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HomeMy WebLinkAboutSUB202300009 Correspondence 2023-01-13Sewage Disposal System Operation Commonwealth of Virginia Depaitment of Health Tax Map No. _ 8-16B-so Permit Health Department Identification No. SD-85-286 Thomas Jefferson Health Department Charles MCRaven is Hereby Granted Permission to Operate a (Type) = Sewage Disposal System Having a Design Capacity of 450 gpd, at Westdside of Rt. 671 SUBDIVISION SECTION/BLOCK LOT N/A This permit is Issued in Accordance with the Provisions of 32.1, Chapter 6 of the Code of Virginia as Amended and Section(s) with Previously Issued permits of the Sewage Handling and Disposal Regulations of the Virginia Department of Health and Dated with the understanding that the Owner and/or any Subsequent Owner will operate the Sewage Disposal System in Accordance with the,Sewage Handling and Disposal Regulations of the Virginia Department of Health and any Variances or Conditions Granted. Issuance.of an Operating Permit does not imply or Guarantee that the Sewage Disposal System will Function for any Specified Period of Time. VARIANCES GRANTED SPECIAL CONDITIONS p NONE. ❑ SEE ATTACHED p NONE ❑ SEE ATTACHED "71�Effective Date Recn mended (San)tarian) Approved (State Health Commissioner) C.H.S.'205 Rev. 4/83 `-S i4age Disposal System Construction Permit PAGE! o,F? Commonwealth of Virginia Health Department-Za(7 Department of Health o Identification Number Health Department Map Reference 9 - ! % id) — General Information New R' Repair ❑ Expanded ❑ Conditional ❑ FHA ❑ VA ❑ Case No. Based on the application for a sewage disposal system construction permit filed in accordance with Section 3.13.01, a construction permit is hereby issued to: Owner (VV)fleN.n,le.-\ / Telephone Address 17-u (� 1 �pn . l )r'. For a Type Sewage disposal system which is to be constructedl!on/at \%)ri,-) �,u-ic (`r'� VI /_'7f nt_/LrYh � VY1t(P ��li-1'1 nt f1-i. (DUI Subdivision /VA _ Section/Block A1i1 Lot `N/1 Actual or estimated water use DESIGN v NOTE: INSPECTION RESULTS Water supply, ezisting� (describe) Water supply location: Satisfactory yes ❑ no ❑ comments G.W.2 Received: yes ❑ ❑ not applicable ❑ To:be installed: class "Tr- cased 9n grouted 9r� ' '.noI LXI -'T IW((f Building sewer: Building sewer: yes [2/no El ❑ comments I.D. PVC 40, or equivalent. Satisfactory Slope 1.25" per 10' (minimum). ❑ Other Septic tank: Capacity i CyDeJ gals. (minimum). Pretreatment unit: yes ❑ono ❑ comments ❑ Other Satisfactory Inlet -outlet structure: Inlet -outlet structure: yes El/no ❑ comments PVC 40, 4" tees or equivalent. Satisfactory ❑ Other Pump and pump station: Pump & pump station: yes ❑ no ❑ comments No ®' Yes ❑ describe and shown design. Satisfactory if yes: , Gravity mains:.2� or larger I.D., minimum 6" fall per Conveyance method: yes [0/ no ❑ comments 1001, 1500 lb. crush strength or equivalent. Satisfactory ❑ Other Distribution box: Distribution box: yes 0/ no ❑ comments Precast concrete with 10 1 ports. Satisfactory ❑ Other Header lines: Header lines: yes E]/ no ❑ comments Material: 4" I.D. 1500 lb. crush strength plastic or equiva- Satisfactory lent from distribution box to 2' into absorption trench. Slope 2" minimum. ❑ Other / Percolation lines: Percolation lines: yes Q/ no ❑ comments Gravity 4" plastic 1000 lb. per foot bearing load or Satisfactory equivalent, slope 2" 4" (min. max.) per 1001. ❑ Other Absorption trenches: Absorption trenches: yes ❑1 no ❑ comments Square ft. required u :depth from ground surface Satisfactory to bottom of trench ; aggregate size Trench bottom slope 2- center to center spacing ;trench width :2' / Date 7; / !