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HomeMy WebLinkAbout06-08 Barleyfield Farm Cottage B&B Bed & Breakfast - Back Creek - BackfileNOTES Date: p g File opened (�/0 Reference Manual updated/number assigned D-base updated LO La �- (� pg Gne location map requested from Mapping Dept, oY /�xj L-1 S ' —1z' � Four sets of labels requested from Data Processing pg File given to Renee' to update Application Action Summary TJAI CLOSE OUT FILE: V09Q?e Approval (or denial) letter mailed to applicant/copy made for file and other applicable cc's 0� File stamped "approved", "denied" or "withdrawn" Reference Manual updated p D-base updated 17 jai 10 j( File given to Renee' for final update to Application Action Summary U:\CuD1\Common\Tracking sheets\CUP.TKK Revised 12/19/02 0 � � N CD N 2 a o o Q o cn N N cn , -- U ! s; III brT U �waC) � / DATE RECEIVED FROM j )L/ ADDRESS C1lP 7 CLA C1 �`rZ ❑FOR RENT ❑FOR ' • • AMT OF CASH ACCOUNT AMT. PAID a CHECK BALANCE MONEY DUE ORDER b No. Q i 6 3 '7WA-13A BY i) A <.2 5ys . 50 0. 6 COUNTY of FREDERICK Department of Planning and Development 540/665-5651 FAX: 540/ 665-6395 MEMORANDUM TO: Finance Department FROM: Diane Walsh, Secretary I SUBJECT: Return Of Sign Deposit DATE: July 29, 2008 The amount of $50.00 was deposited in line item #3-010-019110-0008 for the person named below, as a deposit for one sign for Conditional Use Permit #06-08 for Helen H. Barley. She has returned the sign and is therefore entitled to the return of the deposit. You may pay this through the regular bill cycle. Please send a check in the amount of $50.00 to: Helen H. Barley 967 Marlboro Road Stephens City, VA 22655 107 North Kent Street, Suite 202 • Winchester, Virginia 22601-5000 T A X KI� U L l Y T FREDERICK COUNTY C. WILLIAM ORNDOFF, JR P.O. BOX 225 WINCHESTER VA 22604-0225 SIGN DEPOSITS PLANNING PLANNING 'Picket #:00006U2UU01 Date 6/06/2008 Register: JKH/LKHS3 Trans. #: 16070 Dept # 1095 Acct# Previous Balance $ 50.00 Principal Being Paid $ 50.00 Penalty $ .00 Interest $ .00 Amount Paid $ 50.00 *Balance Due $ .00 Pd by PLANNING Check 13197.00 # VARIOUS BALANCE DUE INCLUDES PENALTY/INTEREST THRU THE MONTH 6/2008 • 10 C a/ APR 2 g 2f Zoning Review for a Business icense Please provide the following information about your business. It is important at,alL o requested information is provided completely to ensure accurate review by the Planning Deen s . Incomplete applications may not be reviewed or approved. If you have any questions (zbout this form or the Zoning regulations of Frederick County, please contact the Planning Department at (540) 665-5651. Approval of this form is required prior to issuance of a business license. - - -- -a APPLICANT NAME: H H- lsatr(e.i DAYTIlvIE PHONE #: ,5_5/0 kG i STREET ADDRESS OF BUSINESS: (provide actual location of business - this address may be differentfrom the mailing address): 4F '7 W\ c. r L6 o r 0 h or, r, s "; OWNER(s) OF PROPERTY (ifjd,�ferentjrom applicant):BUSINESS/TRADE NAME: r te �. (oC r w` C�d"�� �� DESCRIPTION OF BUSINESS (please be as detailed as possible): C aL. r r e. is iCa. s"11' IF BUSINESS IS HOME -BASED (Home or Cottage Occupation): Frederick County home occupation businesses are not permitted additional employees, customer parking/reception, signage, outdoor storage, or more than one business vehicle on the property. Please answer the following: 1. Number of employees other than members of household: Z> 2. Will any new construction on alterations be necess : Yes No 3. Business will be located within: House Accessory Structure 4. Name of subdivision property is located within (where applicable): 5. Are any other businesses located on the property: Yes No (if so, please provide name and description of business IF BUSINESS IS LOCATED WITHIN A COM MRCIAL/INDUSTRIAL DISTRICT: All businesses located within the commercial and industrial zoning districts of Frederick County require an approved commercial site plan on file with the County. Please answer the following: 1. Will Any New Construction or Alteration be Required on the site: Yes No 2. Does this property have a Site Plan, approved by Frederick County: Yes No 3. If yes, the approved Site Plan number (available from Frederick County Planning): 4. Is the proposed business located within an existing building or shopping center: Yes No 5. If yes, provide the name of the shopping center/business/industrial park, etc. property is locatedwithin (where applicable): By submitting this form to the Planning Department, the applicant certifies that the provided information is true to the best of their knowledge. Please Do Not write Below This Line - For Planning Department Staff Review Only PROPERTY IDENTIFICATION # (PIN): �c/ -- �_l Z ZONING DISTRICT:1� Based upon the information provided by the applicant, is the use proposed for the above -referenced location permitted in the identified zoning district? YES !/ NO STAFF COMMENT: STAFF SIOINATURE: DATE: vIJ �J O • 0 M 11JECOPY COUNTY of FREDERICK Department of Planning and Development 540/665-5651 FAX: 540/ 665-6395 July 28, 2008 Mr. and Mrs. Kent Barley 967 Marlboro Rd. Stephens City, VA 22655 RE: Conditional Use Permit #06-08 Property Identification Number 74-A-13A Dear Mr. and Mrs. Barley: This letter is to confirm action taken by the Frederick County Board of Supervisors at their meeting on July 23, 2008. Conditional Use Permit #06-08 was approved for a Motel/Bed and Breakfast. Further conditions associated with the approval of the Conditional Use Permit include the following: 1. All review agency comments and requirements shall be complied with at all times. 