HomeMy WebLinkAboutSUB201700110 Study 2017-09-19 A, ' Page 1 of 6
OSE/PE Report For:
❑ Construction 0 Repair 0 Voluntary Upgrade 0 Certification ® Subdivision
Permit Permit Permit Letter Approval
Property Identification:
911 Address: 4273 Burton Rd. City: North Garden
Lot: residue Section: Subdivision:
GPIN or Tax Map#: 87-53 Health Department ID#:
Latitude: Longitude:
Applicant or Client Mailing Address:
Name: Nicole M.Averill
Street: 4273 Burton Rd.
City: North Garden State: VA Zip Code: 22959
Prepared by:
OSE Name: William J. "Jeff'Loth,IV License Number: 1940001316
Address: 222 Sycamore Lane
City: Afton State: Virginia Zip Code: 22920
PE Name: License Number:
Address:
City: State: Zip Code:
Date of Report: 9/19/17 Date of Revision 1:
OSE/PE Job Number: Date of Revision 2:
Contents/index of this report(e.g.,Site Evaluation Summary,Soil Profile Descriptions,Site Sketch,Abbreviated Design,etc.)
Cover Page
Application
Soil Summary Report
Soil Profile&Design Calculations
Plat
Plat with Drainfield and Sanitary Survey
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(12 VAC5-610),the Private Well Regulations(12 VAC5-630),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.
0 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.1 I
I recommend that a(select one): 0 Construction Permit,0 Certification Letter,®Subdivision Approval,0 Repair Permit,0 Voluntary Upgrade
be(select one): ®Issued, 0 Den'ed
PE/OSE Signature: (70„ re. _ Date:9/19/17
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VDH Uss,....otly
Commonwealt1115f Virginia Health Department ID#
Application for: ® Sewage System❑ Water Supply Due Date:
Owner: Nicole M.Averill _Phone: (434)906-7988
Mailing Address: 4273 Burton Rd. Phone: ( ) -
North Garden,VA 22959 Fax: ( ) -
Agent: Phone: ( ) -
Mailing Address: Phone: ( ) -
Fax: _ ( )
Site Address: 4273 Burton Rd.
North Garden,VA 22959 Email:
Directions to Property: west of Rt.711, 150'north of Rt. 856
Subdivision: Section: Block: Lot: residue
Tax Map: 87-53 Other Property Dimension/Acreage of Property: 2.000
Identification:
•
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.
For New Construction: 0 Certification Letter LI Construction Perm it ®_ Subdivision Review
For Existing Construction: j 0 Repair I 0 Modification f 0 Expansion l 0 Replacement
_--Proposed Use:
TE Single Family Home(Number of Bedrooms 3) Multi-Family Dwelling(Total Number of Bedrooms )
0 Other(described — — — —---- _-- —__-- — —
Will there be a basement: ® Yes ❑ No ? If yes,will there be fixtures in the Basement?-0 Yes ❑ No
Are any conditions proposed on this construction permit? 0 Yes ® No If yes,please check or describe all proposed — —!
Conditions that apply: 0 Reduced Water Flow j 0 Limited Occupancy TO Intermittent or seasonal use
0 Temporary use not to exceed 1 year 0 Other(describe)
Water Supply _—
Will the water suppllybe[] Public or®Private Is the Water supply 2 Existip or Proposed
_ If proposed,is this a replacement well? 0 YeD No Will the old well be abandoned 0 Yes ❑ No
Will any proposed or existing buildings within 50'of the_roposed or existin-g water supply have termite treatment?❑ Yes ® No _—
------- --- — - ------------------
All Applicants
Is this an AOSE/PE application?El Yes 0 No j If yes,is the AOSE/PE package attached? EV Yes 0 No
In order for VDH to process your application you must attach a site sketch and plat of the property.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 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.
