HomeMy WebLinkAboutSUB202200207 Other 2022-12-21 (3)Commonwealth of Virginia VDH Use Only
Health Department ID#
Application for Subdivision Review Due Date
(Page 1 of 2 to be filled out by the Owner or Agent)
OwnerMuroielago, LLC Phone (703) 625-1553
Mailing Address 27 Congress Street, Suite 502 Phone
Salem, MA 01970-4264 Fax
Developer/Agent Steve Gooch Phone (434) 531-0487
Mailing Address 703 Oliver Creek Road Phone
Troy, VA 22974 Fax
AOSE Steve Gooch Phone (434) 531-0487
Mailing Address 703 Oliver Creek Road Phone
Troy, VA 22974 Fax
Directions to Property: From Woodridge take Jefferson Mill Rd. (St. Rt. 618) to 6478 Jefferson Mill Rd. on right
Name of Proposed Subdivision The Farms at Jefferson Mill
Tax Map 123-34C8 Other Property Identification Dimension/Acreage of Property 25.33 Ac.
Number of lots proposed 2 Proposed water source (note: new or existing, public or individual) new, existing, individual
General size of lots 333 Ac. & 22.0 Ac. (give range if appropriate)
Additional description of subdivision
Overview of soils and geology (optional but encouraged)
In order for VDH to process a subdivision application you must attach a plat of the property showing the location of the proposed onsite
sewage disposal systems and the reserve absorption areas (if required) and the location of the water supply system on each lot, if applicable.
Each plat or subsection of a subdivision shall be accompanied by specific soil information for each lot (absorption area and reserve area). If
not provided by the local subdivision ordinance, the district or local health department may require the plat to show streets, utilities, storm
drainage, water supplies, easements, lot lines, and original topographic contour lines by detail survey or other information as required.
When the AOSE site evaluations are reviewed, 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.
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Date
Commonwealth, of Virginia HeehhDelmftewatMN ° -
APPUestion for Subdivision Review Due Date
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(pop 2 of 2 to be tilled out by the county oMcW rogiretlag a VDH review)
County Oboe initiating request
Contact Individual Phone
Local *fibs of the Vbghila Department of Health may review subdivision applications for compliance with state rules and
regulatloos governing sewage treatment and d VmW and private wets Supplies, compliance with local ordinance governing
sewage treatment and disposal and private water supplies and potentially for compliance with other local ordinances, Please
indicate the nature of review you are asking the health department to conduct,
1. Review for conformance with the Sewage Handling and Disposal Regulations
2. Review for conformance with local onaite wastewater ordinances
3. Other (describe below)
Name and title ofrequestor Date
OSE Perm F Revised 7/02/09