HomeMy WebLinkAboutSUB201300071 Assessment - Groundwater 2013-05-20 • t
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Page / of /0
OSE/PE Report for:
Construction Permit P Certification Letter n Subdivision Approval I/
Property Location:
911 Address: City:
Lot 4,,,d Section Subdivision A/46'A, /CAA,
GPIN or Tax Map # J1 y red 4 Health Dept ID #
Latitude / Longitude
Applicant or Client Mailing Address:
Name: jipjte,. !. 3i4 4..c
Street: 5 b - el,,, yet ,ery,44 • ; e , •�
City:_ j i //e. State Of Zip Code Z2`?O1
Prepared by:
OSE Name /I eihhtel0 S/, / 4wi 6 % License # / elt:137
Address e®. 3 ( .5 7
City f✓f6 Sth JI State _ O Zip Code 22 ?e'S
PE Name: License #
Address
City State _ Zip Code
Date of Report 0 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 t y. / - - L oS£ esiA. 5 1Pkrw4; 4 .'ovi 17. /o P xsi • 5, ;I �ra ale L°4.4hta45
t e r 3 -'1 .Site .i.« ; $45
( ,► 't . 5 -7 Adgr.. pes ; fie s e..A
for f- 7 5 ys 4c„ spe...1'.r„ A a.,
Certification Statement
T 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 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 the rk contained herein.
The 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 o : construction permit certification letter El subdivision approval
be (select one) issued enied ❑ .
OSE/PE Signature �_,,,,,,, � ...- - -- °Date D 5 1 a e /.3
Common`W alth of Vi inia VDH Use Only
P g Health Department ILO
Application for: ['Sewage System 1 V ater Supply Due Date
Owner (i�j s y / , . / f! & e» t J��r Phone V3Y - 2947 `% //y
Mailing Address 510 T ✓rrrat s w, �c An> Phone
�jltrr / I o}{ csd� /�C vA 2 Fax
Agent t SIClKv‘ 4+eion f /r/,� Ji.r/ i? sp or' Phone y3y 2?
Mailing Address -5720 tfi✓.e evtJre% /�. rr $.., C lea Phone
/
l i 40-1 0-e..5 i//9 lit 90% Fax
Site Address
Email
Directions to Property: E�v,/4 . or i gw/e 775 ; • 9 „ndes 7 L 7
Subdivision 4144-4-&I /4.14, Section Block Lot f esidur.
Tax Map 1l y parosf Other Property Identification Dimension /Acreage of Property 74./5 7 tilerws
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)
Single Family Home (Number of Bedrooms 3 ) ❑ Multi - Family Dwelling (Total Number of Bedrooms )
❑ Other (describe)
Basement? 6f o (circle one). Walk -out Basement? 4E9, o (circle one) Fixtures in Basement ?d o (circle one).
Conditional permit desired? Yeso "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
Water Supply
Will the water supply be Public or rivate circle one). Is the water supply Existing oi roposed circle one).
If proposed, is this a replacement well? Yes No circle one). Will the old well be abandoned? Ye (circle one).
Will anv buildings within 50' of the proposed well be termite treated? YesQcircle 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 normal business hours for the purpose of
processing this application and to perform quality assurance checks of evaluations and designs until an operation permit is approved.
Signature of Owner /Agent Date
Lot
Lioi to 30/
VDH Use Only
Health Department ID#
Due Date
Site and Soil Evaluation Report
(For certification letters and subdivisions)
General Information
Date : 0 L /ittizo/; /f /6ie,,sr/e County Health Department
Applicant : /c h4/ Z 5;o/4/
Telephone Number : 3V 9f/,
Address : 5 4,i4...ee.44/c � -44re ; 5 /oo / ex.-bye-00A L 9 &re
Owner :C�. jr,�s.s� (�/i'/,hren!154e,Address : 52p £r -�,i- /) ��rsl� / S -.4 o
Au, Location : ivb.' / oL Li 7 /3""; . 9 m • , £iv /I iJ 4./.. 7e 7 //
Subdivision i /5 yof�i Block /Section Lot 4.5' d•at
Soil Information Summary
1. Position in landscape satisfa Yes No _ Describe : s', -efesi ,..
2. Slope 7 %
3. Depth to rock /impervious strata Max. 4 Min. yi None _
4. Free water present No i/ Yes _ Range in inches
5. Depth to seasonal water table (gray mottling or gray color) *49 inches
6. Soil percolation rate estimated Yes Texture group DI EH ❑IV
No — Estimated rated min /in
7. Percolation test performed Yes umber of percolation test holes —
No ;/ Depth of percolation test holes
Average percolation rate — mpi
Name and title of evaluator: J i ie' k ,jvsy c. o., O.