Signature of Owner/Agent Date
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Soil Summary Report �;
General Information
Date: 6/15/17 - LSubmitted to Albemarle County Health Department v-—
Applicant: Nicole M.Averill -_—_ _ j Telephone: (434)906-7988
Address: 4273 Burton Rd.,North Garden,VA 22959
_Owner: same I Address: same
Location: west of Rt.711, 150'north of Rt.856
Tax Map: 87-53 Subdivision:
Property Size: 2.000 ac. Section: Lot: residue
Soil Information Summary
I. Position in landscape satisfactory? Yes ® No ❑
Describe: shoulder - —
2. Slope 8%
3. Depth to Rock or impervious strata: (in) ( Max. 30 I Min.20 —_
4. Depth to seasonal water table(gray mottling or gray color): No ® Yes 0 Inches
't 5. Free water present: No ® Yes 0 range in inches -
Yes® I Texture Group I 0 II 0 III ® IV 0
6. Soil percolation rate estimated? -------t-- -- — --- — -- -------
No 0 I Estimated rate 65 min/inch
7.Permeability test performed Yes 0 No El
If yes,note type of test performed and attach
Drainfield to be placed at 8"depth at site designated on on plat and utilizing
pretreatment approvable by VDH capable of providing TL-3 to the dripfield
®Site Approved in accordance with 12 VAC 5-613,drip dispersal or mound. Drip dispersal
design and installation shall adhere to the requirements of 12 VAC 5-613
and GMP#135.A. Reserve sewage system design must comply with GMP
#156. _
0 Site Disapproved
Reason for Rejection
1. FPlandscape osition in landsce subject to flooding or periodic saturation _
__
; ___
2. 1 g 1 Insufficient depth of suitable soil over hard rock
_3. 01 Insufficient depth of suitable soil to seasonal water table ---
4. ! Rates of absorption too slow.
5. Insufficient area of acceptable soil for required drainfiel�and or reserve area _
6. E Proposed system too close to well
-- -- _____--
7. ❑ Other_Specify _ - - -----
Page 4 of 6
TM 87-53 Residue Parcel �, r... Nome
Albemarle County,Virginia
Soil Profiles
Hole Hzn Dept Material Description Txt
h
1 Ap 0-12 10yr3/3 dark brown Loam 2
BtC/A 12-22 2.5yr4/8 red Clay Loam, SBK,with many fine mica flakes and few pockets of 10yr8/1 white 3
Sandy Loam saprolite with 10yr3/3 dark brown Loam tongues
BtC 22-30 2.5yr4/8 red Clay Loam,SBK,with many fine mica flakes and few pockets of 10yr8/1 white 3
Sandy Loam saprolite
r 30 auger refusal
2 Ap 0-4 10yr3/3 dark brown Loam 2
Bt 4-20 7.5yr5/8 strong brown Sandy Clay Loam,granular structure,with common very highly 3
weathered granitic fragments
r 20 auger refusal
3 Ap 0-4 10yr3/3 dark brown Loam 2
BtC1 4-18 7.5yr5/8 strong brown Sandy Clay Loam,granular structure,with common very highly 3
weathered granitic fragments
BtC2 18-22 5yr5/6 yellowish red Sandy Clay Loam,granular structure,with common very highly 3
weathered granitic fragments
Design Basis
A. Estimated Percolation Rate 65 @ 8 in.
B. Effluent loading rate from Table 1 of 12 VAC 5-613 .027 gpd/sf
C. Number of bedrooms 3
D.Gallons per day(Number of bedrooms X 150 gpd/bedroom) 450
Area Calculations for Drip Dispersal
A. Length of run(ft.) 55
B Length of available area(ft.) 55+
C. Width of available area(ft.) 35+
D. Total footprint required for drip dispersal(450gpd/0.27gpd/ft2),as per 12 VAC 5-613) 1667
E. Square footage provided 1925+
F. Is a Reserve Area required? Yes,this is a 100%Reserve Area
Page 5 of 6
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PROJECT TITLE: REVISIONS:
TAX MAP 87 PARCEL 53 NO. DESCRIPTION DATE 'o+yb
SAMUEL MILLER DISTRICT, 1s� • Dominion
ALBEMARLE COUNTY, VIRGINIA � : �; Engineering
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SHEET TITLE: o nz x,ar u+`,
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N/F PATRICIA M. ZAVADA .`, / #4273 GRAVEL
DB 924 PC 594 '�jh '; - P L\E-"` • / 1/PLAT DB 567 PG 256 C ' 4 NEW 25' PRIVATE // //
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+ WELL & WATERUNE k / /
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+IS N49'4717"W ,��' /�- -- -'o" +
205.60' �� a +
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'� ��i • /��c N/F DONALD MCLAUGHLIN
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per' / + PLAT DB 4673 PC 199
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