2022-CR-35 Combined Redacted.pdf

Repair Sewage Disposal System Sewage and Replacement Well Construction Permit

Contractor Note: Existing wells must be permanently abandoned as specified and approval obtained by the Health Department prior to installing sewage disposal system.

July 13, 2023

77 Boxwood Dr Arvonia, VA 23004

RE: Tax Map: 42-74

HDID: 23-114-33

System Capacity: Residential, 2 Bedrooms, 300 gallons per day Location: 77 Boxwood Dr, Arvonia, VA

The attached drawings, specifications, and calculations constitute your permit to install a replacement well, abandon two existing wells (Existing Wells A & B), and repair a sewage disposal system and 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 Buckingham County Health Department at (434) 969-4244. 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 Buckingham County Health Department.

**Existing Wells A & B must be permanently abandoned prior to installation of the repair sewage disposal system. See specifications for abandonment and location of each well proposed for abandonment on permit pages that follow. A GW-5 abandonment report must be submitted to the Health Department for each well following abandonment. The replacement well can be installed prior to abandonment of the existing wells.

The following documents will be required to obtain the Operation Permit:

System Inspection by the local Health Department Satisfactory Contractor's Completion Statement

If your permit is for a septic system and a private well, you must also obtain:

Satisfactory Well Inspection by the local Health Department Satisfactory Bacteriological Sample Results Water Well Completion Statement or GW-2 from your well driller

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

Tax Map: 42-74

HDID: 23-114-33

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 or well. The owner is responsible at all times for complying with all applicable local, state, and federal laws and regulations.

This construction permit is transferable until expired or deemed null and void. A permit transfer form may be found on the VDH website at http://www.vdh.virginia.gov/environmental-health/gmp-2015-01-forms/ .

If you have any questions, please contact me.

Authorization to construct a sewage disposal system expires: January 13, 2025

Authorization to install replacement well and permanently abandon existing wells expires: January 13, 2028.

Sincerely, C. David Waldrep Environmental Health Manager

VDH OSE Repair Sewage and Replacement Well Construction Permit Certification

Health Department ID: 23-114-33

Property Location:

911 Address: 77 Boxwood Dr, Arvonia, VA Tax Map : 42-74

Applicant Mailing Address:

Street/P.O. Box: 77 Boxwood Dr City: Arvonia State: VA Zip Code: 23004

Designed by:

VDH OSE(s): David Waldrep License #(s): 1940001264 Health Department: Buckingham County Health Department Address: PO Box 198 City: Buckingham State: VA Zip Code: 23921 Date of Report: July 7, 2023

Contents/Index of this report:

Page 3 Certification Statement Page 10 Well Abandonment B - Permit Letter Page 4 Sewage System Specifications Page 11 Well Abandonment B - Illustration Page 5 & 6 Well Permit Letter Page 12 Construction Drawing Page 7 & 8 Well Abandonment A - Permit Letter Attachment Legacy VDH Soil Report Page 9 Well Abandonment A - Illustration

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 Signature: _______________________________ Date: ____________

Journeyman OSE Signature:___________________________ Date: ____________

Sewage System Specifications HDID: 23-114-33

Applicant Information Name: Jennifer Brooks Phone:

Street/P.O. Box: 77 Boxwood Dr City: Arvonia State: VA Zip Code: 23004

Location Information 911 Address: 77 Boxwood Dr, Arvonia, VA Tax Map : 42-74

Directions: Hwy 15 N to Arvonia left on Rt 715 left on Rt 675 left on Rt 710 - property on left

General Information Property Type: Residential Daily Flow: 300 gallons Number of Bedrooms: 2

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 Method: Gravity Material: Sch 40 PVC Pipe Diameter: 4'' Minimum Slope: 6" per 100'

Distribution Box and Header Lines No. of Boxes: 1 No. of Outlets: 8 Header Line Material: Triple Wall PVC 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: 18'' Percolation pipe to be 4'' diameter, trench slope to be between 2-4'' per 100'

Install _5_ Laterals, _80_' long, and _3_' wide, with 9' center to center spacing.

Gravel-less material may be used, in lieu of gravel and pipe, within the approved absorption area in accordance with Table 1 of GMP 2016-01. For utilizing approved gravel-less substitutes install:

Install _4_ Laterals, _75_' long, and _3_' wide, with 9' center to center spacing.