Signature:
Departme , se
ite approved: Drainfield tr/ch bottoms to be pl. -d at 18' (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 1) Revised 7/02/2009
Page `7 of /0
Date of Evaluation: 04/11/2013 Profile Description
SOIL EVALUATION REPORT
Property ID: Tax Map 114 -6 - 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 mvesttgated 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 -5 10YR7/4 Very Pale Brown Silty Clay Loam 111
BA 5 -12 5YR5/8 Yellowish Red Silty Clay Loam III
Bt 12 -34 5YR5/6 Yellowish Red Silty Clay Loam II I
C 34 -49 5YR6/8 Reddish Yellow 10% Schist Frags Silt Loam III
R 49 "+ Rock - Schist
2 A 0 -6 10YR7/4 Very Pale Brown Silty Clay Loam III
Bt 6 -33 5YR5/8 Yellowish Red Silty Clay Loam III
C 33 -42 5YR6/8 Reddish Yellow 15% Schist Frags Silt Loam 111
R 42 "+ Rock - Schist
3 A 0 -6 10YR7/4 Very Pale Brown Silty Clay Loam II I
BA 6 -11 5YR5/8 Yellowish Red Silty Clay Loam III
Bt 11 -41 5YR5/6 Yellowish Red Silty Clay Loam III
C 41 -60 5YR6/8 Reddish Yellow Silt Loam III
REMARKS
OSE Form G (pa 2) Revised7/02/2009
Page .S 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 ❑ primary and reservp area, l■6nly the primary area, ❑ only the
reserve area (check one) for /f!q„ jJ y efru C - Risjue. (property ID).
Design Basis
Total length of available area: 7Q Total width of available area: 75 "
Estimated Pere. Rate: 4 at /8 in. (depth) Number of bedrooms (or GPD): 3U er ys"a 46)
2
Conveyance Method : hr v I Distribution method (specify):
Dispersal system basi I op,? LGMI required? /VU (Ye- ant
)
Effluent quality required: ; ,,rte/ rimary, f econdary, Advanced Secondary)
Square feet per bedroom: ( 0 .- 1 , Total trench bottom area required: I..75 , j ,,i`t
f
Gravity, pump. siphon
, Enhanced flow. 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: ge
6 e
Width of pad or trenches: 3` Center to center spacing: /
�y
Reserve required? t eS Percent reserve area required: /OD /a
Total width of absorption area required _ 18 Total trench bottom area provided: /VV ,
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
kftiol
Page 1p Of /D
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 0 primary and reserr e area, 0 only the primary area, only the
reserve area (check one) for // ,, / — cs (property ID).
Design Basis
Total length of available area: !0 i Total width of available area: 75
Estimated Pere. Rate: 6,0 at If in. (depth) Number of bedrooms (or GPD): 384 BPD
Conveyance Metho ru Distribution method (specify):
Dispersal system basis RDSS 107 pn S LGMI required? �p (Ye- .r
Effluent quality required: 5toon J.4.t y (Primary econda kdvanced Secondary)
Square feet per bedroom: Zo3 7.4. Total trench bottom area required: td9 7 .1 ;
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: rD
Width of pad or trenches: 3 Center to center spacing: 9
Reserve required? Ye S Percent reserve area required: /00 /v
r
Total width of absorption area required _ ./ Total trench bottom area provided: 7
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 7 of / 0
Design Calculations
Property ID: x 1 /11 ) /H G - ,ets, JK c.
Flow
Type of use (r,-sidential, etc) Kes r;lcr►h:a! Show Calculations Here'
No. of bedrooms: 381
No. of employees:
Square Footage of building space:
Daily flow (peak design) in GPD: YS
Treatment
No. of septic tanks: / Show Calculations Here'
Size of septic tank(s): /poo
Pretreatment required? _yes _no
If yes, specify type of treatment device:
Absorption area design
Soil Texture Group: iiE If pump system, enhanced flow, or LPD show
Reserve area f equired? ✓yes _ no calculations here or on a separate sheet.
_ 50% ✓100% _other (check one) (dosing volume, head, pump design, etc.)
