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Sewage Disposal System Construction Permit Page Of <br />Loudoun County, Virginia Health Department �) �J <br />Division of Environmental Health Identification Number �'" <br />777 -0234 Metro 478 -8408 <br />Map Reference <br />2757 <br />��ii ire► �r r�r® <br />A,Atd &1t I-regENERAL INFORMATION <br />New Repair ❑ <br />Site ID. # /J <br />14 <br />Based on the application for sewage disposal system construction permit <br />filed in accordance with Chapter <br />10-66, Codified Ordinances, a <br />constructio ermit is hereby is�`Wed to: <br />� L vRpe / 11.) � J 3 I ff r <br />Owner � O <br />Address (� . ) 0 <br />Fo a Type Sewage disposal system whic is to be constructed on /at <br />inn 7 1 13 1 s i b <br />f <br />Subdivision Section /Block Lot %� 'J OLV <br />Actual or estimated water use D .N S J► : CAI <br />DESIGN <br />NOTE: INSPECTION RESULTS <br />Building sewer: 4" I.D. PVC 40, or equivalent. <br />Slope 1.25" per 10' (minimum). <br />Building sewer: <br />Satisfactory <br />yes ❑ no ❑ comments <br />❑ Other <br />Sep,lloic Tank- Capacity gals. (minimum) <br />Other }t� %t �i YD L J! &Z 6f Ir /1/1 r ✓1 7SU <br />Pretreatment unit: <br />4 factory <br />yes ❑ no ❑ comments <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 F-1 comments <br />Pump and pump station: <br />yes E] no E] comments <br />Pressure Distribution L] Y � <br />Satisfactory <br />Gravity mains: 3" or larger I.D., minimu V. <br />Conveyance method: <br />yes ❑ no ❑ comments <br />100', 1500 lb. ush r ( qu)plent. <br />Satisfactory <br />Q Oth F <br />Distribution box: �'/JqVdajE <br />Distribution Box: <br />yes ❑ no ❑ comments <br />Precast concrete with ports. <br />Satisfactory <br />❑ Other <br />Field Marked <br />yes ❑ no ❑ <br />Header lines: Material: 4" I.D. 150 or <br />Header lines: <br />yes ❑ no ❑ comments <br />equivalent from distribu rench. Slop e 2" <br />Satisfactory <br />minimu er <br />Percolation line: Gravity 4" 1 b. per foot bearing load <br />Percolation line: <br />yes ❑ no ❑ comments <br />or equivalent, sl min. max.) per 100'. <br />Satisfactory <br />❑ Oth <br />Absorption trenches: <br />Absorption trenches: <br />yes ❑ no ❑ comments <br />Square ft. required ; depth from gr surface <br />Satisfactory <br />to bottom of trench ; aggre size <br />Contractor <br />Trench bottom slope <br />center to center spacing ; trench width <br />License # <br />Phone <br />Depth of aggregate <br />Date <br />inspected and approved by: <br />Trench length ; Number of trenches <br />See P imetric for Location and Page for further conditions. <br />sAMTARiAN <br />The sewage disposal system to be constructed as specified by the permit or attached plans and specifications <br />This construction permit is null and void if (a) conditions are changed from those show kn <br />the application (b) conditio are changed from <br />those shown on the construction permit. <br />�� <br />Date: �' Issued by: <br />Date: Reviewed by: <br />Sa ita a n n <br />- <br />The C,onstr ction <br />Pe it V I' til <br />ffSupervisory <br />Sanitarian <br />