2. Any proposed business sign shall conform to cottage occupation sign requirements and shall not exceed four (4) square feet in size. 3. No more than two (2) bedrooms to be used with the bed and breakfast use. 4. Any expansion or modification shall require approval of a new conditional use permit. If you have any questions regarding this action, please feel free to call this office. Sincerely, Cheran ,�— Zoning and Subdivision Administrator MRC/bad cc: Gary A. Lofton, Board of Supervisors, Back Creek District Cordell Watt and Greg Unger, Back Creek Planning Commissioners Jane Anderson, Real Estate Commissioner of Revenue 107 North Kent Street, Suite 202 • Winchester, Virginia 22601-5000 CONDITIONAL USE PERMIT #06-08 Qw4 ti� BARLEYFIELD FARM COTTAGE BED & BREAKFAST Staff Report for the Board of Supervisors Prepared: July 9, 2008 Staff Contact: Mark R. Cheran, Zoning Administrator This report is prepared by the Frederick County Planning Staff to provide information to the Planning Commission and the Board of Supervisors to assist them in making a decision on this request. It may also be useful to others interested in this zoning matter. Reviewed Action Planning Commission: 07/02/08 Recommended approval Board of Supervisors: 07/23/08 Pending LOCATION: This property is located at 967 Marlboro Road (Route 631). MAGISTERIAL DISTRICT: Back Creek PROPERTY ID NUMBER: 74-A-13A PROPERTY ZONING & PRESENT USE: Zoned: RA (Rural Areas) Land Use: Residential ADJOINING PROPERTY ZONING & USE: North: RA (Rural Areas) Land Use: Orchard South: RA (Rural Areas) Land Use: Orchard East: RA (Rural Areas) Land Use: Orchard West: RA (Rural Areas) Land Use: Orchard PROPOSED USE: This application is for a Motel/Bed and Breakfast REVIEW EVALUATIONS: VIRGINIA DEPARTMENT OF TRANSPORTATION: The application for a Conditional Use Permit for this property appears to have little measurable impact on Route 631, the VDOT facility which would provide access to the property. Prior to operation of the business, adequate sight distance west of the existing entrance (500 feet for 45 MPH) needs to be provided to allow 0 Page 2 CUP #06-08 — Barleyfield Farm Cottage B&B July 9, 2008 for safe egress and ingress of the property. Any work performed on the State's right-of-way to improve sight distance must be covered under a land use permit. The permit is issued by this office and requires an inspection fee and surety bond coverage. FIRE AND RESCUE: Plan approval recommended. INSPECTIONS DEPARTMENT: No change of use permit required when under five units if installed in an existing dwelling. Smoke detectors shall be installed per the Building Code. HEALTH DEPARTMENT: The increase in water usage will need to be addressed concerning the current water source and sewage disposal system. Also, the Health Dept. will need more information about all intended uses of the B&B. The issues presented in the letter dated May 12, 2008 have been addressed during a site visit on May 20 with Kent Barley. The Health Dept. is satisfied with the facility and once the conditional use permit is granted, please visit our office to fill out an application any pay the fees so a Bed & Breakfast permit can be issued. Planning and Zoning: The Frederick County Zoning Ordinance allows for motel uses in the RA (Rural Areas) Zoning District with an approved Conditional Use Permit (CUP). This proposed two (2) bedroom bed and breakfast will take place on 27 acres of land in a separate structure from the primary dwelling. The applicant will be serving meals as a part of the bed and breakfast use. The nearest structures from this proposed use are more than 150 feet away. There will be no employees associated with this proposed use, other than those residing on site. Based on the limited scale of this proposed use and evaluation of the property, it appears that this proposed use would not have any significant impacts on the adjoining properties. STAFF CONCLUSIONS FOR THE 07/02/08 PLANNING COMMISSION MEETING: Should the Planning Commission find this use to be appropriate, the staff would recommend the following conditions: 1. All review agency comments and requirements shall be complied with at all times. 2. Any proposed business sign shall conform to Cottage Occupation sign requirements and shall not exceed four (4) square feet in size. 3. No more than two (2) bedrooms to be used with the bed and breakfast use. 4. Any expansion or modification shall require approval of a new Conditional Use Permit. 0 • Page 3 CUP #06-08 — Barleyfield Farm Cottage B&B July 9, 2008 PLANNING COMMISSION SUMMARY AND ACTION OF THE 07/02/08 MEETING: The applicants were available for questions. There were no public comments. No issues or concerns were raised by the Planning Commission. The Planning Commission unanimously recommended approval of the conditional use permit with the same conditions recommended by the staff, as follows: I. All review agency comments and requirements shall be complied with at all times. 2. Any proposed business sign shall conform to cottage occupation sign requirements and shall not exceed four (4) square feet in size. 3. No more than two (2) bedrooms to be used with the bed and breakfast use. 4. Any expansion or modification shall require approval of a new conditional use permit. (Note: Commissioner Oates abstained; Commissioners Thomas and Ours were absent.) • O • C LLTON STTES ■ RRyHILL Barleyfield Far g� 74 A 9 Cottage B&B m n z ALEXANDER H B p Conditional Use 74 A 45 p' STAPLES ROBERT R Permit ■ `D CUP #06-08 ' ■ 0{ Application 73 A 97 H 6 E LC m ■ TOWN OF STEPHENS CITY " Location Map Parcel ID: 74 A 1oB ■_ W BRONANNEMARIEZ ■ Stephens Gity, VA 74 -A - 13A ��� - 74 A 43 73 A 99 ■ - HEATH CHARLES E & LINDA G RINKER PROPERTIES L.0 ■ _ � 74 A 158 i- O HUMPHRIES CHERYL W Map Features A4PLE BANKS NOR ■ ir' O HamletsTN 0 Application • ■ ■ w Z0� - _ 11 Urban Development Area ■ ■ _. ... ftP SWSA ci QZ= D Lakes/Ponds N ■ ^p C� 74 A 41 ^— Streams —� GERRY 0 FARM LLC o a ■ Ito ■ a 0 MARLSORp m�2 W � Y 2 • _ 74 A 13A ■ BARLEY KENT ■ ■ ■ ■ of 5 74 41 19 XIT INC o 12 j I m 74 A 18 WINCHESTER WAREHOUSING INC 74 A 13 ■ XIT INC: PAINTER HILL \\ \ ■ 73 A 104 Location in Surrounding Area WINCHESTER WAREHOUSING INC ■ 74 A N7NCHESTER r . 3 eet ■ WAREHOUSING J INC © Case Planner: Mark Map Document: (N:\Planning_And_Development\ 1_Locator_Mps\2008\BarleyfieldFarmCottage_CUP0608_0610O8.mxd) 6/10/2008 -- 9:15:31 AM \_J i S Barleyfield Far Cottage B&B Conditional Use Permit CUP #06-08 TOWN DF STEPHENS CITY Application ' Aerial Map i, Parcel ID: y� 74-A- 13A Stephens Gity, VA ' MapFeatures O Hamlets f I Y Q Application • Urban Development Area SWSA er 0 LakesiPonds -- Streams ,r YAR�ORp RDA f jf �p o .k • Location in Surrounding Area © Case Planner: Mark Map Document: (N:\PIan ning_And_Development\ 1_Locator Mps\2008\BarleyfieldFarmCottage_CUP0608_061008.mxd) 6/10/2008 -- 9:15:31 AM G 0 Submittal Deadline P/C Meeting BOS Meeting • APPLICATION FOR CONDITIONAL USE PERMIT FREDERICK COUNTY, VIRGINIA 1. Applicant (The applicant if the ✓ owner other) NAME: ADDRESS: TELEPHONE 5 4,)- Fb 5- /.;-:) 1 2. Please list all owners, occupants, or parties in interest of the property: 3. The property is located at: (please give exact directions and include the route number of your road or street) L cq c- Tcd 1,7 nA. #6,1 LJ•r!i� O 4-' /' I- /I (,,- 5-4,tkc t,-, -41 L/C. 2C-'L 4. The property has a road frontage of 'goo feet and a depth of I Zdo feet and consists of 27. 