Specify other_
Water Supply
Class of well: 311 wog Describe (bored, drilled): 04 DA)", ,, gee j
Distance between septic tank(s) and
weII:j't
Distance between absorption area and
well: /port
Information and calculations required for commercial and/or conditional use applications only
OSE Form T Revised 7/2/2009
Page r of /O
System Specifications
Property ID: T 11? // fnru/ f_ - /Ca,!%114c
Applicant Information
Name Phone vy 2
Address 520 SA teli ,s inac�� �.,k /Oo
l364✓1 VIIIG 01 2290/
Location Information
Tax Map No. It ? f ae44,1 , - Property address
GPIN No.
Directions 6,vsfs. t. 4 1Q . 79S' Subdivision /if l /SAou'-
.9 rniks /flodt, aL /o..k 727 Section Block
Lot &
General Information
System Type = Number of bedrooms ,3$4
(e.g. septic tank, drainfield) Daily flow tiro (gpd)
Type of property Ke0, -. w.aa,J
(e.g. commercial, residential, etc.)
Conditions
Sewer Line Septic Tank - Inlet /Outlet Structure
Schedule 40 PVC, 4" c../or equivalent Capacity: /oeo gallons
(add check or describe equivalent below) 2 septic tank #/ /g 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 o.r,+.n No. of boxes /
(e.g. gravity, pun4iping, dosing siphon) No. of outlets 7
If pumping, attach Pump Spec Sheet Surge or splitter box required:
Material 5 yU ii/ Yes No
Pipe diameter if"
Slope of pipe'/t/' /o" (in inches)
Header line Information Percolation line Information /Absorption
Area
1500 pound crush strength Yes if Center to center spacing -7- ft.
Minimum slope is 2 "/100 ft. Yes • Required spacing y ft.
Installation depth i8 inches
Aggregate depth /3 inches
No. of Laterals Lateral lengthN ft.
Lateral bottom slope = inches
Lateral width34 inches
OSE - Date h`/4/ 0 %3
OSE Form J Revised 7/2 ,609
Page 7 of /D
System Specifications
Property ID: %,v,o / //9 p ,,..14
Applicant Information
Name //PA Phone 939- ZYG - yip?
Address a,lp /,.rte.,, ' c rraee ' ,4.,;k /cam
(i' !�,- /lnil-hn ✓r //G 1J,4 22Yo/
Location Information
Tax Map No. 11 y P»ru/ G - Property address
GPIN No.
Directions f44l31 44. /, 77g Subdivision /17,¢44 /54ei
.9
■44 ,1 L p1 , vJc 717 Section Block
Lot "
General Information
System Type Number of bedrooms 3 Pt
(e.g. septic tank, drai field) Daily flow /So (gpd)
Type of property Keo d .k
(e.g. commercial, residential, etc.)
Conditions
Sewer Line Septic Tank — Inlet /Outlet Structure
Schedule 40 PVC, 4" L .V .- jr equivalent Capacity: /000 gallons
(add check or describe equivalent below) 2 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
Conve ante line /force main Information Distribution box Information
Method „ ,,� p No. of boxes /
(e.g. gravity, pun'iping, dosing siphon) No. of outlets y
If pumping, attach Pu ni7 Spec Sheet Surge or splitter box required:
Material L` 56{,j,.Io %' /V/G Yes No
Pipe diameter 2”
Scope of pipe 044 (in inches)
Header line Information Percolation line Information /Absorption
Area
1500 pound crush strength Yes * Center to center spacing 1 ft.
Minimum slope is 2 "/100 ft. Yes ✓ Required spacing / ft.
Installation depth IT inches
Aggregate depth L inches
No. of Laterals 3 Lateral length fro ft.
Lateral bottom slope i -Linches
Lateral width 347 inches
OSE �, _ Date ® l*A0 , 9
OSE Form J Revised 7/2/21
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Page / of f
OSE/PE Report for: /
Construction Permit Certification Letter Subdivision Approval V'
Property Location:
911 Address: City:
Lot 4i „x„ Section Subdivision Awe kit % ijje✓
GPIN or Tax Map # /) y p .,,•1 6 Health Dept ID #
Latitude Longitude
Applicant or Client Mailing Address:
Name: A,'ehrei P 3;toljef /"
Street: 5720 t rwee,n /'t /j 1 ; 5 d /�e /00
City: 0k144 of /e. State 11,4 Zip Code 22
Prepared by: /
OSE Name /l v fv 4 co 1 / �a,� /Poi License # /15
Address ? �• 30,c 522 Y J
City C,h rl- ✓/afl State Vii Zip Code 22705
PE Name: License #
Address
City State Zip Code
Date of Report OY /Z/Z44.3 Date of Revision #1
OSE /PE Job # Date of Revision #2
Contents /Index of this report (e.g., Site Evaluation Summary, Soil Profile Descriptions, p Site Sketch, Abbreviated Design, etc.)
