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Home My WebLink AboutCLE201300126 Legacy Document 2013-09-26AD---Qro-ve-u Application for Zoning Clearance,'` I"0 " 12( Date CLE # �. •� � Illi'iV 11` Zoning Official OFFICE tI E 0 � PLEASE REVIEW ALL 3 SHE' ETS Check # JC> Date: W "i - Other• Official Receipt # q 16 PL,6, Staff: PARCEL INFORMATION Tax Map and Parcel; �' �`l ° ° vo Mme° °gyp �o Existing Zoning -1r Aot -- � y old DO^ UO --0,L OO Parcel Owner; iTe—Vc-e' Pnrect Address; _43A (1:1 4- ` S12 z I_W� 0r-1- ity ov v - , State ` hk Zip zR (include suite or floor) PRIMARY CONTACT t Who should lve call/write concerning this project?o��e,�� 1rp�h `5�ictJVv1�' Address:_ -_L�* ci" 52� City C)-&VV-V0--- A4tate -JA Zip 2+Z Office Phone; Cell # r t,:;�Fnx # E -mnil rn. APPLICANT INFORMATION Cheep any that apply;_ Change of ownership Change of use Change of name _g_Ne►v business 'Business Namei' ypet . cA ,�t sS Previous Business on this site Describe the proposed business Including use, number of employees, number of shifts, available parking spaces, number of vehicles, and any additional information that you can provide; _ 1;2 . v,, c_ ( e_ *This Clearance will only be valid on Clearance will be required. I hereby certify that is true and accurate to Signature approved, or move the use to anew location, a new owner's permis ion to use the space indicated on this application. I also certify that the information provided no vi e. I ve cad the conditions of approval, and I understand them, and that I will abide by them, Printed_ APPROVAL 17,ORMATIONJ j ] Approved as proposed [ ] Approved with conditions [ ) Denied j ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977.4511, xl l7. { ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan, [ ] This site complies with the site plan as of this date. Building Official Date ` Zoning Official Date Zv Other• Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice; (434) 296 -5832 Fax; (434) 972 -4126 Revised 7/112011 Page 2 of `I Intake to complete the following: Y Is us m LI, HI orPDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet, � N Ill there be food preparation? If so, give applicant aHealth Department form, Zoning review can not begin until we receive approval from Health Dept. FAX DATE Reviewer to complete the folio'sving: Square footage of Use: _ / A36• IN ermitted as: _ C,146s Under Section: Supplementary regulations section: Circle the one that applies Parking formula: Is parcel on private well public wat •2 If private well, provide ea De ent form. Zoning review can not b gin until we receive approval from Health Required spaces: j l / Dept, FAX DATE �� CE o fbVJ Y Circle the one that a rp-a s Item o be verified in the field: Is parcel on septic o lic sewer YIN Will you be putting new sign of any kind? If so, obtain proper Sign permit, p Permit # Ins octor ; Date: Y / N Notes; Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # to complete the fo Y /� If so, Vann ce; . YIP) If so, :st: Clearances: 4 SDI"s Revised 7/1/2011 Page 3 of t i e o •j.'L . tom•. � T • lO , z h� rn , p jt#" iM N p g$ 3 "i �7 Fi "dS 0�Q�.' gg � SOCr:,�:, m <tt Z fC„�i ij .� " n e w, z i o10W HIS c n Y 4u� h Y 4u� r z o> pp p 4 �: �� U711 tUry 6J. i g@ � 3 d ns h OT O r co 't ems- S i COMMONWEALTH of VI RC-j NI In Cooperation with [tie T1toiYYli JdAt!,voii MwlflY liistriet State Department of Hoatth 1138 Rose Hill Drive Phone (434) 972.6219 P. O: Box 7546 Fax (434) 972 -4310 CharlottesvUle, Virginia 22906 PE Sewage Disposal System Construction Permit Letter (COV 32.1- 163.6) September 20, 2013 Jeffries II, Inc. P: 0. Box 910 Crozet, VA.22932 RE: Tax Map: 55B -1 HDIM '101 -13 -0370 Dear Jeffries fl, inc.: ALBEtMRLE- CH:AHLO'I "TESVILLE FLUVANNA COUN'T'Y (PALN RA) GRL-'ENE COUNTY (STANARDSVILLE) LOUISA COUN'rY(LOUISA) NELSON GOUNTY (LOVINGSTON) This letter and the attached drawings, specifications and Calculations dated September 18, 2013 constitute.your permit to install a:sewage disposal system on the property referenced above: This approval is based upon the previously approved plans and specifications from ap prove d..permit.101 -11= 0232 dated July 6, 2011. Your application for permit was submitted pursuant to §32.1 -163.6 of the Code of Virginia, .which requires the Virginia Department of Health ,(VD:H) to,accept designs for onsite sewage systems frorn individuals licensed as Professional Engineers (PEs). This law,allows PEs to design onsite.sewage systems that do not fully comply with the Sewage Handling and Disposal Regulations (12 VAC 5= 610 -10 et seq.;) and requires VDH to accept such designs provided they comply with standard ,engineering ipractices, performance requirements.set by the Board of,Health; and certain horizontal setback requirements :necessaryto.protect public health andthe environment. VDH hereby recognizes that ;the design submitted by Michael Craun, P.E. complies with the requirements of the Code' of Virginia and the Regulations for Alternative 0nsite Sewage Systems and grants permission to install the system as designed in the area shown on the attached plans and specifications. If modifications or revisions are necessary between now and when the system is constructed, please contact .the .PE who designed the system upon which this permit is based.. Should revisions be necessary during construction, your contractor should consult with the PE. The PE is authorized to make minor adjustments in the location or design of the system provided that adequate clocurnentation is provided. 'to the Albemarle County Health Department. The PE that submitted the design for this permit is required by the Sewage Handling acid Disposal Regulations to conduct a final inspection of'this sewage system when it is installed and to submit an inspection report:and completion statement to the Albemarle County Health Department. The health department is not required to inspect the installation, but may do so at its sole discretion. The sewage system may not be placed into operation until you have obtained an Operation Permit from the Albemarle County Health Department: If your PE did not submit an Operation and Maintenance Manual for review and approval with the plan package, then (s)he will be required to do so prior to issuance of an Operation Permit. This Construction Permit is null and void if site and soil conditions are changed from those shown on your application or if conditions are changed from those shown on the attached plans and specifications. VDH may revoke or modify any pert-nit if, at a later date, it finds that the system would threaten pub.lic health or the environment. This permit approval has been issued in accordance with applicable regulations based on the information and materials provided at the time of application. There may other local, state, or federal laws or regulations that apply to the proposed. construction of this onsite sewage system. The owner is responsible at all times for complying with all applicable local, state, and federal laws and regulations. If you have any questions, please contact me.. This permit expires on March 22, 2015. This permit is not transferable to another owner or location. Sincerely, Josh Kiirtley Environmental Health Technical Specialist Cc: Michael Craun, P:E. Tax Map /GPIN #: 558 -1 HDID# 101 -13 -0370 WHAT YOU WILL NEED TO GET YOUR SEPTIC SYSTEM OPERATION PERMIT 0 Your systern must have a satisfactory inspection at the time.of installation. This will be done by the designer of your permitted system, a private OSE or PE. Your OSE or PE must submit a copy of the inspection results, complete with an as -built diagram, to the Health Department. 0 Please ensure that your contractor turns in a. Completion Statement to the local Health Department after installation. 0 Should you choose to reduce the size of your installed system using an approved substituted system product, a signed Notice of Substitution must be received by the local Health Department. 0 If your permit is for an alternative system, you must sign, have notarized; and record the attached Notice of Recordation in your locality's land records. Please .bring proof of this recordation to the local Health Department. If you have a conditional permit then you must sign, have notarized, and record the permit in your locality's land records. Please bring proof of this recordation to the Health Department. IF YOUR :PERMIT IS FOR BOTH A SEPTIC SYSTEM AND WEi L YOU WILL ALSO NEED • Your well must have satisfactory inspection results after installation. Please give the..Health Department several days notice to schedule this = inspection .beforeyo.ur:Operation Permit will be requested. 0 The Health :Department must. receive a copy of your water sample test result being negative/satisfactory for coliform bacteria. You are responsible for performing this.testand ensuring the results are received at the Health Department Please ensure that your Well Driller - submits a Uniform Water Well Completion Statement or GW -2 to the Health Department, including documentation of a proper well abandonment if required.by permit Allow 5 business days after the last piece of documentation is received for the Operation Permit to be issued. To avoid delays, clearly label each piece of documentation with the property Tax Map number, and HOD number shown above and on your construction permit, Please note that due to the. individual circumstances of your permit.there.may be additional required items not:covered by this - checklist. If you have any questions about any of the items on this list, please do not hesitate to contact the Albemarle, County Health Department at (434) 972 - 62.19.