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HomeMy WebLinkAboutSUB201700045 Approval - Agencies 2017-05-16 kftv '4k It 1 COMMONWEALTH of VIRGINIA In Cooperation with the Thomas Jefferson Health District ALBEMARLE-CHARLOTTESVILLE State Department of Health FLUVANNA COUNTY(PALMYRA) 1138 Rose Hill Drive GREENE COUNTY(STANARDSVILLE) LOUISA COUNTY(LOUISA) Phone(434)972-6219 P. O. Box 7546 NELSON COUNTY(LOVINGSTON) Fax (434)972-4310 Charlottesville, Virginia 22906 May 16,2017 Christopher P.Perez County of Albemarle au u' WDYED Deartment of Community Development 401 McIntire Road Charlottesville,Virginia 22902-4596 RE: Review of Proposed Subdivision Plat and attached Soils Information for Individual Onsite Sewage Systems as part of a division of Tax Map 110-15A located in Albemarle County, Virginia. Dear Mr.Perez: On March 31,2017,the County of Albemarle requested the Virginia Department of Health(via the Albemarle County Health Department)review the proposed subdivision plat identified above.This letter is to inform you that the above referenced subdivision plat is approved for individual Onsite Sewage Systems in accordance with the provisions of the Code of Virginia,the Sewage Handling and Disposal Regulations, and local ordinances. This request for subdivision review was submitted pursuant to the provisions of§ 32.1-163.5 of the Code of Virginia which requires the Health Department to accept private soil evaluations and designs from an Authorized Onsite Soil Evaluator(AOSE)or a Professional Engineer working in consultation with an AOSE for residential development. This subdivision was certified as being in compliance with the Board of Health's Regulations by: Roger C.Nelson OSE#1940001320. This subdivision approval is issued in reliance upon that certification. Pursuant to§360 of the Regulations this approval is not an assurance that Sewage Disposal System Construction Permits will be issued for any lot in the subdivision identified above unless that lot is specifically identified on the above referenced plat as having an approved site for an onsite sewage disposal system, and unless all conditions and circumstances are present at the time of application for a permit as are present at the time of this approval. This subdivision may contain lots that to do not have approved sites for onsite sewage systems. This subdivision approval does pertain to the requirements of local ordinances. Sincerely, Travis T.Davis,OSE Environmental Health Specialist, Sr. oy A - ©(. 11== !fD RECEIVED EnvirontremtM H a!th Services COUNTY OF ALBEMARLE APR 0 6 2017 Department Of Community Developme t 401 McIntire Road,Room 227 *TKO V iaq, Charlottesville,Virginia 22902-4596 (434)296-5832 March 31, 2017 Teresa Batten Virginia Department of Health 1138 Rose Hill Drive Charlottesville,VA 22906 RE: SUB201700045—Rebenoff Family Subdivision Dear Ms. Batten: The County of Albemarle has received application to develop/subdivide[Tax Map 11000-00-00-015A0]. This project requires Health Department approval before receiving final County approval.The applicant has provided soil information for the proposed lot: Lot Z at 2.006 acres,which is attached. Please review the proposal for suitable subsurface drainfields which comply with the provisions of Chapter 18, Sections 4.2.2,4.2.3,4.2.4, and Chapter 14,Sections 14-309 and 14-310 of the Albemarle County Code. Should you have any comments please feel free to contact me. Sincerely, Christopher P.Perez Senior Planner Department of Community Development Voice: (434)296-5832 ext. 3443 email: cperez@albemarle.org 11# Commonwealth of Virginia Health DepartmentU only Application for Subdivision Review fl1e Date (page 1 of 2 to be filled out by the Owner or Agent) Owner Richard H.Rubenoff and Lynn R.Rubenoff Phone Mailing Address 4621 APplehen'y Mountain Road Phone