- C CCP4, jiir wr/ ; 4p /kQ/t/y+r+ fir /�i'1T tea,% /✓!!`/K <ocA+/�rbssf
p & 3 53= r /.....m/�Y f f
5---4 Pcs,n Le s ; Jr $7
Certification Statement
1 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 and
policies implemented by the Virginia Department of Health. 1 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 the work contained herein.
(/ The 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 e): construction permit certification letter subdivision approval C _
be (select one) issued denied ❑ .
OSE /PE Signature Date 0 9 4E/40/3
Commonwealth of Virginia Health Depart e DHD #se Only nt
Application for: 12<ewage System F Supply Due Date
Owner C � S �le ✓%, /Y) r /�l c .,J/ - Phone $94 - ?//9
Mailing Address 5-249 S < ,`4.e /ea Phone
Ch 4e1.t+,sn /Ce 1J6 ZZ-9o/ Fax
Agent itt 4e.41 /� 5 Phone "3 -9 /i9
Mailing Address SZo A.-eer Vie 1:1 7 s✓irsee ; 5..k /po Phone_
c4.#7144,5 0/k. / J / 1 zao/ Fax
Site Address
t e Email
Directions to Property: £AS }S ; J ,j- 1Qow$G 79s; .? aa�.s �rP o i- ,1-e. 72.1
Subdivision /hs,r /5;j
/or Section Block Lot r.
Tax Map /l / -( Other Property Identification Dimension /Acreage of Property /o. /ro 4ters
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: E 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)
Single Family Home (Number of Bedrooms 3) ❑ Multi - Family Dwelling (Total Number of Bedrooms )
❑ Other (describe)
Basement? Yes circle one). Walk -out Basement? YesQ(circle one) Fixtures in Basement? Yesacircle 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 1 year
Water Supply
Will the water supply be Public o rivate circle one). Is the water supply Existing o(Proposed)circle one).
If proposed. is this a replacement well? YesOcircle one). Will the old well be abandoned? YesO(circle one).
Will anv buildings within 50' of the proposed well be termite treated? YesifOcircle 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 andior
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 normal business hours for the purpose of
processing this application and to perform quality assurance checks of evaluations and designs until an operation permit is approved.
Signature of Owner /Agent Date
f.° p yt 3 c} Y
VDH Use Only
Health Department ID#
Due Date
Site and Soil Evaluation Report
(For certification letters and subdivisions)
General Information
Date : ? y /ZG /Eat 3 County Health Department
Applicant: a,‘c.,LI P . $44rJ ht
Telephone Number : 93 °2 f» - 9/19
Address : S ?O lnn ; $, he) C11s1✓f )4.sv /1c ( 22Yo
Owner :Ck 1 es Ave., /P)n✓ka t AJ,tha,/ /, 54UiAddress : S �r
1d eic .Su
� t .yacc � ' .1c, Jet,
Location : F A5 4,4,1e, 775 . 7 4.5 441 of 4 7z 7
Subdivision MiM.t Atike Block /Section Lot X
Soil Inform ion Summary
1. Position in landscape satisfactory Yes No Describe :
2. Slope 1
3. Depth to rock /impervious strata Max. Z Min. /5'" None
4. Free water present No ,./ _ Range in inches
5. Depth to seasonal water table (gray mottling or gray color) /WO inches
6. Soil percolation rate estimated Yes ✓ Texture group ❑I
No Estimated rate /0o min /in
7. Percolation test performed Yes umber of percolation test holes
No Depth of percolation test holes
Average percolation rate mpi
Name and title of evaluator: '3 k. k3ei G•O-0.
Signature: _ 7
Depart ent Use
Site approved: Drainfield ench bottoms to be aced at 3 (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.1) Revised 7 /02/2009
L
Page y of 8
•
Date of Evaluation: 04/11/2013 Profile Description
SOIL EVALUATION REPORT
Property ID: Tax map 114 parcel 6 - 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 re. 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 - _ 10YR5/4 Yellowish Brown Silty Clay Loam III
Bt 4 -16 10YR6/8 Brownish Yellow Silty Clay IV
C 16 -19 10YR7/4 Very Pale Brown Silty Clay Loam III
R 19 "+ Rock - Schist
2 A 0 -4 10YR6/4 Light Yellowish Brown Silty Clay Loam 111
Bt 4 -25 7.5YR6/8 Reddish Yellow Silty Clay IV
C 25 -28 10YR6/8 Brownish Yellow Silty Clay Loam 111
R 28 "+ Rock - Schist
3 A 0 -7 10YR7/4 Very Pale Brown Silty Clay Loam 111
Bt 7 -15 2.5Y7/4 Pale Yellow Silty Clay IV
R 15'+ Rock Schist
4 A 0 -5 10YR7/4 Very Pale Brown Silty Clay Loam 111
Bt 5 -18 2.5Y7/4 Pale Yellow Silty Clay IV
R 18'+ Rock - Schist
REMARKS
OSE Form G (pg.2) Revised7/02/2009
Page s Of v
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 go5rimary and reserve area, ❑ only the primary area, ❑ only the
reserve area (check one) for 1 N 1 r ,ex.,/ t, P ,____ (property ID).
