permit is based. The name, address, and
phone number of the AOSE/PE appears on the certification form attached to this permit. Should
revisions be necessary during construction, your contractor should consult with the AOSE/PE
that submitted the site evaluation or site evaluation and design. The AOSE or 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.
This authorization is null and void if conditions are changed from those shown on the application
or conditions are changed from those shown on the attached. construction drawings, plans and
specifications. No part of any installation shall be covered or used until inspected, corrections
made if necessary, and approved by the Albemarle County Health Department or unless
expressly authorized by the Albemarle County Health Department. Any part of any installation
which has been covered prior to approval shall be uncovered if necessary, upon the direction of
the Department.
This authorization to construct a sewage disposal system expires: April 13, 2012,
Sincerely,
Travis Davis
Env. Health Specialist
cc: Stephen P, Gooch - 1940 000278
1821 Broadway Street
Charlottesville, Virginia 22902
Page of l D
OSE/PE Report for: 7//
Construction Pennitlz Certification Letter 0 Subdivision Approval `Z
Property Location:
911 Address:
Lot 8 Section Subdivision The Farms at Jefferson Mill
GPIN or Tax Map # 123-34C8 Health Dept ID # I 0 ` 10 - 0'. ;/
Latitude
Longitude
Applicant or Client Mailing Address:
Name: Murcielago Enterprises
Street: 1903 Manakin Road
City: Manakin -Sabot
State Va. zip Code 22553
Prepared by:
OSE Name Steve Gooch
License # 1940 000278
Address 1821 Broadway Street
city Charlottesville
State Virginia zip code 22902
PE Name:
License #
Address
City
State lljfipC
XY
Date of Report 10-5-10 Date of Revision th
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.)
OSE Certification Page Conshaeaen Drawing
Sewage System Application Form System Specs
Soil Information Summary Sheets
Soil Profile Sheets
Design Calculations
Survey Plat
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 mid
policies implemented by the Virginia Department of Health. I further certify that I currently possess any professional license required
by the Imes and regulations of the Commonwealth that have been duly issued by the applicable agency charged with licensure to
perform the work contained herein.
W1The 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 54.1A02.11
I recommend that a (select one): construction permit certification letter[] subdivision approval
be (select one) issued denied ❑ . n
OSE/PE Signature �aA�fQ/1�( 9" • ADZ& Date n y t7
Commonwealth of Virginia
Application for: [Z]Sewage System ❑ Water Supply
Owner Murcielago Enterprises
Mailing Address 1903 Manakin Road Suite F
Manakin -Sabot, Virginia 23103
Agent Spear Builders of Virginia, Inc.
Mailing Address P.O. Box 867
Spotsylvania, Virginia 22553
Site Address �3`G4 F=.—r-`
Z d�-1 u
VDH Use Only
Health Departrnent IDM
Due Date
Phone (703) 625-1553
Fax
Phone 5t-t0.:Jta _1GO
Phone 5 ( to `('
Fax L) ul'o - ' L�% ci s}-
�Ltt 1ArN
Directions to Property: From Woodridge 618 towards Scottsville, property on right approx. 500 ft. past Rt. 622
Subdivision The Farms At Jefferson Mill Section Block Lot 8
Tax Map 123-34CB Other Property Identification
Dimension/Acreage of Property 25.33Ac.
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.
For New Construction: ❑ Certification Letter ❑✓ Construction Permit
For Existing Construction: ❑Repair ❑Modification ❑Expansion []Replacement
Proposed Use:
❑✓ Single Family Home (Number of Bedrooms _4) ❑Multi -Family Dwelling (Total Number of Bedrooms__)
❑ Other (describe)
Will there be a basement: Yes ❑✓ No ❑ . If yes, will there be fixtures in Basement? Yes 0 No ❑
Are any conditions proposed on this construction permit? ❑ Yes 0 No. If yes, please check or describe all
proposed conditions that apply: ❑Reduced water flow ❑Limited occupancy ❑ Intermittent of seasonal use
Temporary use not to exceed I year ❑Other (describe )
Water Supply
Will the water supply be ❑ Public or ❑✓ Private? is the water supply ✓❑ Existing or ❑Proposed?
If proposed, is this a replacement well? ❑ Yes ❑ No. Will the old well be abandoned? ❑ Yes ❑ No.
Will any buildings within 50' of the proposed well be termite treated? t_J Yes U No.
All Applicants
Is this all AOSE/PE application? ❑✓ Yes ❑No If yes, is the AOSE package attached? ❑✓ Yes ❑No.