North Garden,Virginia 22959 Fax Developet/Agent Phone Mailing Address Phone Fax AOSE Roger C.Nelson,#1940001320 phone 434.221.9000 Mailing Address 568 Mayo Creek Lane Phone Wingina,Virginia 24599 Fax Directions to Property: 29S;L on Plank Road;Ron Appleberry Mountain Road to 4621 on L Name of Proposed Subdivision Tax Map 110-15A Other Property Identification Parcel Z Dimension/Acreage of Property 2.006 acres Number of lots proposed 1 Proposed water source(note:new or existing,public or individual)new private General size of lots (give range if appropriate) Additional description of subdivision Overview of soils and geology(optional but encouraged) dQO'. ED 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 plat 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 OSE 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 Onsite Soil Evaluator(OSE)or a Professional Engineer(PE)as necessary until the sewage disposal system has been constructed and approved. 1P...�- OPIP ..ar �(A)ieil 017 ift • t)2r (,t, )C6 246 Commonwealth of Virginia Health Use°'" Application for Subdivision Review Due Date (page 2 of 2 to be filled out by the county official requesting a VDH review) County Office initiating request Albemarle County Planning and Zoning Contact Individual Phone Local offices of the Virginia Department of Health may review subdivision applications for compliance with state rules and regulations governing sewage treatment and dispersal and private water supplies,compliance with local ordinance governing sewage treatment and dispersal and private water supplies and potentially for compliance with other local ordinances. Please indicate the nature of review you are asking the health department to conduct. 1. Review for conformance with the Sewage Handling and Disposal Regulations 2. Review for conformance with local onsite wastewater ordinances 3. Other(describe below) Name and title of requestor Date Air, Soil, &Water Environmental, LLC 568 Mayo Creek Lane.Winging.Virginia 24599 Page 3 of 6 OSE/PE Report for Construction Permit Certification Letter_Subdivision Approval_X Repair Permit`Voluntary upgrade Property Location: 911 Address:4621 Appleberry Mountain Road City:North Garden GPIN or Tax Map#: 110-15A Health Dept,ID#: Subdivision: Section: Lot:Z Applicant or Client Mailing Address: Name:Richard H. Rubenoff and Lynn R. Rubenoff Address:4621 Appleberry Mountain Road.North Garden,Virginia 22959 Agent:n/a Address:tela r;n Telephone: I V U 0"'�" OSE Name:Roger C. Nelson License#: 1940001320 Address: 568 Mayo Creek Lane City: Wingina State:Virginia Zip Code:24599 PE Name: License#: Address: City: State: Zip Code: Date of Report:28 February 2017 Date of Revision#1: OSE/PE Job#: Date of Revision#2: Contepts/[ndes of this report(e.g.,Site Evaluation Summary,Soil Profile Descriptions,Site Sketch,Abbreviated Design,etc.) Application Certification Site Evaluation,Design&Soil profile Description Survey Plat and Cover Statement Certification Statement I hereby certify that the evaluations and/or designs contained herein were conducted in accordance with the applicable provisions of the Sewage Handling and Disposal Regulations(12VAC 5-610),the Private Well Regulations(12VAC 5-630),the regulations for Alternative Onsite Sewage Systems(12VAC 5-613)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 work contained herein. x 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 54.1402.A.11 I recommend that a: Constniction Permit Certification Letter_Subdivision Approval X Repair Permit Voluntary upgrade be issued x be denied OSE Signature: 2---- Date: 2$ Zo l`] PE Signature: Date: Roger C.Nelson,Onsite Soil Evaluator#1940001320,434.221.9000 Air, Soil, & Water Environmental, LLC 568 Mayo Creek Lane,Wingina,Virginia 24599 Richard IL Rubenoff and Lynn R Rubenoff Page 4 of 6 4621 Appleberry Mountain Road T.M.