3 a acres. (Please be exact) 5. The property is owned by lee I',-f 30, r / e `, as evidenced by deed from W- ' I 1 c-,r 5 _ !3 a F I e > recorded (previous owner) in deed book no. 3 if on page 6,),gj , as recorded in the records of the Clerk of the Circuit Court, County of Frederick. 6. Tax(Parcel) Identification (I.D. )No. 7,V. A 13,E Magisterial District Rn k Current Zoning 7. Adjoining Property: USE North cc� rgn 14- inr4J 9W-0- . East o South West o4 c l'c-r 'A� ZONING n.A /3,A A -`EIVED MAY 1 2008 8. The type of use proposed is (consult with the Planning Dept. before completing) be� R.o a ,bec� d .%2e�-1e 1.. w% j �{�c rr•_0J.& Se4?_U!A 9. it is proposed:--that-,the following buildings will be constructed: 10. The following are all of the individuals, firms, or corporations owning property adjacent to both sides and rear and in front of .(across street from) the property where the requested use will be conducted. (Continue on back if necessary.) These people will be notified by mail of this application: NAME ADDRESS °I 7 MaP,16- ka,. PROPERTY ID # Al I t NAME APR--f�CQaL.LG ADDRESS PROPERTY ID# NAME a4± Le- ��—C ADDRESS PROPERTY ID# 7'� -- A NAME f.-li,,j4j� L , e &�t �►on v� (nl. __ ADDRESS PROPERTY ID#7ZZ=-- A -- 1 Z NAME 'ADDRESS PROPERTY ID# NAME ADDRESS PROPERTY ID# NAME PROPERTY ID# ADDRESS NAME ADDRESS PROPERTY ID# / r-a-r, erf, L AI svv , O..r?s �� . _ f!A —Pr) _fix &kp4nS .Ci 11. Please use this page for your sketch of the property. Show proposed and/or existing structures on the property, including measurements to all property lines. C'O Ate- 1 1 Sri, 1 -cr nrmnr PHASE TWO f wswxroroe.rm PRESERVATION LOT 'm1 ZaF'-?I 73-(A)-104 NATIONAL FRUIT ® 73-(A)-18 0 NATIONAL FRUIT ORCHARDS, INC INSTR, 010007327 ORCHARDS, INC ZONED: RA INSTR. 010007327 USE: ORCHARDS/ ZONED: RA AGRICULTURAL USE. -ORCHARDS f 104 ACRES 0 VER VIEW 1 "= 600' W Q 0 DATE: AUGUST 19, 2003 SCALE: 1" : 100' FILE NO. 0090 SHEET 1 OF 1 to � a 04/04/U1 16:49 FAX 54 7 8159 ll .I 11i_LUD-41M1N 1605 Apr 04 01 15:06 Edmunds Calaman,III 5-4390 p.5 IOTM- BOtAO�kT ST�IfY HEAeON 7415 OETERMNED RT A EfELO RUN 56RvEr SWEET 2 Oi R PERF'O(tMEp V ARTZ A: ASSOMTES ON SEPTEIWRER e, 2000_ n05 PLAT 15 SMtCT TO Ekq)Of1RS AND IRL57R1 rQ,?5 OP RECORn. O 1 L OTNER R1pT1;-oi'-HAy= ON EASEME1N[n.. IF AAN�1, ARE NOT yjDW IRS AT ZONED RA US(-' RFraDENTTAL Pitt Do' R/W CI C8 1 L�Z Z0 4D RA LbL REWENTIAE PIPE m_M7 L 15 131 �� IRS AT • 19.06• '1 cif AT 6D 8RL / j IB.E8' IRS AT P/F 15, 7 C�8 w 14EWBT VACATED p .� ONED RA Ri AT , USE.I01RES C RA(� / ` \ Q fh p v REpAR / USE RESIDEr,TW FOUND INS /3�•\ J} �\ 74-A-1i / F L12 ro / / ZONED RA Pr E �• USE: OXWO % IPF 5 ..lZ _,�1R5 <\ fly . ter@,6Es MOP // J-A- 0, ` V 1J2�J• PARCEL 2 Zase RA / I ( �. \ " / USE ORCPARD C: RESOENTIAL / \ w� ZONED Wt \ \ DST: ORGNAn /, Ki5 ►+i t`II 1Pr / - 13 1T�. PARCilEL 1 5SJ9 RES USE. ORC}IIM N LoW-MAlf. V "I IRS . REW SET fj - Rr - R[ Wi SOUND W262 CORrq,R (B ZONED RA W.- DIRCyM APE - 1RM ME FDuvo P051 IRS PDMI 1T>r+ED RA / 1y�118 ACR S USE: DRC1uRD `[Cx�"JP�K" ZONED RA q K {nAv/ ` ' G y�A�' USE: ORCNARO ✓U�8//�CI b�IW rvjLJI r(w () I w Nf PA. RVYj INC, Jam: fff" - 600 � VA2. K 8, 2000 #p pKM�7 75 A VBpff 775_ ra mo #14- MICHAEL M. AFTZ ; No. 1 1 PROJECT jwo195 Artz and AmodiLtes I ur ({ � mesas WKMMaxon" srmu b VIL M"7i-� a Ri ub--N?-Xw rn Uo-e67,11HO rlU FM i-b'--im 7S)0 ,Y/3a /a6 i J i I I J 12. Additional comments, if any: �jo&-ld %k, `- h� a I (we), the undersigned, do hereby respectfully make application and petition the governing body of Frederick County, Virginia to allow the use described in this application. I understand that the sign issued to me when this application is submitted must be placed at the front property line at least seven (71) days prior to the first public hearing and maintained so as to be visible until after the Board of Supervisors' public hearing. Your application for a Conditional Use Permit authorizes any member of the Frederick County Planning Commission, Board of Supervisors or Planning and Development Department to inspect your property where the proposed use will be conducted. Signature of Applicant Signature of owner Owners' Mailing Address Owners' Telephone No. 96 7 �-h k4 Ste- yo- 1a a a TO BE COMPLETED BY ZONING ADMINISTRATOR: USE CODE: RENEWAL DATE: r _��, �•Ry .;ems �����i„�%r � �..`'� �' / .-- � �" � � a '� y =. � • .._ Lim"". i � i , . `� �'CONDITIONAL USE 4�!A_ 1.4 PUBLIC HEARIN Board R11 Frederick County Administration Building04 .4.' * 665-5651 Ago- 07.17.2008 DEPT. OF GEOGRAPHIC INFORMATION SYSTEMS FREDERICK COUNTY, VIRG9-aA GIS, MAPPING, GRAPHICS WORK REQUEST DATE RECEIVED: 4�' ' REQUESTED COMPLETION DATE: /J REQUESTING AGENT: Department, Agency, or Company:_ Mailing and/or Billing Address: Telephone: E-mail Address: ESTIMATED COST OF PROJECT: FAX: DESCRIPTION OF REQUEST: (Write additional -information on back -of -request) C` Cup � 06 -68 Z fn f0 �- ip fl Lf yFI�L� R�r'� L'�4`t�s� PIAJ DIGITAL: PAPER: E_MAIL:...... SIZES: BLACK/WHITE: NUMBER OF COPIES: COLOR: BLACK STAFF MEMBER: COMPLETION DATE: MATERIALS: DATE OF PICK-UP/DELIVERY: AMOUNT DUE: AMOUNT BILLED: METHOD OF PAYMENT: HOURS REQUIRED: AMOUNT PAID: CHECK NO.#, Frederick county GIS, 107 North Kent Street, Winchester, VA 22601, (540)665-5651) E COUP CONDITIONAL USE PERMIT #06-08 BARLEYFIELD FARM COTTAGE BED & BREAKFAST w Staff Report for the Planning Commission Prepared: June 12, 2008 1)JP Staff Contact: Mark R. Cheran, Zoning Administrator This report is prepared by the Frederick County Planning Staff to provide information to the Planning Commission and the Board of Supervisors to assist them in making a decision on this request. It may also be useful to others interested in this zoning matter. Reviewed Action Planning Commission: 07/02/08 Pending Board of Supervisors: 07/23/08 Pending LOCATION: This property is located at 967 Marlboro Road (Route 631). MAGISTERIAL DISTRICT: Back Creek PROPERTY ID NUMBER: 74-A-13A PROPERTY ZONING & PRESENT USE: Zoned: RA (Rural Areas) Land Use: Residential ADJOINING PROPERTY ZONING & USE: North: Orchard Land Use: RA (Rural Areas) South: Orchard Land Use: RA (Rural Areas) East: Orchard Land Use: RA (Rural Areas) West: Orchard Land Use: RA (Rural Areas) PROPOSED USE: This application is for a Motel/Bed and Breakfast REVIEW EVALUATIONS: VIRGINIA DEPARTMENT OF TRANSPORTATION: The application for a Conditional Use Permit for this property appears to have little measurable impact on Route 631, the VDOT facility which would provide access to the property. Prior to operation of the business, adequate • 0 CUP #06-08, Barleyfield Farm Cottage B&B June 12, 2008 Page 2 sight distance west of the existing entrance (500 feet for 45 MPH) needs to be provided to allow for safe egress and ingress of the property. Any work performed on the State's right-of-way to improve sight distance must be covered under a land use permit. The permit is issued by this office and requires an inspection fee and surety bond coverage. FIRE AND RESCUE: Plan approval recommended. INSPECTIONS DEPARTMENT: No change of use permit required when under five units if installed in an existing dwelling. Smoke detectors shall be installed per the Building Code. HEALTH DEPARTMENT: The increase in water usage will need to be addressed concerning the current water source and sewage disposal system. Also, the Health Dept. will need more information about all intended uses of the B&B. The issues presented in the letter dated May 12, 2008 have been addressed during a site visit on May 20 with Kent Barley. The Health Dept. is satisfied with the facility and once the conditional use permit is granted, please visit our office to fill out an application any pay the fees so a Bed & Breakfast permit can be issued. Planning and Zoning: The Frederick County Zoning Ordinance allows for motel uses in the RA (Rural Areas) Zoning District with an approved Conditional Use Permit (CUP). This proposed two (2) bedroom bed and breakfast will take place on 27 acres of land in a separate structure from the primary dwelling. The applicant will be serving meals as a part of the bed and breakfast use. The nearest structures from this proposed use are more than 150 feet away. There will be no employees associated with this proposed use, other than those residing on site. Based on the limited scale of this proposed use and evaluation of the property, it appears that this proposed use would not have any significant impacts on the adjoining properties. STAFF CONCLUSIONS FOR THE 07/02/08 PLANNING COMMISSION MEETING: Should the Planning Commission find this use appropriate, Staff would recommend the following conditions: 1. All review agency comments and requirements shall be complied with at all times. 2. Any proposed business sign shall conform to Cottage Occupation sign requirements and shall not exceed four (4) square feet in size. 3. No more than two (2) bedrooms to be used with the bed and breakfast use. 4. Any expansion or modification shall require approval of a new Conditional Use Permit. • 0 CUP #06-08, Barleyfield Farm Cottage B&B June 12, 2008 Page 3 Following the requisite public hearing, it would be appropriate for the Planning Commission to offer a recommendation concerning this application to the Board of Supervisors. , _ . r' ! r COUNTY of FREDERICK Department of Planning and Development 540/665-5651 FAX: 540/ 665-6395 NOTIFICATION OF PUBLIC HEARING July 9, 2008 TO: THE APPLICANT(S) AND/OR ADJOINING PROPERTY OWNERS(S) RE: CONDITIONAL USE PERMIT APPLICATION #06-08 FOR BARLEYFIELD FARM COTTAGE BED & BREAKFAST On behalf of the Frederick County Board of Supervisors, you are hereby notified of a public hearing being held on Wednesday, July 23, 2008, at 7:15 p.m. in the Board Room of the Frederick County Administration Building at 107 North Kent Street, Winchester, Virginia to consider the following application: Conditional Use Permit #06-08 for Barleyfield Farm Cottage Bed & Breakfast, for a Cottage Occupation — Bed & Breakfast. This property is located at 967 Marlboro Road (Route 631), and is identified with Property Identification Number 74-A-13A in the Back Creek Magisterial District. Any interested parties having questions or wishing to speak may attend this public hearing. A copy of the agenda will be available for review at the Handley Library and the Bowman Library the week of the meeting, or at the Department of Planning and Development located at 107 North Kent Street in Winchester, Virginia. Information regarding this application will also be available via the Planning Department's website at www.co.frederick.va.us. SiWR6 Zoning Administrator MRC/bad 107 North Kent Street, Suite 202 - Winchester, Virginia 22601-5000 This is to ce tif„y that the attached correspondence was mailed to the following on from the Department of Planning and Development, Frederick County, Virginia: 74 - A- - 13-A BARLEY KENT 967 MARLBORO RD STEPHENS CITY VA 74 - A- - 13- XIT INC 967 MARLBORO RD STEPHENS CITY VA 74 - A- - 10-D APR MINI -STORAGE LLC 127 MERCEDES CT WINCHESTER VA 74 - A- - 10-C HOTTLE JANICE M 111 CARTERS LN STEPHENS CITY VA. 74 - A- - 15-B HUMPHRIES CHERYL W LEWIS, PAMELA W LEWIS PAMELA W PO BOX 141 STEPHENS CITY VA STATE OF VIRGINIA 74 - A- - 19- STAPLES CHARLES WILLIAM PO BOX 986 STEPHENS CITY VA 22655-0986 22655-5247 22655.5247 22603-4638 22655.5210 22655.0141 2 Mark R. heran, Zoning & Subdivision Administrator Frederick County Planning Department COUNTY OF FREDERICK I, , a Notary Public in and for the State and County aforesaid, do he 6 y certify that MaiV R. Cheran, Zoning & Subdivision Administrator for the Departme t of Planning and Development, whose name is signed to the foregoing, dated , has personally appeared before me and acknowledged the same in my State and Co my aforesaid. Given under my hand this q�day of My commission expires on BEVERLY H. DELLINoil N0�'ID N 331878 COMMONWEq TH Op. VIRGINIA MY COMMISSION EXPIRES JULY 31. 2011 /. X0 it %/ _ I zOW r, 4 / 6— COUNTY of FREDERICK Department of Planning and Development 540/665-5651 FAX: 540/ 665-6395 NOTIFICATION OF PUBLIC HEARING June 20, 2008 TO: THE APPLICANT(S) AND/OR ADJOINING PROPERTY OWNERS(S) RE: CONDITIONAL USE PERMIT APPLICATION #06-08 FOR BARLEYFIELD FARM COTTAGE BED & BREAKFAST On behalf of the Frederick County Planning Commission, you are hereby notified of a public hearing being held on Wednesday, July 2, 2008, at 7:00 p.m. in the Board Room of the Frederick County Administration Building at 107 North Kent Street, Winchester, Virginia to consider the following application: Conditional Use Permit #06-08 for Barleyfield Farm Cottage Bed & Breakfast, for a Cottage Occupation - Bed & Breakfast. This property is located at 967 Marlboro Road (Route 631), and is identified with Property Identification Number 74-A-13A in the Back Creek Magisterial District. Any interested parties having questions or wishing to speak may attend this public hearing. A copy of the agenda will be available for review at the Handley Library and the Bowman Library the week of the meeting, or at the Department of Planning and Development located at 107 North Kent Street in Winchester, Virginia. Information regarding this application will also be available via the Planning Department's website at www.co.frederick.va.us. Sincerely, 0-�`�ark R. Cheran Zoning Administrator MRC/bad 107 North Kent Street, Suite 202 • Winchester, Virginia 22601-5000 • • This is to certify that th attached correspondence was mailed to the following on from the Department of Planning and Development, Frederick County, Virginia: 74 - A- - 13-A BARLEY KENT 967 MARLBORO RD STEPHENS CITY VA 74 - A- - 13- XIT INC 967 MARLBORO RD STEPHENS CITY VA 74 - A- - 10-D APR MINI -STORAGE LLC 127 MERCEDES CT WINCHESTER VA 74 - A- - 10-C HOTTLE JANICE M 111 CARTERS LN STEPHENS CITY VA. 74 - A- - 15-B HUMPHRIES CHERYL W LEWIS, PAMELA W LEWIS PAMELA W PO BOX 141 STEPHENS CITY VA STATE OF VIRGINIA COUNTY O 74 - A- - 19- STAPLES CHARLES WILLIAM PO BOX 986 STEPHENS CITY VA 22655-0986 22655-5247 22655-5247 22603.4638 22655.5210 22655.0141 Mar R. Cheran, Zoning & Subdivision Administrator Frederick County Planning Department I, , a Notary Public in and for the State and County aforesaid, do ereby certify that Ma . Cheran, Zoning & Subdivision Administrator for the Depart nt Planning and Development, whose name is signed to the foregoing, dated has personally appeared before me and acknowledged the same in my State Ad Co my aforesaid. Given under my hand this r26 day of My commission expires on BEVERLY H. DELLINGER NOTARY ID #E 331878 NOTARY 06 zl'e COMMONWEA THUOFIVIRGINIA ����///Ae , MYCOMMISSIONEXPIRES JULY31,2011 NOTARY PL&LIC 8. The type of use proposed is (consult with the Planning Dept. before completing) be d Q.o a" bed d ,b 1 A -le 4A L L- / 17 *- n—.4.1 Se t-. !& 9. It is proposed that the following buildings will be constructed: 10. The following are all of the individuals, firms, or corporations owning property adjacent to both sides and rear and in front of (across street from) the property where the requested use will be conducted. (Continue on back if necessary.) These people will be notified by mail of this application: NAME X L L h L ADDRESS % 1 M aPA ozz iLe,4 PROPERTY ID# N - c� NAME NPR i✓i1 - �fyrQa� LLC ADDRESS R7 4_ `cs'Ce-a0pz %, PROPERTY ID# /Q,D NAME {- . may, i ADDRESS L A/ PROPERTY ID# 7q — A - Inc C` � - [1A NAME ADDRESS PROPERTY ID#� NAME ADDRESS PROPERTY ID# NAME ADDRESS PROPERTY ID# NAME ADDRESS PROPERTY ID# • • REQUEST FOR CONDITIONAL USE PERMIT COMMENTS Virginia Department of Transportation Attn: Resident Engineer 14031 Old Valley Pike Edinburg, Virginia 22824 (540)984-5600 The local office of the Transportation Department is located at 2275 Northwestern Pike in Winchester if you prefer to hand deliver this form. Applicant's name, address and phone number: ��ele►. i�Ma¢.►v� / C � Ie u 1'-', e 1 � (-a,e.�, %''�`" /�� g-i k as/ L, ram. i ( -� I ne z -xi. K 540-&101-1111 - Name of development and/or description of the request: Location: 9 4 ? lY�o R.16 2d ::S'C�. ' 1r& Zz b =— /.� m.lcs ti�es1- e, R#- If in Sfe.Pkens Ut. Va. Dept. of Transportation Comments: The aDDlication for a Conditional Use Permit for this oroDerty appears to have little measurable impact on Route 631, the VDOT facility which would provide access to the property. Prior to operation of the business adequate sight distance wesf ot the existing entrance MPH), needs to be piovided to allow f0i safe egress and ingress of the prope". Any W8F'( p@pfQrP4.LQd Ap. thip State's pight-Gf-way tQ improve sight Histance MiiSf he Coverpri under a land use permit. The permit is issued by this office and requires an inspection fee and surety bond coverage. (/ C j VDOT Signature and Date: c' 92 e1`'t I 1 (NOTICE TO RESIDENT ENGM E#*PLEAWRETUP4 THIS FiDRM TO APPLICANT.) NOTICE TO APPLICANT It is your responsibility to complete this form as accurately as possible in order to assist the agency with their review. Also, please attach two (2) copies of your application form, location map and all other pertinent information. 0 0 REQUEST FOR CONDITIONAL USE PERMIT COMMENTS Frederick County Fire Marshal ATTN: Fire Marshal 1080 Coverstone Drive Winchester, Virginia 22602 (540) 665-6350 The Frederick County Fire Marshal is located at 1080 Coverstone Drive, at the Public Safety Building if you prefer to hand deliver this review form. Applicant's name, address and phone number: He -ten �e Y �F � ley -Pe-4 *6a—A, Co a1a4-�+ Rio? 13C'S'i Name of development and/or description of the request: IVetX-- K &"tDIV ac Aedoeo 0 1- '4'j --- Xl-i 'j e Location: I nY'(eS Wesi- k & II " S' 'q 7 fYlQA(L6" ko-A Fire Marshal Comments: Fire Marshal Signature & Date (NOTICE TO FIRE MARSHAL - PLEASE RETURN THIS FORM TO APPLICANT.) NOTICE TO APPLICANT It is your responsibility to complete this form as accurately as possible in order to assist the agency with their review. Also, please attach a copy of your application form, location map and any other pertinent information. ir rom: L I FESAFE . 05/&008 11 : 21 #085 P.001/001 - _ frederick_ Ctsun- lire att -Y :-.. �:-.. d Rescue._.:::::-`:..:.:_ -....-...- .............-.-..... -... -. - . .::......:.. .�.:... Elf!ce:=6f:the:�F :.:...:... :.: .:::Cirirti e yr era R.., t€d Control number Date received Date reviewed Date Revised 4/30/2008 5/612008 Project Name Applicant Barleyfield Farm Collage Bed & Breakfast Helen Barley Address City State Zip Applicant Phone 967 Marlboro Road Stephens City VA 22655 540-869-1222 Type Application Tax ID Number Fire District Rescue District Conditional Use 74-A-13A 11 11 Current Zoning Election District R Recommendations Back Creek Automatic Sprinkler System Automatic Fire Alarm System Residential Sprinkler System No Yes Yes Other recommendation Emergency Vehicle Access Hydrant Location Fire Lane Required Not identified No Siamese Location RoadwaylAisieway Width Special Hazards No Emergency Vehicle Access Comments Access Comments Additional Comments Plan Approval Recommended Reviewed By Signature Yes J Neal Title I FIERICK COUNTY FIRE & RESCUE DEATMENT OFFICE OF THE FIRE MARSHAL 1080 Coverstone Drive Winchester, Virginia 22602 (540)665-6350 Date: Street No. Street Name Suite/A t. l..f. 71 ]r Occupant / Business Name Telephone II Manaeer/ReDresentatjve Telephone II 11 Building Owner's Last Name Owners Address Telephone 11 Fire Prevention Permit No. Re -Inspection Date Max Load TYPE OF INSPECTION I . Kitchen / hood 2. Sprinkler / ss 3. Alarm system 4. Overhead door 5. yd New building 6. ❑ Burning permit 7. ' Blasting S. Fumigation 9. a Tent 10. ❑ Plan review 11. ❑ UST installation 12. ❑ UST leak 13. ❑ UST removal 14. ❑ UST liquid spill 15. ❑ Annual inspection 16. ❑ Complaint 17. 7 Violation 18. Fire lane inspection 19. Fire lane approval 20. Re -inspection 21. Other INSPECTION GUIDELINE - CORRECTIONS REQUIRED The Following Conditions Need Corrections: BUILDING EXIT AND EGRESS 061. Unapproved or defective gas connection ❑ 1. Space under stairs used for storage purposes 031. Inadequate means of egress 062. Damaged or deteriorated vent pipe on gas burning ❑ 2. Broken ceilings and/or walls -exposed lath on 032. Second means of egress not readily accessible appliance ceilings and/or wall *unnatural openings) 033. Aisles and/or passageways obstructed 063. Vent hood, vent and/or duct systems need cleaning ❑ 3. Defective and/or unapproved incinerator and/or 034. Panic hardware (anti -panic latches & bolts) 064. Combustibles being stored near hot water heater spark arrestor screen required on exit doors ORDINARY HAZARDS 114. Cardboard ceilings and/or walls 035. Discharge from exits, outside building, etc 065. Poor housekeeping conditions ❑ 5. Fire door not serviceable 036. Exitway blocked and/or obstructed 066. Improper storage o 6. Fire door blocked or wedged open 037. Exit door locked and/or barricaded 067. Storage of floor oils, cleaning compounds, etc. 117. Oil soaked wood floors 1138. Exit not properly designated or marked ❑68. Storage of excelsior, straw, sawdust, burlap, etc o 8. Attic areas open to the outside. Screen to prevent ❑39. Exit lights provided by not operative 069. Metal drip pans required, but not provided entry by birds. 040. Illuminating directional signs to exits required ❑70 Excessive grease on stove ❑ 9. Door requiring self -closing device not so equipped 041. Exit door swinging against line of exit travel 071. Cockloft cover off ❑ 10. Prohibitive -should be razed ❑42. Stairways not properly enclosed and/or equipped 072. Unapproved trash containers ❑ 11. Open and exposed foundation beneath building with non-standard doors SPECIAL HAZARDS ❑ 12. Post max occupancy load 043. Stairways not properly illuminated 1173. Unnecessary and/or disorderly accumulation of ELECTRICAL ❑44. Emergency white lights Boxes, etc. collapse -maintain orderly arrangement ❑ 13. Illegal and/or boot -leg wiring FIRE PROTECTION 074. Smoking in hazardous location. "No Smoking" ❑ 14. Inadequate service and/or insufficient circuits 045. Fire extinguishers required, but not provided signs needed ❑ 15. Insufficient receptacles ❑46. Fire extinguishers need recharginglinspection ❑75. Flammable liquids/gases improperly used/stored ❑ 16. Defective, deteriorated or spliced wiring 047. Unapproved type fire extinguishers 076. Inadequate ventilation in hazardous location 1117. Defective and/or broken fixtures 048. Fire extinguishers not properly mounted 4"-60" 077. Storage of compressed gas cylinders without 1118. Defective and/or broken switches and/or sockets 049. Fire extinguishers not readily visible proper anchorage (racks or chains) ❑ 19. Circuit breakers by-passed or blocked open 050. Standpipe hose deteriorated/not racked 078. Oxygen cylinder stored/used in greasy/oily location 1120. Oversize fuses and/or circuit breakers set too high 051. Fire protection system 079. Oxygen cylinder stored near acetylene/fuel gas cyl 021. Pennies behind plug type fuses 052. Defective standpipe nozzle 080. Oxidizing material stored with acids, sulfur, etc 022. Metal strip of fuse holder cut back 053. Standpipe system disconnected 081. Unapproved and/or hazardous paint spraying ❑23. Fuses jumped or bridged 054. Sprinkler heads, cut-offs or Siamese blocked ❑82. Trash room door not equipped w/self-closing device 024. Open junction box and/or fuse box 055. Inadequate sprinkler head clearance (18" required) ❑83. Open flame heating in hazardous location -125. Fuse panel obstructed and/or inaccessible 30" 056. Sprinkler valves not properly identified ❑84. Vacant at time of inspection 26. Motors and/or fans dirty or dust covered HEATING AND COOKING ❑ 85. Locked at time of inspection 27. Unapproved extension cords/drop cords 1157. Defective heating unit-fumace, gas boiler, stove, etc [186. See supplement sheet 28. Excessive use of multiple outlet plugs 058. Defective cooking unit -range, hot plate, etc 7, IN THE OPINION OF THE INSPECTOR, ❑29. Lamps, fixtures, equipment, etc. Not properly ❑59. Gas meter blocked and/or obstructed/not protected THERE WERE NO HAZARDOUS enclosed (hazardous locations only) 1160. Furnace, boiler, heating, cooking and/or smokepipe CONDITIONS IN THIS AREA AT THE 030. Dead and unused wiring; should be removed and vent pipe clearances from combustible TIME OF THIS INSPECTION materials, not standard COMMENTS: Inspector (print) I Spector signature) Received by (print) Received by (signature) K • 0 REQUEST FOR CONDITIONAL USE PERMIT COMMENTS Frederick County Inspections Department Attn: Building Official 107 North Kent Street, Suite 200 Winchester, Virginia 22601 (540) 665-5650 The Frederick County Inspections Department is located at 107 North Kent Street, 2nd floor of the County Administration North Building in Winchester, if you prefer to hand deliver this review form. Applicant's name, address•and phone number: i-Ic?&A I djUe u ' k GGL21ey-1 ire Id_hzRrrl UM -f e- Q•b _ Iq , I nUeu�blw (d" 540 Name of development Location: 1•'1 6-i,Ies r description of the request: Inspections Department Comment: r Code Administrator Signature & Date: (NOTICE TO INSPECTIONS DEPT*1 enS s-L—�.►-ri C_v © USL •Q N �r i• G� ✓e �^ FORM NOTICE TO APPLICANT It is your responsibility to complete this form as accurately as possible in order to assist the agency with their review. Also, please attach two (2) copies of your application form, location map and all other pertinent information. • REQUEST FOR CONDITIONAL USE PERMIT COMMENTS Winchester -Frederick County health Department 107 North Kent Street, Suite 201 Winchester, Virginia 22601 (540) 722-3480 /The, Winchester -Frederick County Health Department.is located in the County Administration Building at 107 North Kent Street in Winchester, if you prefer to hand delivered this form. Applicant's name, address and phone number: �efe n �/IZa Iev (eV Aye fd Q,,, 0,4k,,., 6a a.d MM R to Name of Bevel pment and/or description of the request: deb �'2ea.h 4&/-- a &WOOd•>ft i o (a.; i I I D R,e.D a.Q,e_ Vo o ci ; n m.. l.o • - 4--tZ._ -L A 4--Q u Location: l•% /h;/&s Weain 'l(9 MaR-Ibov. P-&a4 It eita Rk rt:nc(,�+H. j aft- O-e'.i r �7 �S ti `sP/ ��f (1/I/13i'� a t,// 8 tkj o `�/® oy, of Aet �a a $ d d-+�Jr�'ii U/ P" iT ea,h2 i`SI✓e!(� NOTICE TO APPLICANT ; 'l:0 It is your responsibility to complete this form as accurately as possible in order to assist the 547"101, agency with their review. Also, please attach a copy of your application form, location map and all other pertinent information. Lord Fairfax Environmental Health District 107 N. Kent St. Winchester, Virginia 22601 (540) 722-3480 FAX (540) 722-3479 Counties of- Clarke, Frederick, Page, Shenandoah, Warren, and City of Winchester Helen Barley May 12, 2008 967 Marlboro Rd. Stephens City, VA 22655 Subject: Request for conditional use permit comments. Mrs. Barley, The Frederick/Winchester Health Department will require additional information and clarification on the proposed bed & breakfast. No information was available under the tax map number listed on your request, however, two older permits dating back to 1957 and 1960 were found under the name Miller Barley. Any records for the septic system and water supply will aid in your request. A site visit may be necessary to match the older permits to your property. The older permits for Miller Barley are for a two (2) bedroom on one property and a one (1) bedroom on the other. If the cottage were to be added on as a bed & breakfast, the Health Department would need to verify the existing drain -field on your property could handle the increased water usage or if additional facilities would need to be added. The Health Department would also need a yearly water test from an approved water source. Please provide information for the source of potable water for the proposed bed & breakfast. Also, be aware the Planning and Zone Department have restrictions on more than one structure being connected to the same sewage disposal system. Please elaborate on the number of meals that will be provided to the guest of the bed & breakfast. The Commonwealth of Virginia Board of Health Food Regulations state " a bed & breakfast operation that prepares and offers food only to guests if the home is owner occupied, the number of available guest bedrooms does not exceed six, breakfast is the only meal offered, the served does not exceed 18, and the consumer is informed by statements contained in published advertisements, mailed brochures, and placards posted at the registration area that the food is prepared in a kitchen that is, by these regulations, exempt from this chapter." Basically, no additional food facility permit is needed. However, if additional meals are offered or other criteria are not met, then a food facility permit will be required and the food regulations enforced in addition to the bed & breakfast permit. Lastly, please list any additional uses of the bed & breakfast or kitchen facility like temporary events, festivals... that may require further thought and planning by the Health Department. If there are any questions, please call at 540-722-3480 or email at matthew.cloud@vdh.vir irg Zia. og_v. Matthew Cloud, Environmental Health Specialist Senior 44� 411 tptv,Aj j1A 2�r �c� r ✓n"' % 5lit''r� RECORD Sy INSPECTION SEWAGE DISP� -7& totd�� W K�11 rDate 64 0Case No. Owner Addres Phone � ,/%/ ,/ - (Mailing Addre• Occupant—�//1�.�►���/ Address ��Gl--J Phone (Mailing Address) Exact Location of Premises 1 a vision, StreVlor Road Name, Sectiojeor Lot • WATER SUPPLY INSPECTION Installed According to Permit Design- ❑ Yes ❑ No. Distance to Nearest House Sewer feet. Distance to Nearest Sewage Disposal System feet. (Use Form LHS-143 for Detailed Inspection of Water Supply Reference Materials.) SEWAGE DISPOSAL SYSTEM INSPECTION (1) LOCATION: Alloted Area quate: es ❑ No. Distance from near- est: Lot Line eet._Trees -%Q feet. Water Supplies -MZ feet. _Buildings 1� feet. (2) INSTALLATION AND DESIGN: Installed According to Rermit Design: elYes ❑ No Have Additional Household Appliances Been Added NOT on Permit: ❑ Auto asher ❑ Garbage Disposal ❑ Other ���' (Describe) (3) SOIL CONDITION: Are there soil conditions now evident which indic system may be unsatisfactory as designed: ❑ Yes LJONo. If Yes, show adjustments required under "Remarks" below. (4) HOUSE SEW LINE: ` Installed- s No'.". Ty e of material: 14 Size nches. (5) SEPTIC TANK: Constructed of _ nd of Material) Inside Dimensions- Length feet. Width _feet. Liquid Depth feet. Depth of Air Space nches. Inside Fittings comply with requirements: es ❑ No. Septic Tank Contractor: — Address (6) DISTRI UTION BOX: Wa ight and equal surcharge to each line by Water Test: es ❑ No. Distribution Box provided wit (Number) extra outlets for future use (7) SUB -SURFACE ABSORPTIONJIELD: Total Area in Bottom of itche square feet. Number of Ditches _' Lent of Ditches feet. Grade of Ditches • 'Minimum Inches per 100 feet. Maximum _ inches per 100 t. Has system been checked by instruments (L 1) es ❑ No Type Aggregate Used Depth of Aggregate Under Tile inches Total Depth of Aggregate inches Depth of Backfill Over Aggregate .?,A inches (8) SURFACE DRAINAGE: Storm Drains from House and Ba ent Flowing Away from Sub -Surface Drainage Field: Yam' ❑ No. Was Surface Drainage Required: ❑ Yes i o. If Yes, has this been provided: ❑ Yes ❑ No. Has area been drain y lower- ing Ground Water Table: ❑ Yes ❑ No of quired. (9) Are follow-up inspections necessary: ❑ Yes j2'No• Phone This System (Is) +I-P-NttMpproved by Z " l�l..L.