Design Basis
Total length of available area: go' Total width of available area: 39
Estimated Perc. Rate: MO at 3 in. (depth) Number of bedrooms (or GPD): 3 $g of gra 6PD
2
Conveyance Method : r� +y Distribution method (specify): Pyre - 5 : ef
Dispersal system basis 40$5 LGMI required? jriQ (Yes
Effluent quality required: Se efl,,, � (PrimatyZecondary;Advanced Secondary)
Square feet per bedroom: Soo 7 , Total trench bottom area required: S''a x,
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: Fe)
Width of pad or trenches: i 9 Center to center spacing: i •S
Reserve required? Ye5 Percent reserve area required: /00
Total width of absorption area required _ 3 Total trench bottom area provided:
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 of 8'
Design Calculations
Property ID: T X , o /l y / 0, h - e l C A „�� X
Flow
Type of use ( roide„t ai, etc) JQtse,,},;, f Show Calculations Here'
No. of bedrooms: 3 BBC
No. of employees:
Square Footage of building space:_
Daily flow (peak design) in GPD: 'fro
Treatment
No. of septic tanks: / Show Calculations Here'
Size of septic tank(s): Moo po//,
Pretreatment required ?,/'ye§ no
If yes, specify type of treatment device:
Absorption area design
Soil Texture Group: lir If pump system, enhanced flow, or LPD show
Reserve area;equired? es _ no calculations here or on a separate sheet.
50%1./100% _other (check one) (dosing volume, head, pump design, etc.)
Specify other
Water Supply
Class of well: 1. dtJ.j( Describe (bored, drilled): In $dreJ or pealed
Distance between septic tank(s) and
well: 50
Distance between absorption area and
well: Jo0'i-
I Information and calculations required for commercial and /or conditional use applications only
OSE Form 1 Revised 72 /2009
Page 7 of S
System Specifications
Property ID: 1 /jy,arjI b pied X "
Applicant Information
Name /I_A_6 P S,,dju Phone 4'3y - - 9//9
Address Sio 6Avo i'el1 7:; - v -4 e. ; 5,4;6 /ao
c r�of fcsv jl� v,4 Z19o/
Location Information
Tax Map No. /iv ee u / poi ./ "X" Property address
GPIN No.
Directions Ensl�, o� £, Jc. 72r Subdivision /YI,o,•f•r, f S►sd /er'
• 9 .4.4 A tl, o "mac 7L 7 Section Block
Lot 7 �p,,,a,I „X
General Information
System Type Number of bedrooms 3Y
(e.g. septic tank, drainfield) Daily flow Ora (gpd)
Type of property /2„
(e.g. commercial, residential, etc.)
Conditions
Sewer Line / Septic Tank — Inlet /Outlet Structure
Schedule 40 PVC, 4" V or equivalent Capacity: gallons
(add check or describe equivalent below) 2 septic tank gallons
Per the 2000 Sewage Handling & Disposal
Regulations, Check which option chosen:
Septic tank with inspection port .ice
• Septic rank with effluent filter _
Reduced maintenance septic tank
Conveyance line /force main Information Distribution box Information
Method No. of boxes /
(e.g. gravity, pu,hping, dosing siphon) No. of outlets
If pumping, attach Pump Spec Sheet Surge or splitter box required:
Material 5ckd L� Yes _ No ,,f`
Pipe diameter (1"
Slope of pipe't/" I t o " „..t o ' (in inches)
Header line Information Percolation line Information /Absorption
Area
1500 pound crush strength Yes Center to center spacing 1.S" ft.
Minimum slope is 27/100 ft. Yes t Required spacing 1.S ft.
Installation depth 3 inches
Aggregate depth G inches of sjrf�,
No. of Laterals 3 Lateral length $0 ft.
Lateral bottom slope 0 inches
Lateral width 1.5 inches
OSE Date O // /La/3
OSE Fonn .1 Revised /2/2009
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