#110-15A Parcel Z AlbemarleCounty,Virginia Site Evaluation: Date: 26 January 2017 Well:IIIC INEPEE] Position in landscape: shoulder Slope: 9% Texture group: III Estimated perc rate: 55 mpi Depth to seasonal water table:none Free water present:none Depth to rock: SPD 1—44" Abbreviated Design: Projected daily flow: 450 gpd(3BR) Trench bottom square feet/BR 412 sq.ft. Number of trenches: 5 EZflow trenches Width of trench: 3' Length of trench:65' Length of available area:70' Width required: 39' Width of available area: 120' Installation depth:24" Center to center spacing:9' Design square footage: 975 sq.ft. Total square footage required: 927 sq.ft. Pump required:no Reserve area required: 100%available Soil Profile Descriptions: SPD Horizon Depth(inches) Color/Texture Texture Group 1 A 0-3 7.5yr 3/2 dark brown loam Iib AB 3-6 5yr 4/3 reddish brown loam Iib B 6-39 2.5yr 4/4 reddish brown light clay loam III C 39-44 5yr 5/6 yellowish red loam Iib refusal at 44" 2 A 0-3 7.5yr 3/2 dark brown loam Iib AB 3-6 5yr 4/3 reddish brown loam Iib B 6-33 2.5yr 4/4 reddish brown light clay loam III C 33 -48 5yr 5/6 yellowish red loam Ilb 3 A 0-3 7.5w 3/2 dark brown loam IIb AB 3 -9 5yr 4/3 reddish brown loam Iib B 9-44 2.5yr 4/4 reddish brown light clay loam III C 44-48 5yr 5/6 yellowish red loam Iib Roger C.Nelson,Onsite Soil Evaluator#1940001320,434.221.9000 7 ' Albemarle County VIRGINIA DEPARTMENT OF HEALTH Louisa County PU Box 7546 Thomas Jefferson Health District PO Box 336 Charlottesville,VA 22906 Louisa,VA 23093 (434)972-6259-Office ENVIRONMENTAL HEALTH SERVICES (540)967-3707-Office (434)972-6221-Fax (540)967-3733-Fax Fluvanna County Greene County Nelson County PO Box 136 PO Box 38 PO Box 98 Palmyra,VA 22963 Stanardsville,VA 2297 /1 p p R O\ [�. Lovingston,VA 22949 (434)591-1965-Office (434)985-2262-Oflic I I 1 L (434)263-4297-Office (434)591-1961-Fax (434)985-4822-Fax 434)263-4304-Fax REQUEST FOR NEW CONSTRUCTION WITH EXISTING SEWAGE DISPOSAL Applicant's Name Agent's Name El � 2 -) �6��� Applicant's Address Agent's Addres o(CI to qO o� 3 3,... �zr_5 t J 2-R5j--)4Z4Rd oQ. -� , 'MI ) City State Zip City tate Zip Home Phone: Home Phone: Work Phone: Work Phone: Cell Phone: 1L7 ?2 9 tk ( Cell Phone: t3 h—ItcA, \lur PROPERTY INFORMATION Parcel: Building/Zoning Permit Number: c:;,c1 4:43 cp—cD:::›-- OR--ci. ---620\--+ Subdivision Section Block Lot — ---4qH A-F-- �p s U 1� Proposed Npw Construction Directions to Property: �� �• d- a � &cy\rzy.s . '/�' N • k,,,,,, _.) ,„,_,__, ,,,33 ,ss \r ),.,, rii.t c?11\.\--- Nr-ts4s , 7—c:5-b41 -4 PLEASE ANSWER THE FOLLOWING QUESTIONS Circle One 1.)Was your septic system installed and approved within the last 10 Years? YES Zj1 t✓J C 2.)Does proposed addition or replacement come within 20'of the drain field or reserve area? YES �1� \r 3.)Does proposed addition or replacement come within 50'of your well? YES 4.)Are there wet spots in your yard,slow running drains,backups,or discolored spots in lawn? YES 0 By signing this statement you are requesting that the Environmental Health Specialist evaluate your system and are granting him/her permission to enter your property. If a site visit is needed, X11 c ((7 you may be required to •cover your septic and distribution box lids. ..4 CT ( 19l Applicant/, !" t Signature Date SEE PAGE 2 FOR HEALTH DEPARTMENT FINDINGS PAGE 1 of 2 PAGE 2 of 2 HEALTH DEPARTMENT USE ONLY Site Visit WAS NOT made and existing water supply WAS NOT evaluated, unless otherwise noted under comments. ADEQUATE DESIGN A review of our records indicate the existing sewage disposal system(SDS)and reserve area (where indicated)appears to be adequately designed for the proposed use.This does not imply that the existing SDS will continue to function properly for any minimum period.No conflicts were noted when the attached site plan(including