Note: The well location must comply with §32.1-176.5:2
In order for VDH to process your application you must attach a site sketch and plat of the property. 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 system sites must be clearly marked
and the property sufficiently visible to see the topography, otherwise this application will be denied.
I give permission to the Virginia Department of Health (VDH) 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 an
Authorized Onsite Soil Evaluator (AOSE) or a Professional Engineer (PE) as necessary until the sewage disposal system has been
constructed and approved.
0 �y
Signature of Owner/Agent
Date
AOSE Fomt D Revised 7/03/07 Page _ of _
Page -3- of /0
Appendix 2
Soil Summary Report
GENERAL INFORMATION
Date 10-5-10 Submitted to Albemarle County Health Department
Applicant Murcielago Enterprises Telephone Number (703) 625-1553
Address 1903 Manakin Road Suite F Manakin -Sabot, Virginia 23103
Owner same Address same
Location State Route 618 past State Route Route 622
Tax Map 123-34C8 Subdivision The Farms at Jefferson Mill
Block/Section Lot 8
SOIL INFORMATION SUMMARY P u
1. Position in landscape satisfactory? Ix Yes r" No
Describe side slope
2. Slope 4 %
3. Depth to rock or impervious strata: Max. Min. None X
4. Depth to seasonal water table (gray mottling or gray color) FX- No C Yes inches
5. Free water present R No I- Yes range in inches
6. Soil percolation rate estimated C Yes Texture group 1 II _ II IV
F No Estimated rate 60 min/inch
7. Permeability test performed I- Yes
IX No
If yes, note type of test performed and attach
rSite Approved: Drainfield to be placed at 60" depth at site designated on permit.
L- Site Disapproved:
Reasons for rejection:
1. I® Position in landscape subject to flooding or periodic saturation.
2. I— Insufficient depth of suitable soil over hard rock.
3. r Insufficient depth of suitable soil to seansonal water table.
4. (— Rates of absorption too slow.
5. r Insufficient area of acceptable soil for required drainfield, and/or Reverse Area.
6. (- Proposed system too close to well.
7. 1-
Other Specify
(attach additional pages if necessary)
Hole
A
Soil Profile
Primary Drain Field
Lot 8
The Farms at Jefferson Mill
TM 123-34C8
Albemarle County
Depth Horizon Material Description
(in.)
0-3 A Gray (IOYR 5/1) loam
3-8 E Light yellowish brown (2.5Y 6/4) loam
2-25
BE Red (I OR 4/8) silty cReddish yellow lay �oamclay loam
45-84 CB Pale red 5/8) silty clay sandy
loam with seams of red
B 0-3
A
Gray (IOYR 5/1) loam
brown (2.5Y 6/4) loam
3-6
E
BE
Light yellowish
Reddish yellow (7.5YR 6/8) clay loam
6-15
15-47
Bt
Red (I OR 4/8) silty clay loam
47-84
CB
Pale red (I OR 7/4) sandy loam
Soil Texture
Group
2
2
3
3
3
2
2
3
3
2
2
C 0-4
A
Gray (JOYR 5/1) loam 2
Light yellowish brown (2.5Y 6/4) loam 3
4-9
9-13
E
BE
Reddish yellow (7.5YR 6/8) clay loam 3
13-32
Bt
Red (I OR 4/8) silty clay loam
Red (I OR 4/8) silty clay loam and pale red (1 OYR 7/4) 3
32-66
BC
C
sandy loam 3
Yellow (IOYR 7/8) silt loam schist saprolite
66-84
D 0-3
A
2
Gray (IOYR 5/1) loam 2
Light yellowish brown (2.5Y 6/4) loam
3
3-8
E
BC
Red (2.M 5/8) silty clay loam with weathered schist
8.44
fragments 3
44-54
Bt
Red (I OR 5/8) silty clay loam 3
54-84
C
Pale red (1OR 7/4) silt loam
g 0-3
A
2
Gray (10YR 5/1) loam 2
Light yellowish brown (2.5Y 6/4) loam 3
3-8
E
BE
Reddish yellow (7.5YR 6/8) clay loam 3
8-12
12-45
Bt
Red (1 OR 4/8) silty clay loam
of red (2.5YR 5/8) 3
45-70
CB
Pale red (IOR 7/4) silt loam with seams
clay loam 2
Light red (2.5YR 6/6) sandy loam schist saprolite
70-84
C
Page J�7 of ID
Appendix 2
Soil Summary Report
GENERAL INFORMATION
Date 10-5-10 Submitted to Albemarle County Health Department
Applicant Murcielago Enterprises Telephone Number (703) 625-1553
Address 1903 Manakin Road Suite F Manakin -Sabot, Virginia 23103
Owner same Address same
Location State Route 618 past State Route Route 622
Tax Map 123-34C8 Subdivision The Farms at Jefferson Mill
Block/Section Lot 8
SOIL INFORMATION SUMMARY yktvk-
1. Position in landscape satisfactory? [X Yes r No
Describe side slope
2. Slope 6 %
3. Depth to rock or impervious strata: Max. Min. None X
4. Depth to seasonal water table (gray mottling or gray color) R No r Yes inches
5. Free water present rX No I•- Yes range in inches
6. Soil percolation rate estimated [x Yes Texture group 1 II III IV
F- No Estimated rate 95 minfinch
7. Permeability test performed I— Yes
r No
If yes, note type of test performed and attach
(x Site Approved: Drainfield to be placed at 60" depth at site designated on permit.
