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IIMONWEALTH OF VIRGINIA gi P - 4 - e� <br /> DEPARTMENT OF HEALTH • <br /> PROPOSED SMALL SEWAGE TREATMENT PANT (OTHER THAN SCHOOLS) <br /> REQUEST FOR APPROVAL (PRELIMINARY) (� <br /> I . a. Facility to be served 5 bedroom dwelling ~' ` <br /> Lot 32, Section IV, Richland Acres, <br /> b. Location <br /> Broad Run Magisterial District, Loudoun County <br /> 2. a. Owner of Sewage Treatment Works John A. - Skinner <br /> 6. Address Rt. 2, Box 140, Sterling, Va. '.2 - <br /> 3. Type of Installation or Degree of Treatment Covered sand filter <br /> 4. Population or Other Basis of Design edrooms Q 2 p . son per bedroom <br /> 5. a. Sewage Flow loc gp d. <br /> b. Daily Duration of Flow 12- 6 No. Hrs. <br /> 6. Location of Plant Lo 2 Section IV Rich es Subdi vision <br /> 7. a. Name of Receiving Stream S u a Pun <br /> b. All weather or intermittent stream All w Cher <br /> c. Drainage Basin Potomac <br /> r <br /> r <br /> 8. Location of Point of Discharge approximately 2 i north of Rt. 7 ~� <br /> 9. Distances See attached schedule <br /> a. Plant to residences within 600 feet <br /> b. Adjacent Property Lines — <br /> c. Other premises within 600 feet <br /> 10. a. Character and Uses of: Stream below discharge Undevelo ed Vnd zeneral farm land. <br /> b. Downstream Property General Farm Land <br /> 11. Source of Water Supply well on sJ to <br /> For Use of Local Department, e <br /> R Recommend permit be iss ued. Da te: 3 -26 -63 Signed:S.I.Gran <br /> or Use of Local Health Services a, � <br /> y n ed of Engineering Division s _ l ;' _ 2 ,__.rS <br /> G �o �i�t_._a �o.� o �e s c <br /> • Co. . _.1 r_ _ 9 <br /> To be responsible for future surveillance Date: ��Signed: <br /> For Use of State Water Control Board <br /> Dn_cliried jt:irisdic'clon b; t:;l °phony con;re_ <br /> sation <br /> ."rith R. V. Davis Date 1 °:pz l Signed: <br /> LHS•120 <br />