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Sewage Disposal System Copstruction Permit Page ' <br />of <br />Loudoun County, Virginia b �0 1 r '--11 Health Department / �7 <br />Division of Environmental Health Identification Number�'� 3 75' <br />777 -0234 Metro 478 -8408 <br />Map Reference a© M o a o o� gil o ©c <br />GENERAL INFORMATION <br />' <br />New ❑ Repair ❑ Expand ❑ Bandon4 Alter ❑ STP <br />❑ Pump & Haul ❑ Site ID# <br />Based on the application for sewage al system construction permit filed in accordance with Chapter 1066, Codified Ordinances, a <br />construction p rmit is hereby issued to: <br />Owner L .L, e <br />Telephone �� 3 -— <br />G <br />/ `mod <br />Address _j e4 56kT UA& V 41 <br />idurdl 01 <br />-/ 2 Z <br />For a Type Sewage disposal system_ which is to be constructedon/at <br />4 U CSI 11 <br />Subdivision Section /Block S <br />Lot / L <br />Actual or estimated water use <br />DESIGN <br />NOTE: INSPECTION RESULTS <br />Building sewer: 4" 1. D. PVC 40, or equi lent. <br />Building sewer: <br />yes ❑ no ❑ comments <br />Slope 1.25" per 10' (minimum). <br />Satisractory <br />F-1 Other <br />Septic Tank: Capacity gals. (minimu ) <br />,4Qher fZC <br />Pretreatment unit: }des no ❑ comments <br />Satisfactoryuy�r�c9".°craL 1`707 r�-- 5.ZS•L�O <br />Inlet- outlet structure: PVC 40, 4" tees or equivalent <br />Inlet- outlet structure: <br />yes ❑ no ❑ comments <br />❑ Other <br />Satisfactory <br />Pump and pump station: yes ❑ no comments <br />Pressure Distribution ❑ Y ❑ N <br />Pump and pump station: <br />Satisfactory <br />yes ❑ no ❑ comments <br />Gravity mains: 3" or larger I.D., mi ' um 6" fall per <br />Conveyance method: <br />yes ❑ no ❑ comments <br />100', 1500 lb. crush strength or uivale, <br />❑ Other <br />Satisfactory <br />Distribution box: 0 <br />Distribution Box: <br />yes ❑ no ❑ comments <br />Precast concrete with _ port <br />Satisfactory <br />❑ Other <br />Field Marked <br />yes ❑ no ❑ <br />Header lines: Material: 4 ".t.D. 15001. cru n street lastic or <br />equivalent from distributio ox to Qo a �tlon trench. Slope 2" <br />Header lines: <br />Satisfactory <br />yes ❑ no ❑ comments <br />minimum ❑ Other t' <br />Percolation line: avit "plastic 1000 } per foot bearing load <br />Percolation line: <br />yes ❑ no ❑ comments <br />or equivalent, slop 2" ( in. m ) pe 1 0'. <br />Satisfactory <br />❑ Other <br />Absorption tr n AV <br />Square ft. re uire depth from ground surface <br />Absorption trenches: <br />Satisfactory <br />yes F] no ❑ comments <br />to bottom tre ; aggregate size <br />Trench b t p <br />center c r sp ; trench width <br />Dept of a g gat <br />Contractor <br />License # <br />Date `.�' ' Z� ' 7C�C) <br />Phone <br />inspected and approved by: <br />Tre h lengt ;Number of trenches <br />-7 <br />Se Plannimetric for Location and Page for further conditions. <br />SANITARIAN <br />The sewage disposal system to be constructed as specified by the permit r attached plans and specifications ❑. <br />This construction permit is null and void if (a) conditions are changed from those shown on the application (b) conditions ere changed <br />from those shown on the construction permit. <br />Date: Issued by: <br />Date: �$ Reviewed l4 : <br />Sanitarian <br />f^•� - ---- -- <br />- <br />The Construction <br />Per it Valid Until <br />Zc� <br />-' <br />Supervisory Sanitarian <br />