F- Site Disapproved:
Reasons for rejection:
1. 1- Position in landscape subject to flooding or periodic saturation.
2. r- Insufficient depth of suitable soil over hard rock.
3. (- Insufficient depth of suitable soil to seansonal water table.
4. r Rates of absorption too slow.
5. F- Insufficient area of acceptable soil for required drainfield, and/or Reverse Area.
6. r Proposed system too close to well.
7. Other Specify
(attach additional pages if necessary)
Soil Profile
Reserve Drain Field
Lot 8
The Farms at Jefferson Mill
TM 123-34C8
Albemarle County
Soil Texture
Hole Depth
Horizon
Material Description
Group
(in.)
2
F 0-4
A
Gray (IOYR 5/1) loam
Light yellowish brown (2.5Y 6/4) loam
2
3
4-8
E
BE
Reddish yellow (7.5YR 6/8) clay loam
4
8-16
Bt
Red (I OR 4/8) silty clay, white feldspar
16-84
2
G 0-3
A
Gray (IOYR 5/1) loam
Light yellowish brown (2.5Y 6/4) loam
2
3
3-7
E
BE
Reddish yellow (7.5YR 6/8) clay loans
3
7-12
12-42
Bt
Red (1 OR 4/8) silty clay loam
of red (2.5YR 5/8) 3
42-84
CB
Pale red (I OR 7/4) silt loam with seams
clay loam
0
H 0-3
A
Gray (IOYR 5/1) loans 2
Light yellowish brown (2.5Y 6/4) loam 3
3_8
8-11
E
BE
Reddish yellow (7.5YR 6/8) clay loam 3
11-48
Bt
Red (I OR 4/8) silty clay loam 3
48-84
C
Pale red (I OR 7.4) clay loam
2
1 0-3
A
Gray (JOYR 5/1) loam 2
Light yellowish brown (2.5Y 6/4) loam 3
3-6
E
BE
Reddish yellow (7.5YR 6/8) clay loam 3
6-10
10-48
Bt
Red (1OR 4/8) silty clay loam
6/4) silt loam with weathered 3
48-84
C
Light reddish brown (5YR
schist fiagments
Note: Design reserve drabs field on estimated percolation rate of 95 minutes per inch. Engineered
system will it within footprint of area tested (holes F-I). Area may have to be expanded for
conventional system.
V-
INSTALL:
7 TRENCHES
90 FT. LONG
60 IN. DEEP
3 FT. WIDE
9 FT. CENTERS
INSTALL ON CONTOUR*
*NOTE: CONTOUR FLARES
GRAVEL SYSTEM MUST BE
MSTALLED.
D -BOX MEASUREMENTS:
1) IRON AT LEFT FRONT LOT CORNER
OF LOTTO D-BOX — 244 FT.
2) POINT ON BOARD FENCE ON FRONT
PROPERTY LINE ON Rt. 618 108 ft. FROP
IRON AT LEFT FRONT PROPERTY
CORNER TO D-BOX — 212 FT.
NO GRADING IN DRAIN FIELD AREA
PRIOR TO INSTALLATION
LIFT PUMP REQUIRED FOR
BASEMENT PLUMBING
P
e
E--' 13ua,�("s Gcsl,� Us> u.ec,k- twvF°��'�t1e
fF
�1cMz 6I k �t Corte ,
r
Scale 1 "=100' - - Soil Profile Hole
Drain Field Layout
Lot 8
The Farms at Jefferson Mill
Albemarle County, Virginia
Gooch Engineering & Testing, Inc.