%'= /tinsp'ected `and approved by: Depth of aggregate a' Trench length ; Number of trenches ; r Sanitarian C.H.S. 202A Revised 6184 t t _2 Health Department Identification Number ScKematic drawing of sewage disposal system and topographic features. PAGE L OF Show the lot lines of the building lot and building site, sketch of property showing any. topographic features which may impact on the design of the system, all existing and/or proposed structures including sewage disposal systems and wells within 100-feet of sewage disposal system and reserve area. The schematic drawing of the sewage disposal system shall. show sewer lines, pretreatment unit, pump station, conveyance sys- tem, and subsurface soil absorption system, reserve area, etc. When a nonpublic drinking water supply is to be located on the same lot show all sources of pollution within 100 feet. ❑ The information required above has been _drawn on the attached copy of the sketch submitted with the application. Attach additional sheets as necessary to illustrate the design. no (249.�er JC' forµ The sewage disposal system is=to be constructed as specified by the permit ❑ or attached plans and specifications ❑ . This sewage disposal system construction permit is null and void if (a) conditions are changed from those shown on the application (b) condi- tions are changed from those shown on the construction permit. No part of any installation shall be covered or used until inspected, correctionsmade if necessary, and approved, by the local health department or unless expressly authorized by the local health dept. Any part of any installation which -has been covered prior to approval shall be uncov- ered, if necessary, upon the direction of the Department. Date: 7 /H ISS Issued by: zW' t �7 (-& This Construction V sanitarian Permit Valid until Date: Reviewed by: Supervisory Sanitarian ------------------------------------------`---"-"'------------- If FHA or VA financing Reviewed by Date C.H.S. 202B Revised 6164 Supervisory Sanitarian 11-2A Date Regional Sanitarian . . . ., f ., / � J letion Statement Commonwealth of Virginia State Department of Health Health Department Identification Number �> >- � ZS6 1/1� 11Q �J'Yi,c�l Health Department Name of Company/Corporation/Individual: Address: 40�1 '76� u 5e.4 ''� P) V J5e ` Telephone: cl 77 _!7 2W Owner's Name ,Ar Owner's Address Location of Installation: Lot Block Section: Subdivision: .� Other: W� ,ire C-11 Ri . b71 c,l k,,,I i i„lI\Iric,t oil 16 Lit I I hereby certify that the onsite sewage disposal system has been installed and completed in accordance with the con- struction permit issued (date) and is in compliance with Part D of the Sewage Handling and Disposal Regulations and when appropriate the plans and specifications for the -project. Date / Signature and Title '. C.H.S. 203 - Rev. 4/63 411 PERMIT TOINSTALL LCI REPAIR, ❑ REASONS FOR REJECTI0t4 ❑ p 1 WATER SUPPLY. ❑ SEWAGE DISPOSAL SYSTEM 61 - tIl..-ie oid after (72)-twelve months. -(2) Automatically cancelled when site conditions -are changed from those show on permit. (31 Automatically cancelled should facts later become known that a potent) •hazard woWrrtntihuingi ysX llatioFHA/VA Yes NoDCa.p�Owner) {'W6LJR-A —AddrQ M45i•, c- wA 9 / �.. �.1�� ; Occupant Address v - �— - Phone i - - (Mailing Address) Exact -Location / r / of pr I�se^�s i,�� r 1 `► -, • a. ' - , , � • )SubilkL n, Street or Road Name, Section m Lot No-) FOR%,12 Dwelling ❑ Other - 11 • f I _ Automatic Washing Machine it . Yes No Consumption Y ✓ t.) gal. per day II Actual , Potential � Bedrooms S Garbage Disposal Unit0 Yes d Na, r❑,Actual ' a.estimated Water Additional wastes l - Yes No (,•)WATER SUPPLY (Existing) Class N n. Approved. Othe - ITobe,instaNed) Class IT—_Cased.Yt -ft. to be grouted"fL, - - (Unless supported by positive evidence Class III is to be considered as to be installed, SOIL STUDY Naturally • dramed, suitable by sight Yes No Technical Classification Estimated Percolation Rate 1-10(2)- ... • - E - 11-25 .