PLEASE NOTE: Sewage Disposal System Construction Permit expires: January 8, 2025

Private Well Construction Permit Sewage and Well Contractors: Please notify Health Department and OSE or PE 48 hours prior to installation to arrange for inspection

RE: Tax Map: 42-74

HDID: 23-113-33

The attached drawings and below specifications constitute your permit to install a private well on the property referenced above. This 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 attached construction drawings and specifications. VDH may revoke or modify any permit if, at a later date, it finds that the site conditions, well location, and/or design do not substantially comply with the Private Well Regulations, 12 VAC 5-630-10 et seq, or if the well would threaten public health or the environment. There may be other local, state, or federal laws or regulations that apply to the proposed construction of this private well. The landowner is responsible at all times for complying with all applicable local, state, and federal laws and regulations, and for ensuring that the water well is properly located on the landowner's property and in the approved area indicated on the attached schematic.

Your private well must be inspected by a representative of the local health department. Your private well may not be placed into operation until you have obtained a Record of this Inspection (ROI) from the Buckingham County Health Department.

Tax Map: 42-74

HDID: 23-113-33

Before you can obtain your ROI, you must provide the Health Department with a Uniform Water Well Completion Report /GW-2 from your well driller and a record of a satisfactory bacteriological sample result.

Well Purpose: Drinking/Domestic Use Well Class: IIIB Minimum Casing Depth: To Rock - 50' min Minimum Grout Depth: (Grout with Pressure Pump and Tremie Pipe)

THIS PERMIT EXPIRES: January 13, 2028

Sincerely, C. David Waldrep, Environmental Health Manager

Private Well Abandonment Permit

RE: Well Abandonment (Existing Well A) Tax Map: 42-74

The attached drawings (pages 9 & 12) and below specifications constitute your permit to permanently abandon a private well (bored) on the property referenced above. VDH may revoke or modify any permit if, at a later date, it finds that the site conditions or abandonment procedure does not substantially comply with the Private Well Regulations, 12 VAC 5-360-10 et seq.

This is an enhanced abandonment procedure for the purpose of reducing the required setback distance from an abandoned bored or dug well to a proposed sewage system absorption field.

Additional cement or bentonite grout filling is required. See attached illustration. Bored wells abandoned in this manner must continue to maintain 75 feet separation when located downhill of a contamination sources and 50 feet separation uphill of contamination sources. Following abandonment, the well must be permanently marked and continue to meet this setback requirement from contamination sources. The landowner is responsible at all times for complying with all applicable local, state, and federal laws and regulations, and for ensuring that the water well is properly abandoned. The well proposed for abandonment by this permit is designated on the attached construction permit drawing.

Well Abandonment (Existing Well A)

Tax Map: 42-74

A representative of the local health department must inspect the well abandonment. This abandonment permit is transferable until expired or deemed null and void. The landowner must provide the health department with a complete Water Well Completion Statement/GW2 from your well driller verifying the abandonment.

Issued by:________________________________________ Date: ________________ C. David Waldrep, Environmental Health Manager

Attachments: Well Construction Permit Drawing

Well Abandonment Specifications

Private Well Abandonment Permit

RE: Well Abandonment (Existing Well B) Tax Map: 42-74

The attached drawings (pages 11 & 12) and below specifications constitute your permit to permanently abandon a private well (drilled) on the property referenced above. VDH may revoke or modify any permit if, at a later date, it finds that the site conditions or abandonment procedure does not substantially comply with the Private Well Regulations, 12 VAC 5-360-10 et seq.

The landowner is responsible at all times for complying with all applicable local, state, and federal laws and regulations, and for ensuring that the water well is properly abandoned. The well proposed for abandonment by this permit is designated on the attached construction permit drawing.

A representative of the local health department must inspect the well abandonment. This abandonment permit is transferable until expired or deemed null and void. The landowner must provide the health department with a complete Water Well Completion Statement/GW2 from your well driller verifying the abandonment.

Issued by: ________________________________________ Date: ________________ C. David Waldrep, Environmental Health Manager

Attachments: Well Construction Permit Drawing

Well Abandonment Specifications

DocuSign Envelope ID: 6B6C712B-C9A5-4C66-955B-1796EBE02FC9

Approved - CDW