1821 Broadway Street
Charlottesville, Virginia 22902
�u,)e- Y OFF n
System Specifications
Property ID: The Farms at Jefferson Mill - Lot a
Applicant Information
Name Murcielago Enterprises
Phone (703) 625-1553
Address 1903 Manaldn Road Suite F
Manakin -Sabot, Virginia 23103
Location Information
Tax Map No. 123-34C6
Property address
GPIN No.
Subdivision The Farms at Jefferson Mill
Directions From Woodridge Rt.618 towards Scottsville,
approx. 400 ft. past Rt. 622 on right in woods
Section Block
Lot 8
General Information
System Type septic lank/drain field
Number of bedrooms 4
(e.g. septic tank, drainfield)
Daily flow 600 (gpd)
Type of property residential
(e.g. commercial, residential, etc.)
Conditions
Sewer Line
Se )tic Tank — Inlet/Outlet Structure
Schedule 40 PVC, 4" ✓ or equivalent
Ca acity: 1250 gallons
(add check or describe equivalent below)
2e septic tank - 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 gravity
No, of boxes 1
(e.g. gravity, pumping, dosing siphon)
No. of outlets 12
If pumping, attach Pump Spec Sheet
Surge or splitter box required:
Material Thin wall PVC or equivalent
Yes ✓ No —
Pipe diameter 4"
Slope of pipe 6^/100 in inches
Header line Information
Percolation line Infonnation/Absorption
Area
1500 pound crush strength Yes ✓
Center to center spacing 9 ft.
Minimum slope is 2'Y100 ft. Yes _
Required spacing 9 ft.
Installation depth 60 inches
Aggregate depth 13 inches
No. of Laterals 7 Lateral length 90 ft.
Lateral bottom slope _2-4 inches
Lateral width 36 inches
AOSE
Date
ROSE Pomr J Revised 11/16/06 Page _ of _
f4�` I ofIo
Design Calculations
Property ID: Farms at Jefferson Mill - Lot 8
Flow
Type of use (residential, et,) ra5ldemlal
Show Calculations Here
No. of bedrooms: 4
No. of employees:
Square Footage of building space:
Daily flow (peak design) in GPD: 600
Treatment
No. of septic tanks: I
Show Calculations Here
Size of septic tank(s): iz50
Pretreatment required? _yes ✓ no
If yes, specify type of treatment device:
Absorption area design
Soil Texture Group: "I
If pump system, enhanced flow, or LPD show
Reserve area required? ✓ yes _ no
calculations here or on a separate sheet.
50% ✓ 100% _other (check one)
(dosing volume, head, pump design, etc.)
_
Specify other
Estimated percolation rate - 60
Trench length - 90'
Width of trench - 31
Number of trenches - 7
Center to center spacing - 9'
Depth of trenches - 60"
Depth to rock - 84"+
Total square footage required - 1808
square footage in design - 1890
Water Supply...
Class of well: sc (existing)
Describe (bored, drilled): drilled (existing)
Distance between septic tank(s) and
Well: 160 ft.
Distance between absorption area and
well:180 f.
' Information and calculations required for commercial and/or conditional use applications only
AOSE Form 1 Revised 12/9105
Page _ of
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THE FARMS JI JEFFER50N MILL
V.t(xV eS saJ llivllle Nagls t«lal ObIr IU m
11 AtOENFflLE COUNTY VIRGINIA
o VSLTIEAI.t1 un
JWD MORRIS FOSTER
Ldlp SMRIE,OR
— — — Not to scale
Drain Field Layout
Lot 8
The Farms at Jefferson Mill
Albemarle County, Virginia
Gooch Engineering & Testing, Inc.
1821 Broadway Street
Charlottesville, Virginia 22902
Entered By; Judy Martin on 1010812010
Associated Building Permit
Work Class: Frame Type; Water Supply Typ� SewaTypeisposal Footing /
I Foundation Type:
New ] WDDd private private �asement
Jurisdictional Area (No Service Other Foot /
Found. Desc.:
Work Valuation $ 154,000.00
Work NEW SINGLE DWELLING WITH ATTACHED GARAGE (INCLUDES ALL SUBPERMITS) POWER COMPANY IS
Descriptlon: APPALACHIAN POWER
Directions ST. 20 TO SCOTTSVILLE, LEFT ON CARTER'S MOUNTAIN ROAD, RIGHT ON SECRETARY'S ROAD, GO 1
STRAIGHT THRU 4-WAY STOP AT BLENHEIM ROAD, TURN RIGHT AT NEXT 4-WAY STOP ONTO ROLLING
ROAD, IMMEDIATE RIGHT ON JEFFERSON MILL ROAD TRAVEL APPROX. 5 MILES
Legal
Description: THE FARMS AT JEFFERS
Use Group
Construction Type
Square Footages: # of Stories 2
1st Floor 9
2nd Floor 9
3rd Floor
Finished Basement
Other Habitable
Total Habitable Sq. Footage 1,963
Porches 128
Decks I
Garage 440
Swimming Pool
Unfinished Basement 992
Other Unfinished
Total Unfinished Sq. Footage 1,460
Total Building Sq. Footage 3,423
Set Backs: Front
Back
Zoning Pre -Construction? ❑ Land Use? ElFire
Side
Ld
Right Side Ld
Alarms Required?