©�1r50 �- >51 ❑ _;Percolation Test Required Yes No n.Z'Rate (Minutes per incMin h) - '• / (utes per inch to nearest 10 minutes) t Depth to Grey Mottles we • i ches lestimateover 4 ft.l OT R _ - ^ Surface drainagerequiredID Yes �No -'OTHER DRAINAGE - - ' (� HOUSE•SEWER LINE Size a inches. Type of material required - r ista ce from Water Supply:. text- VVV (��DETAI Li OF'CONSTRUCTIONfNatertight Septic Tan of + / F'E �• Meter 1 Liquid Capacity ti f gallo s. ` Inside Dimensions Length feeC Width_feet. Liquid Depth._.__fijet- Depth of Air �'pacf�___ feet SUBSURFACE ABSORPTION FIELD Number of square feet ren wd ! l __Type F..Tre req....dt r any - w^^CC��11 Depth of aggregate fr m\ se of tile to bottom of ditches - -- inches. - Alloxmble fall �._._ _to /, mches.�� / Total aggregate minimum depth —f-. — inches ar more. Depth of drainfield to be inches from su ace of original ground ` 1 Distance from well to septic tank fi[t r feet; distance from well to dramfmld GG t- ).vl fy t .{. Y ,R,r-„ ee „ 1 j j. )';, / s t•,�, i - '� Rough Sketch of Premises (including adjacent,properties•if pertinent, Showing Location of Lot Line, Buildin ater Supplies, swage Disposal Sysle s• Trees, and Other Possible Sources of Contamination of Water Supplies, by Indicating Distances and Slope with rega to one another- u�t t 3 0 Note: Owner or his agent must notify 1 A 1f `� 1 \1 c stallation is ready for inspection. If any Sewage Disposal Sys em, dr Pi du reof, is savors oe covered at the direction of the Health Director or his agent- CONDITIONS DISCOVERED m SYSTEM DESIGN. Changes from above specifications require Health Department approval Based on the above information, the undersigned recommends that this permit be is_su/C�'td. r/ Date —Approved - _ LHS-121 REV. 12/71 (Reviewing Authority) Virginia State Department of Health, ` DUPLICATE _ Health Deism before being iml URING INSTAL eta. being me& ITC t wAf��d in- un, OF ��� h :, l ,y Yy1 rt { ,y .ry+. M 1,•l't Y4N .. r1i � '� , � •a 4' 5 � 1 i..d t Y.. 5 .',t I �Y J N F 1 f -a..�a 1 Y.,: V ♦ •` �� .� + '.. r a a•' 1 5 11 v. 5. Y Y -' ' I �: .may,'. 1 �� • .. r h], y i h' I ' • I � fir' 'f ... ,. � a • _ � . �,' ' .. it w ., c ' - y `. 1 :fit F t ... 4� Y g •. '.}' ,{ • n a • n '� .,; .. •.• ,.. :., .. is .r �..'. .. " ;. . 'Y ., A •t4 t J hN �r A { X N ♦, i J '. A F 4 � d 1 u: l J l • n V•�.�y N � ' {1 � � � a I • �. ,,.. a �. {f �+ 1 '! it r �`� ,a. rW If r �)PAPU..(�L�� ! �('�i u •�I YX .;YI t R&AVN '7 ONONAVd - t Ty QD • v x e e :T r QQ - � 1 r v, ct �N r °ys Imo Nto p y, i O 3c a' �i V tia k w .Q ,( 3 2gQ 1:17h 0, jTa vYs ' iW IF �S a Q" a RRa 3 �1y�S 3.: k � B Q p rv•f v_ : w !1 �f w ootW T c 3 Q,w 6 �L. Q� Iq t: 0 0 o�m ti G1IA �N a• it O ��F g N �? _ It h Q hh,00 cv�` 4' Y \I i letion Statement Commonwealth of Virginia State Department of Health Health Department Identification Number Name_ of Company/Corporation/Individual:. ,"/4 11042 M� zi as Address:A34 Telephone Health Department 97� — e_�/7F41 Owner's Name Owner's Address Location of Installation: Lot Section: Other: Block I hereby certify that. the onsite sewage disposal system has been installed and completed in accordance with the con- struction permit issued (date) _7f'% ;�and is in compliance with Part D of the Sewage Handling and Disposal Regulations and when appropriate the plans and specifications for the project. Date � Signature and Title C.H.S. 203 Rev. 4/83 )MCI j ! ! Inspections Department 101 MCIItiT.wc gpwp I � I ., QMww�OTr[6+a�[i VIw61Mw 22901.4396 1 16041 296.3632 TO: Thomas Jefferson Health De a ' rtment I I1 � I P I I i i I I FROM: Inspections Department I iDATEi �PERSON CONTACTED; RE: Owner Building Permit {Id TaxlMap 4� ParcelB — Lo( Block i 'Section Subdivision i General Location -6 lei �7- I, 1 — i� , 1 ' I PLEASE CHECK YOUR RECORDS FOR: SEPTlC PERMIT _ YES _ NO ----- ._ I , I NAL INSPECTION & APPROVAL -DES) NO ! ADDITIONAL COK4ENTS: 1 � ' I � J i HFALTH DEPAR'I;MfiNT INSPECTIONS n1iPAR'PMBNT i I j 1