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HomeMy WebLinkAboutSDP201600012 Calculations 2016-02-24 %.r+ 41,4010 Page 1 of 11 :t, OSE/PE Report For: Construction E Repair Voluntary Upgrade Certification — Subdivision Permit J Permit Permit Letter Approval Property Location: 911 Address: 2300 Hunters Way City: Charlottesville Lot 1 Section Subdivision Hunters Hall GPIN or Tax Map# TM 78-49A Health Dept ID# Latitude Longitude Applicant or Client Mailing Address: Name: Heatrock Farm LLC Street: 2521 Summit Ridge Trail City: Charlottesville State VA Zip Code 22911 Prepared by: OSE Name Steve Gooch License 41940000278 Address 703 Oliver Creek Road City Troy State VA zip code22974 PE Name Michael F Craun License # 036859 Address 2036 Forest Drive City Waynesboro State VA Zip Code 22980 Date of Report 2/24/16 Date of Revision#1 OSE/PE Job# Date of Revisio Contents/Index of this report(e.g.,Site Evaluation Summary,Soil Profile Descriptions,Site.' ley\ Q F 111 see table of contents on next page �,� l. '. } 7 O&M Manual - Separate z •4 i.•' r' Plans - 11"x17" - Separate - 9 Pages �` ex,:' *. ( C- o'l)(193 j z Certification Statement 0 �`G J y1/4/�u V I hereby certify that the evaluations and/or designs contained herein were conducted in accordar i the Sewage Handling and Disposal Regulations(12 VACS-610),the Private Well Regulations(12 Vs ,.Ait Q'' Alternative Onsite Sewage Systems(12VAC5-613)and all other applicable laws,regulations and p OFFSSION Department of Health. I further certify that I currently possess any professional license required t Commonwealth that have been duly i ed by the applicable agency charged with licensure to pc The work attached to thi-cite/page has been conducted under an exemption to the practice of engineering,specifically the exemption in Code •f V r nia Section 54.1-402.A.11 I recommend that a(select •fie) • truction permit 0 certification letter 0 subdivision approval ID be(select one) Issued l - it permit 0 voluntary upgrade 0 Denied 0 OSE/PE Signature Date 2'/1'ib This form contains personal information subject to disclosure under the Freedom of Information Act Ravicprl 11/timid Table of Content v Page Z of I I Cover page/Certification Statement 1 Table of Contents 2 Application Page 3 AOSE Soil Report(Steve Gooch) 4-6 KSAT Tests 7-9 Supplemental Design Calculations 10-15 Drainfield Design Calculations 16 System Specification 17 Well Specifications 18 Well Abandonment Specifications 19 O&M Manual Appendix • Old Dominion Engineering Commonwealth of Virginia VDHUseonly Health Department ID# Application for: ❑r Sewage System ETWater Supply Due Date Owner Heatrock Farm LLC Phone 434-409-4308 Mailing Address 2521 Summit Ridge Trail Charlottesville, Virginia, 22911 Phone Fax Agent Kevin Schuyler Phone 434-295-4572 Mailing Address 675 Peter Jefferson Parkway,Suite 160Charlottesville,VA 22911 Phone 4344094308 Fax Site Address 2300 Hunters Way Charlottesville, Virginia, 22911 Email Kschuyler@cstonellc.com Directions to Property: Take 164 East. Take exit 124(Rt 250 East). Take a left on Hunters Way. Property on the left. Subdivision Hunters Hall Section Block Lot 1 Tax Map TM 78-49A Other Property Identification Dimension/Acreage of Property 1.46 Sewage System Type of Approval: Applicants for new construction are advised to apply for a certification letter to determine if land is suitable for a sewage system and to apply for a construction permit(valid for 18 months)only when ready to build. OCertification Letter Q Construction Permit D Voluntary Upgrade ❑Repair Permit Proposed Use: Single Family Home(Number of Bedrooms ) Multi-Family Dwelling(Total Number of Bedrooms Other(describe) Garage - 584 GPD Permit Basement?