I
Fire Sprinkler NAPA Code/Year
❑ Bldg Pre -Construction? ElLeft
•r r r �
Dwelling Units 11 Accessory Structures
Mobile\Prefab. Homes lQ
Mobile Offices\Prefab. Units
Carports Bedrooms 4�
Baths
Paint Spray Booths
Garages
Kitchens
Swimming Pools\Hot
Tubs\Spas
Other
Elevators\Escalators\Lifts
(Res. Only)
I
Page t of 2
Application # 1 B201001874SP
Application Type I Building Permit
Address
Associated Building Permit
AOPLICATION CONTACTINFORMATION ' .
Entered By: Judy Martin on 1010812010
Sub Application Type (Detached Single Family Dwelling
Unassigned
_
Street Address
City / State
Phone
Fax #
E-mail
Zip Code
Cellular #
Owner/Applicant
Name BCIELAGO LLC
Street Address 600 LORING AVENUE SUITE 3
phone
Fax
City /State SALEM MA ���
Zip Code 01970--4264
E-mail
Cellular # ( )
Mechanics Lien
Name ADVANTAGE TITLE AND SETTLEMENT
Street Address 701 KENMORE AVE,
) 899-2600
Phone #[224
Fax #City
i
/ State( FREDERICKSBURG, _—
VA
Zip CodeE-mail
Cellular # -
General Contractor
Name'SPEAR BUILDERS OF VA...
_.
Phone # (540) 582-9641
Street Address P. O. bOX 867
City / State S�POTSYLVANIA VA�
- -
_�
Fax #
Zip Code 22553-0000
E-malls.-
Cellular # ( )
Business Name: State License # License Types (i.e. Electrical, Plumbing, Mechanical)
Separate permits may be required for Electrical, Plumbing, Heating, Ventilating and Air Conditioning.
This permit becomes null and void if work or construction authorized is not commenced within 6 months, or if construction or work is suspended or
abandoned for a period of 6 months at any time after work is commenced.
I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances
governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to
violate or cancel the provisions of any other slate or local law regulating construction or the performance of construction.
By signing this building permit, the owner and/or their agent hereby grant employees of the Albemarle County Community Development & Real
Estate Departments the right to enter and inspect the subject property Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m.,
holidays excepted.
Signature of Owner, Contractor or Authorized Agent
Signature of Building offival or Authorized Representative
Date
Date
Page 2 of 2
Orrice Savdaoe _nd lydefer Procr_m
T',GSh'EET
I C' OO I recai t ..
0 70
err' n Type:D Bare � LOOS �0036
D Combination d - D Engineered
�'eptic OnIY ❑Repair
❑ yell Only D Replacement Well D Certification Latter
11 Well 1Ab2ndonrnLnf
h'ealfh Dept Permit ID
Owner of Property:
Agent for Owner; _
Ta-- Map a' Parcel:
Subdivision: 7uv
Lot:
arse visit: EHS Assigned
Scheduled Dafe:
P,escheduled Date:
Comments: �- n
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Section:
Level I D Level II Review Completed:
DATE
106
Permit: XI sued
D Denied
�01-
Given to Office Support for Data Entry:
Data Entry Completed by Office Support:
Date ParmiJDenial Letter: ❑ Mailed 0 Picked Up
'Irked Up By:
�—
DATE
Installation Inspection Called In:
Contractor: —_
Follow -Up inspection Called In:
Time Requested:
All Completion Documents P.eceivad: 0 YES D Id0
Operation Permit Signed c Issued: ❑ YES ONO
Copy: 0 Wailed/Faxed to Building inspections
D Mailed to Owner/Agent
Time Pequesfed:
Time:
Time:
-- O
10
Block: