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Home My WebLink AboutSUB202300001 Correspondence 2023-01-30Commonwealth of Virginia Application for Subdivision Review (Page 1 of 2 to be filled out by the Owner or Agent) Owner Meara Chametzki Mailing Address 3795 Earlysville Road Earlysville, VA 22936 Steve Gooch Mailing Address 703 Oliver Creek Road VA 22974 AOSE Steve Gooch Mailing Address 703 Oliver Creek Road VA 22974 Directions to Property: From Charlottesville take Earlysville Rd. to 3795 Earlysville Rd. on right Name of Proposed Subdivision Tax Map 31-26D & 31-26E Other Property Identification VDH Use Only Health Department ID# Due Date Phone Phone Fax Phone (434)531-0487 Phone Fax Phone (434)531-0487 Phone Fax Dimension/Acreage of property 6.15 Ac. Number of lots proposed 2 Proposed water source (note: new or existing, public or individual) existing, public and new, individual General size of lots 2.69 Ac. & 3.46Ac. (give range if appropriate) Additional description of subdivision The water source for TM 31-26D is the public water system that serves the adjacent Earlysville Forest subdivision (note water meter shown on plat). The existing well is not being used. The water source for TM 31-26E will be a new, individual well. 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. RianabTm n7C)wner/A oen`t Date Coin In 01th of Virginia Appheadonl for SSubovWon Review (pap 2 of 2 to be filled out by the munry official roVWng a VD19 review) County Office iwtladrp r"t Contact IA&ldual we► » aly llealhh Dapialmrat lhhe oats Phone Wool off o s of the Viro0a DeptMrnmt of Hedtb tray miew subdWisior ptpl{oadau for oa"liarce with state ruled and reguhatotu govrriapowge ttw MI and dispersal atd prWae watx saq+pl* aompiiance with loci ordlnataco gov»nLhg wwap hatmsrtt and d1�Mao "d VfV" watt 11ba and po atial for compliance with other local ordinances. Plow indicate the nature of ew you are "king the 1, Review fbr mnfomtwon with the Sewage HanMq and Dlepo"I Regulations 2, Review fbr oonfbrmanoo with local onsita wastewater ordinances 3. Other (describe below) Nam and title o roquedtor a^ 052 Form P Itavi»d 7102M