footprint)was compared to those records. Exact locations may vary from records and it is suggested that the exact location of the SDS be confirmed before beginning construction. INADEQUATE DESIGN Existing SDS inadequate.Applicant must apply at the Health Department for a sewage disposal construction permit.Permit must be Issued and a copy submitted to building inspections before Building/Zoning permit is issued. AS-BUILT DRAWING: • COMMENTS: • 1:42.090)0 Wm( w L NrT (CC. r IiJ Iid(tit'AieO 1JA'ft11 WS 44e. (./oo a t' 1.0,414 36R f_kt1)tD14 804A C j.C('itd T pay Rook i Nov istDpeum MBA Ix) 16MN (-1/1-4 117 Health Department Official Date VIRGINIA Albemarle County Health Department DEPARTMENT PO BOX 7546• HEALTH (434) VA 22906 OF (434)972-6219 Voice Protecting You and Your Environment (434)972-4310 Fax Sewage Disposal System Operation Permit Property Owner Dominion Development Co.LLC Health Dept. ID: 101-15-0506 P.O.Box 6367 Tax Map/GPIN: 46-36A Charlottesville,VA 22902 Locality: Albemarle County Property Location PPEC\IED Property Address: 2945 Daventry Lane Charlottesville,VA 22911 Subdivision: Proffit Ridge Section: Lot: 18 is hereby granted permission to operate a Residential Conventional Onsite Sewage System at the above referenced location,under the following parameters: Daily Flow: 600 gallons Number of Bedrooms: 4 This permit is issued in accordance with the provisions of Title 32.1, Chapter 6 of the Code of Virginia as Amended, and Section 12VAC 5-610-340 of the Sewage Handling and Disposal Regulations of the Virginia Department of Health. The issuance of an operation permit does not denote or imply any guarantee by the department that the sewage disposal system will function for any specified period of time. It shall be the responsibility of the owner or any subsequent owner to maintain, repair, or replace any sewage disposal system that ceases to operate in accordance with the regulations. April 18,2017 Travis Davis Effective Date Environmental Health Specialist, Sr. Signature • f Albemarle County Health Department fiD ifi/ VIRGINIA PO BOX 7546 DEPART Cha11 rlottesville, VA 22906 OF HEALTH (434) 972-6219 Voice Protecting You and Your Environment (434) 972-4310 Fax PRIVATE WELL SYSTEM OPERATION PERMIT Property Owner Health Dept. ID: 101-15-0477 Dominion Development Co, LLC Tax Map: 46-36A P.O. Box 6367 Charlottesville,VA 22902 Locality: Albemarle Property Location Eg P-PROVED Property Address: 2945 Daventry Lane Charlottesville, VA 22911 Subdivision: Proffit RidgeLot 18 Directions: From Charlottesville 29 North, right on Proffit Road, left on Proffit Crossing Lane, left in Proffit Ridge Lane, left on Daventry Lane, lot at end of cul-de-sac. is Hereby Granted Permission to Operate a Class IIIB Well located at the above reference property. This Permit is Issued in Accordance with the Provisions of Title 32.1, Chapter 6 of the Code of Virginia as Amended and Section(s) 12-VAC5-630-330 of Private Well Regulations of the Virginia Department of Health and permit dated November 10, 2015 . Special Conditions: April 18, 2017 j__:. j j--: Effective Date Travis T. Davis, EHSS VIRGINIA Albemarle County Health Department yr) DEPARTMENT PO BOX 7546 HEALTH11 Charlottesville, VA 22906 OF (434)972-6219 Voice Protecting You and Your Environment (434)972-4310 Fax Sewage Disposal System Operation Permit Property Owner Chris & Marilyn Weiss Health Dept. ID: 101-16-0440 1513 Old Trail Drive Tax Map/GPIN: 71-34C1 Crozet,VA 22932 Locality: Albemarle County Phone: (703)304-5702 Property Location Property Address: 6318 Midway Road / 0 p Crozet, VA 22932 iiIG/ Chris & Marilyn Weiss is hereby granted permission to operate a Residential Conventional Onsite Sewage System at the above referenced location,under the following parameters: Daily Flow: 600 gallons Number of Bedrooms: 4 This permit is issued in accordance with the provisions of Title 32.1, Chapter 6 of the Code of Virginia as Amended, and Section 12VAC 5-610-340 of the Sewage Handling and Disposal Regulations of the Virginia Department of Health. The issuance of an operation permit does not denote or imply any guarantee by the department that the sewage disposal system will function for any specified period of time. It shall be the responsibility of the owner or any subsequent owner to maintain, repair, or replace any sewage disposal system that ceases to operate in accordance with the regulations. May 09,2017 Travis Davis Effective Date Environmental Health Specialist, Sr. Signature VIRGINIAAlbemarle County Health Department il /IT PO BOX 7546 DEPARTMENT Charlottesville, VA 22906 OF WEALTH (434) 972-6219 Voice Protecting You and Your Environment (434) 972-4310 Fax PRIVATE WELL SYSTEM OPERA HON PERMIT Property Owner Health Dept. ID: 101-16-0342 Chris & Marilyn Weiss Tax Map: 71-34C1 1513 Old Trail Drive Crozet,VA 22932 Locality: Albemarle Phone: (703) 304-5702 Property Location Property Address: 6318 Midway Road P P RG.I Ey Crozet, VA 22932 Directions: 1-64 West to Crozet Exit; Left on Route 250; Left on Burchs Creek Road; Left on Miedway Road; Property on Left across from House#6317 Chris & Marilyn Weiss is Hereby Granted Permission to Operate a Class IIIC Well located at the above reference property. This Permit is Issued in Accordance with the Provisions of Title 32.1, Chapter 6 of the Code of Virginia as Amended and Section(s) 12-VAC5-630-330 of Private Well Regulations of the Virginia Department of Health and permit dated August 05, 2016 . Special Conditions: May 9, 2017 je•—: Effective Date Travis Davis, EHSS Albemarle County VIRGINIA DEPARTMENT OF HEALTH . Louisa County PO Box 7546 • Thomas Jefferson Health District PO Box 336 " Charlottesville,VA 22906 Louisa,VA 23093 • (434)972-6259-Office • ENVIRONMENTAL HEALTH SERVICES (540)967-3707-Office (434)972-6221-Fax (540)967-3733-Fax - Fluvanna County Greene County Nelson County PO Box 136 PO.Box 38 ' h! PO Box 98 • Palmyra,VA 22963 Stanardsville,VA 22973 111►' p R(Il E 7 Lovingston,VA 22949 • (434)591-1965-Office (434)985-2262-Office lllnnnllllllJJl 1 U (434)263-4297-Office (434)591-1961-Fax (434)985.4822-Fax 434)263-4304-Fax REQUEST FOR NEW CONSTRUCTION WITH EXISTING SEWAGE DISPOSAL • Applicant's Name Agent's Name � l ela. SuIIiVoJ Applicant's Address • Agent's Address • 7420 -Ce I+ RI) City • . State Zip City State Zip • .9-0,(0%0)lit V/I 22413 • . Home Phone: 434-3..'7 a$4O Home Phone: -- Work Phone: 5 - -p- atz v2 Work Phone: Cell Phone: S ,p - tie_ Cell Phone: - PROPERTY INFORMATION • - Parcel: Building/Zoning Permit Number: • 03ioo X 000/11E0 ' ��oi'� o�q8 . Section Block Lot 146 VNS� •y,0. Proposed Nevi)Construction • _ - • AM 2-4 X24 eiucsL acek-eryn5 O✓,- roperty: O.✓a4,Z)i• & 3}X 214 t*4 r O'✓' . • m Cvi I Ie �Mtc IUSv A le u� l - TDI�L t? c:o . • Kaci GR —RS) to E -tcas4h i le . IUM L .-- r 7)r?i tZoc+c/ - - - /p o 4-r - t,-s to mai Ix'sc NG Ort +he rkgih E- PLEASE ANSWER THE FOLLOWING QUESTIONS Circle One 1.)Was your septic system installed and approved within the last 10 Years? YES• illb 2.)Does proposed addition or replacement come within 20'of the drain field or reserve area? YES . 1• 3.)Does.proposed addition or replacement Come within 50'of your well? YES i�►,,��;'�� 4.)Are there wet spots in your yard,slow running drains,itackups,or discolored spots.in lawn? • YES CP By signing this statement you are'requesting that the Environmental Health Specialist evaluate your system and are granting him/her permission to enter your property. If a site visit is needed, you maybe ,-• fired i• uncover your septic tank and distribution box lids. /,/• pplicant/Agent Signature Date • SEE PAGE 2 FOR HEALTH DEPARTMENT FINDINGS PAGE 1 of 2, • • U 11 I , . meg-45 . PAGE2of2 HEALTH DEPARTMENT USE ONLY Site Visit WAS NOT made and existing water supply WAS NOT evaluated, unless otherW/se noted under comments. ✓ I ADEQUA ESlh�s'N t A review of our re `1ndeate the existing sewage disposal system(SDS)and reserve area (where indicated)appears to be adequately designed for the proposed use.This does not imply that the existing SDS will continue to function properly for any minimum period.No conflicts were noted when the attached site plan(including footprint)was compared to those records.Exact locations may vary from records and it is suggested that the exact location of the SDS be confirmed before beginning construction. . I INADEQUATE DESIGN Existing SDS inadequate.Applicant must apply at the Health Department fora sewage disposal. construction permit. Permit must be issued and a copy submitted to building inspections before Building/Zoning permit is Issued. AS-BUILT DRAWING: E� s'i3OTC �tItr'l� I6i-1l-0Zi3 • • • • COMMENTS: ( h DOS" Aporri.dgL Dmikki�o lit(nic•f0 T o<1?,rc1 Qi2A,NF�rti. .S( T1. E�CP�#N1rw . fe1b1T 41-11-ali) 0014,4,0 !o A umwiv tic•: 4 ra. DwaUv, (Aro 4,0) /8117 Health Department Official Date Page f of S , �R I I Albemarle County Health Department 'f{ DEPARTMENT PO BOX 7546 Charlottesville, VA 22906 OF HEALTH (434) 972-6219 Voice (434)972-4310 Fax Protecting You and Your Environment Sewage Disposal System Construction Permit Angela Sullivan May 08, 2017 7420 Celt Road Stanardsville, VA 22973 Subject: 151 Health Department ID #: 101-17-0213 ��'[�QD�.�ED P Tax Map#: 31-14E Subdivision: N/A 146 Reas Ford Road, Earlysville, VA 22936 Dear Angela Sullivan: The attached drawings, specifications, and calculations constitute your permit to install a sewage disposal system on the property referenced above. The attached schematic shows the approved area for the sewage disposal system. If modifications or revisions are necessary between now and when you construct your dwelling, please contact the Albemarle County Health Department at (434) 972-6219. No part of any installation shall be covered or used until inspected, and the sewage system may not be placed into operation until you have obtained an Operation Permit from the Albemarle County Health Department. The following documents will be required to obtain the Operation Permit: • System Inspection by the local Health Department • Satisfactory Contractor's Completion Statement This Construction Permit is null and void if conditions are changed from those shown on your application or if conditions are changed from those shown on the Site and Soil Evaluation Report and the attached construction drawings, specifications, and calculations. VDH may revoke or modify any permit if, at a later date, it finds that the site and soil conditions and/or design do not substantially comply with the Sewage Handling and Disposal Regulations, 12 VAC 5-610-20 et seq., or if the system would threaten public 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 be 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 authorization to construct a sewage disposal system expires: November 07, 2018. This Permit is NOT TRANSFERABLE to any other person or location. Issued by: „IL vis T. Davis, Environmental Health Specialist, Sr. Page 2 of S VDH OSE Construction Permit Report Property Location: 911 Address: 146 Reas Ford Road City: Earlysville Tax Map#: 31-14E Applicant Mailing Address: Name:Angela Sullivan Street: 7420 Celt Road City: Stanardsville State: VA Zip Code: 22973 Designed by: VDH OSE: Travis T. Davis License#: 1940001418 Health Department:Albemarle County Health Department Health Department Address: PO BOX 7546 City: Charlottesville State: VA Zip Code: 22906 Date of Report: May 08, 2017 Contents/Index of this report: Approval letter(1) Permit report(2) System specifications(3) Site/soil evaluation report(4) Construction drawing (5) Certification Statement I hereby certify that the evaluations and/or designs contained herein were conducted in accordance with the applicable provisions of the Sewage Handling and Disposal Regulations(12VAC5-610),the Private Well Regulations(12VAC5-630),the Regulations for Alternative Onsite Sewage Systems(12VAC5-613),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 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. Master OSE Signat - - 5/0Date: Page I of f' System Specifications 101-17-0213 Applicant Information Name:Angela Sullivan Phone: (434) 327-2840 Address: 7420 Celt Road Stanardsville, VA 22973 Location Information Tax Map#: 31-14E Property Address: 146 Reas Ford Road Albemarle VA Directions: Route 743 to Earlysville. Left on Reas Ford Road; 0.4 Miles on Right. General Information Property Type: Residential Daily Flow: 450 gallons Number of Bedrooms: 3 Sewer Line and Septic Tank Sewer Line: 3"or 4"schedule 40 PVC or equivalent, cleanouts required at 50'-60' intervals Septic Tank Capacity: 1000 gallons The inlet structure shall be 1-2 inches higher than the outlet structure and shall extend 6-8 inches below and 8-10 inches above the liquid level. The outlet structure shall extend 35-40% below and 8-10 inches above the liquid level. The septic tank shall either have an inspection port or an effluent filter, or be a reduced maintenance tank. Conveyance Line Distribution Box and Header Lines Method: Gravity No. of Boxes: 1 Material: 1500#for non-pump/SCH 40 for pump No. of Outlets: 12 Pipe Diameter: 4" Header Line Materia1:1500#crush or equivalent Minimum Slope: 6" per 100'for non-pump Header Line Minimum Slope: 2" per 100' Percolation Lines/Absorption Area Install:1200 sq feet when using gravel aggregate Size of Aggregate:0.5-1.5", Depth of Aggregate in Trench: 13" Installation depth: 60 " Percolation pipe to be 4"diameter, trench slope to be between 2-4" per 100' Install 4 Laterals, 100' long, and 3'wide,with 9' center to center spacing. PLEASE NOTE: 100% Reserve area provided This permit expires: November 07, 2018. This permit is not transferable to another owner or location. 11/( Site and Soil Evaluation Report General Information Date: May 02, 2017 Albemarle County Health Department Owner: Angela Sullivan Owner Telephone Number: (434) 327-2840 Property Address: 146 Reas Ford Road Earlysville VA Soil Information Summary Position in Landscape Satisfactory: Yes Describe Landscape Position: Shoulder Slope: 0 to 6% Depth to rock/impervious strata: > 84 inches Free Water Present: N/A Depth to seasonal water table: > 84 inches Estimated soil percolation rate: 55 min/in Estimated at 60 in Name and title of evaluator: � t) 1 j7itVl� 561F/94000/4/8 Signature: /`-- J Soil Descriptions Hole# Horizon Depth (in.) Description of color, texture, etc. Texture Group 1 Ap 0 -3 Yellowish Brown (10YR 5/4) L(Loam) II (2) Bt 3-46 Red (2.5YR 4/6) C (Clay) IV(4) Cb 46 -84 Reddish Yellow(7.5YR 6/8) SCL(Sandy Clay Loam) II (2) with 2.5YR 4/6 red Hole# Horizon Depth (in.) Description of color, texture, etc. Texture Group 2 Ap 0-7 Dark Yellowish Brown (10YR 3/4) L (Loam) II (2) Bt 7- 30 Red (2.5YR 4/6) C (Clay) IV(4) Cb 30-48 Reddish Yellow(7.5YR 6/8) CL (Clay Loam)with III (3) 2.5YR 4/6 red C 48- 84 Dark Yellowish Brown (10YR 4/6) SL(Sandy Loam) II (2) with 7.5YR 5/6 reddish yellow; soft saprolite Hole# Horizon Depth (in.) Description of color, texture, etc. Texture Group 3 Ap 0-7 Dark Yellowish Brown (10YR 3/4) L (Loam) II (2) Bt 7-25 Red (2.5YR 4/6) C (Clay) IV(4) Cb 25-45 Reddish Yellow(7.5YR 6/8) CL (Clay Loam)with III (3) 2.5YR 4/6 red C 45-84 Dark Yellowish Brown (10YR 4/6) SL (Sandy Loam) II (2) with 7.5YR 5/6 reddish yellow; soft saprolite s/c ft:,-°9 N p o ei y en G. 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