❑YespNo Walk-out Basement?❑Yes[]No Fixtures in Basement❑Yesto Conditional permit desired?Dyespo If yes, which conditions do you want? ❑Reduced water flow ❑Limited Occupancy ❑Intermittent or seasonal use ❑Temporary use not to exceed 1 year Do you wish to apply for a betterment loan eligibility letter' YesONo *There is a$50 fee for determination of eligibility. Water Supply Will the water supply be❑Public or1:1Private? Is the water supply❑Existing orE Proposed? If proposed,is this a replacement well?[JYes:No If yes, will the old well be abandoned?EYes ONo Will any buildings within 50' of the proposed well be termite treated?Dyes I1No All Applicants Is this a private sector OSE/PE application?['Yes❑No If yes, is the OSE/PE package attached? E1Yes❑No Is this property indeed to serve as your(owners)principal place of residence?EYes❑No In order for VDH to process your application for a sewage system you must attached a plat of the property and a site sketch. For water supplies,a plat of the property is recommended and a site sketch is required. The site sketch should show your property lines,actual and/or proposed buildings and the-desired location of your well and/or sewage system. When the site evaluation is conducted the property lines, building location and the proposed well and sewage sites must be clearly marked and the property sufficiently visible to see the topography. I give permission to the Virginia Department of Health 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 a private sector Onsite Soil Evaluator or Professional Engineer as necessary until the sewage disposal system and/or private water supply has been constructed and approved. Signature of Owner/Agent Date This form contains personal information subject to disclosure under the Freedom of information Act. Revised 12/l'2014 Soil Information Summary Page -1 of 11 Project: TM 78-49A Drainfield Area: Primary and Reserve Area 1. Position in landscape satisfactory? Yes 17,1 No r1 Describe: Shoulder to Side Slope 2. Slope: 12% 3. Depth to Rock or impervious strata: Max. 156+ Min. 156'4 4. Depth to seasonal water table(gray mottling or gray color): No Yes Li Inches 5. Free water present: No 7 Yes [ _i range in inches Yes Pi Texture Group 1 Li II IXC III Vi IV j 6. Soil percolation rate estimated? No Li Estimated rate min/inch 55 @'118"to 144" 7. Permeability test performed Yes `< No E If yes,note type of test performed and attach KSAT see attached Pad to be placed at 118"to 144"depth at site designated on permit X Site Approved Site Disapproved Reason for Rejection 1. [_1 Position in landscape subject to flooding.or periodic saturation 2. ( _1 Insufficient depth of suitable soil over hard rock 3. 11 Insufficient depth of suitable soil to seasonal water table 4. Uj! Rates of absorption too slow. 5. Insufficient area of acceptable soil for required drainfield, and or reserve area 6. 1 1 Proposed system too close to well 7. 7 Other Specify Od Dominion Engineering *411004Soil Profile 2300 Hunters Way Albemarle County Hole Depth Horizon Material Description Soil Texture (in.) Group 1 0-3 A Weak red(1 OR 4/2) clay loam, friable 3 3-30 Bt Dark red (1 OR 3/6) silty clay, firm 4 30-84 Bt2 Red (10R 5/8) silty clay loam, firm 3 84-98 Cl Reddish yellow (5YR 6/8) clay loam, firm 3 98-156 C2 Olive yellow(5YR 6/6) silt loam, friable, 10-20% 3 greenstone fragments 2 0-2 A Weak red (10R 4/2) clay loam, friable 3 2-30 Bt Red (10R 5/8) silty clay loam, firm 3 30-90 CB Yellow(10YR 7/8), red (IOR 5/8) silty clay loam, firm 3 w/white (10YR 8/1) feldspar, 90-156 C Brownish yellow(10YR 6/8) clay loam, slightly moist, 3 w-/manganese coatings on joint surfaces, white (10YR 8/1) feldspar 3 0-4 A Weak red (1OR 4/2) clay loam, friable 3 4-24 Bt Dark red (10R 3/6) silty clay, firm 4 24-94 Bt2 Red (10R 5/8) silty clay loam, firm 3 94-1 14 Cl Yellowish red(5YR 5/8)clay loam, friable 3 114-156 C2 Yellow (10YR 7/8) clay loam, friable 3 0-5 A Weak red (1 OR 4/2) clay loam, friable 3 5-83 Bt Red (10R 4/8) silty clay, firm 4 83-98 Bt2 Light red (2.5YR 6/8) silty clay loam, firm 3 98-156 C Yellowish red (5YR 5/6) clay loam, friable 3 0-2 A Weak red (10R 4/2) clay loam, friable 3 2-70 Bt Red (10R 5/8) silty clay loam, firm 3 70-105 BC Red (1OR 5/8) silty clay loam, firm w/yellow(10YR 7/8) 3 loam 105-156 C Yellow (10YR 7/8) loam. friable 2 156- Cr 6 1 0-2 A Weak red (IOR 4/2) clay loam, friable 3 2-73 Bt Red (IOR 5/8) silty clay loam, firm 3 73-96 BC Red (IOR 5/8) silty clay loam, firm w/yellow (10YR 7/8) 3 loam 96-156 C Yellowish red (5YR 5/8), yellow (IOYR 7/8) loam, friable 2 1 Soil Profile 2300 Hunters Way Albemarle County Hole Depth Horizon Material Description Soil Texture (in.) D 0-2 A Weak red (10R 4/2) clay loam, friable 3 2-77 Bt Red (l OR 5/8) silty clay loam, firm 3 77-90 Bt2 Light red (2.5YR 6/8). yellowish red (5YR 5/8) silty clay 3 loam, firm 90-136 Cl Yellowish red (5YR 5/8) clay loam, friable, manganese 3 coatings on joint surfaces 136-156 C2 Yellow (10YR 7/8) loam, friable 2 8 0-42 Bt Red(IOR 5/8) silty clay loam, firm 3 42-94 Cl Yellowish red(5YR 5/8) clay loam, slightly moist, friable 3 manganese coatings on joint surfaces 94-120 C2 Olive yellow(5Y 6/6) clay loam, friable, manganese 3 coatings on joint surfaces 120- Cr 9 0-6 A Weak red (10R 4/2) clay loam, friable 3 6-90 Bt Dark red (1 OR 3/6) silty clay, firm 4 90-120 13t2 Light red (2.5YR 6/8) silty clay loam, firm 3 120 129 BC Red (2.5YR 5/8), yellow(10YR 7/8) clay loam, friable 3 w!greenstone fragments 129- Cr a s � . �S.d c LE-I)G 12 t� De tt, U V°(PS S1+°w�J OA) LN6� P1-4" low, van. __ 1.0 d' V' M a' M C • N c > O O O O O O O 0 • O *0 O (1)j '�- 1 r — > a O 1`� co Q1 h- co ,--p O i- co Cp N t` 0 z L N N N t- N r r CC _ C .0 0 O O O O O O am m O q.) 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'y o E o o Q 'O 2 �, N A m �p x CO z ° 0 0 to � E g c, a) c) c) rs) O o Cb C U) C C C > an d a +. ymOmmO m d > z F- to 1'_ q I Page 10 of I Supplemental Calculations Project Description The site currently has two model homes with a public well and small conventional septic system (rated at 100 gpd). The model homes are not currently being used (and no plans exist to use them as they are in very poor shape). The owner is going to build a small auto repair garage. (6 bays). The owner will eventually tear down the model homes and replace them with warehouse units with limited office space and other low water usage tenants. The public well will be abandoned and replaced with a IIIB well built to IIB standards. This permit is for a new well and septic system to serve the new garage and the abandonment of the existing well. Extra capacity is provided in the treatment and dispersal systems to handle expansion at the site for the phase 2 expansion. The phase 2 building will have its own dedicated septic tank and pre treatment flow equalization pump tank. A separate VDH permit will be obtained for phase 2. Wastewater Characterization Basic Auto Repair Garage Usage Data: • 6 bays at .5 cars per hour for 8 hours per day = 24 cars per day • 6 days per week @ 24 cars per day = 144 cars per week • 6 employees per day (Monday through Saturday) Water Usage and Wastewater Strength Basis•2300 Hunters Way Auto Repair Water Usage BODlTSS Usage Rates Water Usage Estimate Basis Strength BOD/TSS Strength Basis (gpd/unit) ('nglt) USEPA Onsite Wastewater Treatment Systems Manual Table Per 4 x 12VAC 5-810.670 BOD 6/Day converted to Vehicles Served B 3-4,Auto Service Station-(range 8-15 gal per vehicle 120 concentration-service station servedcustomer) USEPA Onsite Wastewater Treatment Systems Manual Table Per 12VAC 5.610-670 BOD ft/Day converted to Employees 13 3-4,Auto Service Station Employees-(range 9-15 typical 13 240 concentration-Office Employee gpd/per employee per day) ) ) pr Now' NNW Page i t of (9 Peak Daily Water Usage and Wastewater Strength Estimate 2300 Hunters Way Auto Repair E21 m a� as 0 'o E a in _ N 0 p t w m J 0 c c 'CS O Water Usage Activity o °= 0 a u m v R a `0 E am v .0 gi 's a> E o a E 3 _N o Z = f.- . �— W m Vehicles Served 24 8 192 120 0.2 Employees 6 13 78 240 0.2 Total 270 154 0.3 Peak Weekly Water Usage and Wastewater Strength Estimate 2300 Hunters Way Auto Repair Na7 a) a) 0 v C y N0 p 00 NCO J0 0 C 0 13 CI Water Usage Activity a ro P u m .0 �E _g 3 a E — _on E m if) Q Z = 0 W m Vehicles Served 144 8 1152 120 1.1 Employees 36 13 468 240 0.9 Total 1620 154 2.1 Equalized over 7 Days 231 154 0.30 The treatment unit and dispersal area are designed for the ultimate capacity of 584 gpd. The peak daily flow of 270 gpd will be used to size the septic and pump tanks service the Garage. Flow equalization being utilized prior to treatment will keep the average daily flow to the treatment system and dispersal area <270 gpd until the warehouse buildings are built. 4 Page I of 19 Design Criteria Peak Daily Water Usage at Garage - 270 GPD Average Daily Peak Week Water Usage - 231 gpd Garage - BOD/TSS Weekly Average - 154 mg/I Treatment Design - 584 GPD Dispersal Design - 584 gpd Final Development - BOD/TSS Weekly Average - 240 mg/I Septic Tank Peak Daily Flow= 270 GPD Septic Tank Size = 1500 gallon Detention Time = 1500 gallon _ 270 gpd = 5.6 days Total Nitrogen Removal Calculation (per GMP 156) 5 KG TN Approved Proprietary TN Treatment Technology - 50% 2.5 KG TN Pad Dispersal - 20% 2.0 TN (4-2.0)/4) x 100= 50% OK Pump Tank Pump Tank= 1500 gallon Liquid Depth = 56" 26.13 gallons per inch Minimum Liquid Level = 16" Timer on Float= 23" Required storage above alarm float 6 hr x 1 d/24 hr x 270 GPD = 67.5 gallons = 2.6" Set alarm float 4" below invert of pipe (104.5 gallons) Set override timer 6" below alarm float (156.8 gallons) Required flow equalization = 18 hrs x ld/24hr x 270 GPD = 202.5 gallons= 7.75" Actual flow equalization= 52"—23"=29" = 758 gallons one dose per 2 hours = 12 doses per day 231 gpd÷ 12 doses per day= 19.25 gal per dose @ 12 gpm = 1.6 min per dose 1:36 min on 1:58 hr off 270 gpd _ 12 doses per day= 22.5 gal per dose @ 12 gpm = 1.875 min per dose 1:53 min on 1:58 hr off 1/01 Page f 3 of (C1 Pump Size Calculation Job Description: TM 78-49A Pump: STEP Flow Equalization Pump Prepared by: MFC Date: 2/24/2016 Worksheet-Pump Sizing A) Desired Pump Capacity 12.00 gpm B) Pipe size 1.25 inch C) Pressure loss in 100 ft. of pipe 0.91 psi D) Friction head in 100 ft. of pipe 2.10 ft. E) Static head i) Height from pump to tank outlet 6 ft. ii) Elevation increase or decrease 23 ft. F) Total static head 29 fl. G) Friction head i) Equivalent length of fittings 125 ft. ii) Distance from pump to outlet 225 ft. iii) Total equivalent length of pipe 350 ft. iv) Total effective feet 7.35735 ft. vi) Headloss through Water Meter 0 ft. 0 psi vii)Headloss through Zone Valve 1 0 ft. 0 psi viii Head at PM 0 ft. 0 psi H) Total friction Head 7.35735 1) Total dynamic head 36.36 ft. J) Minimum pump capacity 12.00 gpm K) Estimated Velocity 4.01 fps L) Choose the pump Orenco PF 10051 1 (12 gpm @ 140') 4 4 PF Series High-head Effluent Pumps (continued) • Using a Pump Curve A pump curve helps you determine the best pump for your system. Pump curves show the relationship between flow(gpm or L/sec) and pressure(total dynamic head,or TOR), providing a graphical representation of a pump's optimal performance range..Pumps perform best at their nominal flow rate—the value, measured in gpm, expressed by the first two numerals in an Orenco pump nomenclature.At low flow rates,TDH varies from pump to pump,so it is represented as a dashed line in the pump curves. For most accurate pump specification, use Orenco's PumpSelectr"software. 60 Hz Models 800 400 , PF10 Series,60 Hz,0.5-2.0 hp , PF20 Series,60 Hz,0.5-1.5 hp PF1020 700 350 1PF2015 1 c 600 ,� 300 IIPF2010 500 250 ......... w 400 PF1010_-- --- --- en 200 -c .c PF2005i cn 300 PF1007- 150 PF100 :,,, > 'C 200 — 100 Is Li 100 -------- w/IA.,flow - 50 controller __. 0 ' 0 2 4 6 8 10 12 14 16 0 5 10 15 20 25 30 35 40 Flow in gallons per minute (gpm) Flow in gallons per minute(gpm) 900 450 PF3050 PF30 Series,60 Hz,0.5-5.0 hp PF5050 I PF50 Series,60 Hz,0.5-5.0 hp 800 - ! -- 400 m w °' 350 C 700 — — _�__�— --__ 6000 300 PF30301 i.--- 500 .:..... . zt 250 -- --- w a, ra 400 PF3020 — 200 ~` E PF5015 150 ,. C 300 -•-•— 5 _ 'a PF3010 'a PF5010I 200 100 .,..` 1 IQ PF3007 F� PF5007 100 -PF3005 50 '13F50 --------------------________ 00 5 10 15 20 25 30 35 40 45 00 10 20 30 40 50 60 70 80 90 Flow in gallons per minute (gpm) Flow in gallons per minute (gpm) NTD•PU-PF-1 ©2009 Orenco Systems'Inc. Rev.1.8,©12/09 Page 4 of 6 NIS +trod' Page 1S— of 19 Vegetative Recirculating Gravel Filter Media - Gravel VDOT washed 78 and VDOT 5 Active Media Depth - 24" Size - 18'x18' = 324 ft-' Hydraulic Loading Rate- 584 gpd± 324 ft2 = 1.80 gpd/sqft (<15 gpd/ft2 OK) Biological Loading Rate- 1.17 lbs per day _ 324 ft2 = 3.6 lbs/1000ft2/day (<15 Ibs/1000ft2/day OK) Recirculation Ratio - 6 Dose Volume - 4088 gpd Doses per Day - 48 Number of Laterals = 9 Holes per lateral = 9 Diameter of Holes = 1/8" Residual Head (design) = 2.5' Flow per l0 laterals =Q= 81 x 12.38 x (l/8)2 x (2.5)*' = 25 gpm TDH = hs+ hhv + h1+hdti, + hr hs = static head hh,, = minor loss through pump discharge hi= loss through transport pipe hd,, = loss through distributing valve hr=residual head .000995LQ'85 TDHdesig, =hs +.002Q2 + D $7 +h,,,, + h,, TDHdesign =8+.002(25)- 000995(40')(25)185 +0+ 2.5' 1.36 4.87 TDH des;g„ = 15.2 Pump Requires = 25 gpm @ 15.2' - Orenco PF200511 - 25 gpm @ 70' Set residual Head to 2.5' Timer Settings (design) 85.17 gallons + 6.9 gallons (pipe fill volume). @ 25 gpm = 3.41 minutes on (.28 min fill) - 26.59 min off Dosing depth in VRGF 85.17 gallons per dose x 12"/1' x .1337 ft3/gal / 324 sqft = .42" ponding depth Effluent Quality TL3 Abbreviated Design Form Page Ito of N Project: TM 78-49A Drainfield Area: Primary and Reserve Conveyance Method: Gravity Distribution Method: Pad Effluent Quality: TL3 Design Basis A. Estimated Percolation Rate 55 @ 118" to 144" Pad Bottom Area .5899 • B. - Basis TL 3 Pad - .61 gpd/sqft C. Water Usage (GPD) 584 Area Calculations Length of Pad (ft.) 55' D. Length Available (ft.) 55' E. Width of Pad (ft.) 18' F. Number of Pads 1 G. Center to Center Spacing(ft.) NA Width Required (ft.) 18' H. Width of Available Area (ft.) 40' I. Total Square Footage Required (sqft) 957.4 J. Square Footage in Design (sqft) 990 Reserve Requirement (%) 100 K. 100% Reserve drainfield area available in area surveyed Notes: Reduction allowed in area with substituted system L-1 Yes 1>1 No LGMI Required 1_ Yes [2\I No NO SUBSTITUTED SYSTEMS ALLOWED KSAT equivalent rate of 11.3 cm/day— 35-40 mpi Old Dominion Engineering . 41001 Page (3- of�y System Specifications VDH Use Only HDIN: Application Information Name: Heatrock Farm LLC Address: 2521 Summit Ridge Trail Charlottesville,Virginia,22911 Phone: 434-409-4308 Location Information Tax Map/GPIN #: 1-1'11 78-49A+ Property Address: 2300 Hunters Way Charlottesville,Virginia,22911 Subdivision: Hunters Hall Section: Block: Lot: 1 Directions: Take 164 East. Take exit 124(Rt 250 East). Take a left on Hunters Way. Properly on the lett. General Information Property Type (e.g. residential): commercial Number of Bedrooms: N/A Daily Flow: 584 gpd Conditions: none Notes: Sewer Line Diameter: 4 in. Material: SCH 40 PVC (or equivalent)Notes: Pretreatment Unit(s) Treatment Level: TL3 Septic Tank Capacity: 1500 gallons Number of Septic Tanks 1 Size of Septic Tank(s) 1500 gallons Per the Sewage Handling and Disposal Regulations, check which option(s) chosen: D Septic tank with inspection port B Septic tank with effluent filter 0 Reduced maintenance septic tank Secondary treatment device(s), if applicable: Vegetative Recirculating Gravel Filler Notes: see supplemental calculations Conveyance Line Distribution Method and Header Lines Conveyance Method: pump to gravity Distribution Method: pump to gravity If pumping, include pump specifications sheet. No. of boxes: 1 No. of outlets: 12 Material: SCH 40 PVC Diameter: 1.25' Surge or splitter box required: O Yes ® No Notes: see supplemental calculations Header Line Material: 4•PVC Percolation Lines/Absorption Area Dispersal Method (e.g. laterals, pad, mound): pad If using pressure dispersal (e.g. drip), include pressure dispersal specifications sheet. No. of laterals/pads: 1 , Length of lateral(s)/pad(s): 55 ft. Width of lateral(s)/pad(s): 18 feel in. Center to center spacing: N/A ft. Installation depth: 118'-144' in. Aggregate depth: t3 in. Size/Type of Aggregate: 1'2"to 3/4"diameter Aggregate per VDH SHDR 2000 Lateral/pad slope: 1-2 in. per 50 ft. Reserve Area Provided: 100 % Notes:NO EZFLOW SUBSTITUTION ALLOWED Please Note: see supplemental calculations and design This form contains personal information subject to disclosure under the Freedom of Information Act. Revised 1211/2014 Page ISof ( 1 Well Specifications VDH Use Only HDIN: Applicant Information Name: Heatrock Farm LLC Address:2521 Summit Ridge Trail Charlottesville.Virginia,22911 Phone: 434-409-4308 Location Information Tax Map/GPIN#: TM 78-49A Property Address: 2300 Hunters Way Charlottesville,Virginia,22911 Subdivision: Hunters Hall Section: Block: Lot: 1 Directions: Take 164 East. Take exit 124(Rt 250 East). Take a left on Hunters Way. Property on the left. General Information Well Purpose (select all that apply): B Domestic Drinking Water 0 Agricultural 0 Irrigation 0 Industrial/Commercial 0 Geothermal Well Class: IIIB(built to IIB Standards) Minimum Casing Depth: 50 ft. Estimated Water Usage: 584 GPD Minimum Grout Depth: 50 ft. Horizontal Setbacks Distance from Building Sewer: 54 ft. Distance from Pretreatment Unit(s): 1fi0 ft. Distance from Conveyance System: 135 ft. Distance from Absorption Area: 96 ft. Distance from Property Line: 34 ft. Distance from foundations: 22 ft. Distance from other source(s) of contamination: N/A ft. List other source(s): Note: This well is going to be permitted to IIIB Standards however all construction of the well will be to IIB Standards. Sampling and wet yield testing will be done at a later time if the well will need to be upgraded. Existing well shall be abandoned This form contains personal information subject to disclosure under the Freedom of information Act. Revised 12,172014 kW° 440410 Page N of N Well Abandonment Specifications VDH Use Only HDIN: Applicant Information Name: Heatrock Farm LLC Address:2521 Summit Ridge Trail Charlottesville,Virginia,22911 Phone: 434-409-4308 Location Information Tax Map/GPIN#: TM 78-49A Property Address: 2300 Hunters Way Charlottesville,Virginia,22911 Subdivision: Hunters Hall Section: Block: Lot: 1 Directions: Take 164 East. Take exit 124 (Rt 250 East). Take a left on Hunters Way. Property on the left. Abandonment Information Current Well Purpose(select all that apply): 0 Domestic Drinking Water 0 Agricultural ❑ Irrigation e Industrial/Commercial 0 Geothermal Well Class: IIB Total Depth of Well: 275 ft. Static Water Level: Method of abandonment: Permanent Type of Fill Material: N/A Depth of Fill Material: From to ft. From to ft. Type of Grout: cement grout or dry clay compacted in place Depth of Grout: From 0 to 275 ft. From to ft. Method of permanently marking location: Additional abandonment criteria: Well shall be chlorinated prior to plugging Horizontal Setbacks Following Abandonment Distance from Building Sewer: 29 ft. Distance from Pretreatment Unit(s): 94 ft. Distance from Conveyance System: 70 ft. Distance from Absorption Area: 26 ft. Distance from Property Line: 56 ft. Distance from foundations: 0 ft. Distance from other source(s)of contamination: N/A ft. List other source(s): Note: Abandon per VDH Waterworks Regulations - 12 VAC 5-590-840 section 14 This was a public water supply source This form contains personal information subject to disclosure under the Freedom of Information Act. Revised 9:24'2014