+L Health Department. With proper maintenance, approved systems may be expected to function satisfactorily, provided no overloading or physical dam- age occurs to the system. Remarks: Date Date Approved ' (Health Director) Date Approved Date Approved Virginia Department of Health LHS - 141 11-57 (Advisory Sanitarian) (Reviewing Authority — Other Agency) ►1 wand/or SEWAGE DISPOSSYSTEMS ice..-•"'�' Date ` (�a' se No. Owner "°" Address • ...y� 44a_/'if7ing_.'�_ Phone s Occupant �'� t�-�°'�'-.�e./'� Address Mailing Address Phone Exact Location �+ of Premise..-_ —� F Subdivision, Street or ad DFame, Section/- of o.) OWNER SIRES TO FOR NSTALL ❑ REPAIR Wolflwelling ❑ Other ❑ WV,cr Supply System ❑ Water Supply System Actual or potential Bedrooms ewage Disposal System p _Actual or estimated Water y ❑Sewage Disposal System Con,ur::.ti,,r, ❑ Septic Tank Coins Tank t' gal. per day Automatic Washing Machi Health Department recommen� Yes o Garbage Disposal unit ❑ Yes No. di- 1 wastes DETAILS OF RECOMMENDED SYSTEMS (1) WATER SUPPLY ar. to be approved by Sanitarian. Type ❑ Drilled Well Dr' `d}1 ❑ Bored Well ❑ Dug Well ❑ Other Cased feet. Casing to be properly sealed and vented if necessary. Casing to extend at least 6 inches above pump room floor. Grouted feet. All sur- face drainage to flow away from water supply. Well to have a platform of concrete or other impervious material, at least 4 inches thick at casing, extending at least 24 inches in all directions from casing, gently sloped for drainage. (2) SOIL STUDY Naturally drained, s ' able -by s' es ❑ No Technical Classification --_ -- +� �" , e 5 Rough Classification ❑ Sandy odium ❑Clay ❑ Pipe Clay. Percolation Test required ❑ Yes [�.Pf'o Rate '^""""` Minutes per inch. 'Depth of Water Table ' feet stimated) Surface drainage required [] Yes Ll � Area D inage by Lowering Ground Water Table required [IYes 1�1'r O e h Sketch of Premises (including adjacent properties if pertinent, Showing Location of Lot Line, Buildi Trees, and Other Possible Sources of Cont;�t' r, of Water Supplies, by Indicating Distances and Slope (3) D� S OF CON TRUCTION Watertight Septic Tank of (Kind of Material) Z f,Inside Dimensions Length eet. Widthfeet. Liquid Depth feet. Depth of Air Space - """ feet. Li uid Capacity,&el gallons. (4) HOUSE S E LINE Size inches. Type of material requir istance from Water Supply feet. (5) SUBSURFACE ABSORPTION FIELD Distribution Box required. Ditches of equal len th required. Number of squ feet required Type aggregate required roken Stone Gravel 0 Slag. Size range om tz inches to 2% in Deptli of aggregate from base of tile to bottom of ditches inches. Total aggregate must equal minimum depth�� inches or more. Soil Cover over tile not to exceed Jr inches. Distance from Sewage Disposal S stem to the nearest point of a Water Supply System will be f et. Water Supplies, Sewage Disposal Sys - regard to one another. �Dp. dddnnnttt _feet Note: Owner or his agent must natif.»^p t �» „�—,rsady for inspection. If any $enragal health De artment, Phon •/ 1 .at the direction of the Health Direct y'Yem' or part taereof, is covered before being inspected by the Health Department, it shall b installation uncovered Director or his agent. CONDITIONS DISCOVERED DURING INSTALLATION MAY REQUIRE ADJUSTMENTS OF SYSTEM DESIGN. Changes from above specifications require health Department approval before being made. Based on the above information, the undersigned recommends that this permit he issued. r Date Approved (Reviewing Authority) — D�.S�aed 4.itaia. .,` LHS - 121 Rev. 11-57 a ealth Direc.or) Virginia State Department of Health ^•��a RECORD O ISPOSA r U°p LY ?�$ "rAkt`►! �' � a .J , 4r. Case No. r t,G ANEW :INSTALLATION dz ty or nicpalrty 4• ADDRESS llr �, PHONE OIL: ,..«..�.. MM jV 34 S e Dwe ng Unit Mule le we�linS 'I�lumbe of BedtOoms or tial _ Unu ..6, ... .. _ .accost , . LOT =a,-, Widob � �?'."d,_+' ..:: y".".'.'p1R.'-:<^'v'.+rtc r.'^:t'^¢u' . :.'!"_»+. • Yi-„`f-''7. :. u : �;ak'._ '`t'�IIPIF,..a�wrc_s:"Nm. .._�.s, y�'iAew+iii�i:e SEWAGE DISPOSAL: stem" ❑ Othet , .._..,..:..:..»,.M _...,, .:, ..'„.,.:r- ..h.�r -•, describe a _ „. " ' TF '"6rbage�dispos der�xm++Xes Atttomauc 4undr elWfariuny�-� _ . Intl wastes- _. ..DESK. .. . Dose Sewer lei ize _ • . Type_. �••.M..., dank capacity''` Gallons Tank ensions' e 1 , _ #h!n �" ". &�E !t: �Width7" ` � :, fL` ft. .•�, .. -� _ �`*; Subsurface- ra na e N f, 4 ; ,Total ra ge " A A s A� .. INSPECTION I�INDINGSe' v,(I) . LOCATION. Lot ad�a�tc Y sys�S� (5a) D�AGE FiE�.p Total _ dtti� 1. �acrgte>c r w oL" ttpl kngtl :•, ated rtlatty } e v ' x 1�[0;, a; Aee, erly locate es No 00 " of es o£ open grade s © No: D es Laid- ` o tcoter*- ratiisa es O.A.- X:•�a _ fir- _, . � .-� " t'o4 -cs- tr _, -.,, .. •...�..,.:..., .... _..r _. _;. a" 5b) E�ReF2lVAGE als;- etc.), " DOA - ttts ` pra8tetiCed No. with approved strips yYes El No. Approved fit material �na}�`��e r am• .. Q Aioa di- of filter matem "tinder the rttyes catttp y gttleetfilrn es N oran drains from 7 t ` c g tofik _dira fiat 3tol s e( rat nevi d b% tmne „ owlsl bn Yes re5§ n±w tlowin J f tr g4 fiieldSee es N es pro DIAS szrttlz es 7rTo 'Ii"r%�ioit`t tts ' LigfitT ° es Sao w "w i equate 'numb Lets �"t 'd is �» connected to outlets and leading, nito 3"u iurface ditches"tqo, 1 Surcharge I a e lines graded to I or more S S o e to'10 feet length" ' - ' � es ❑ No. REMARKS; v t � B on the above information, this is to certify" &i this system ( has) _ ( has ner) been located and installed according to Local State Req ements. System requires roper a and adequate maintenance. Va Date, t. A MEW # Signed*=*€:. (Inspector) (Title)lei Signed (Reviewing Official) i (Title) With proper maintenance and avoi` -of overloading, this system can be expected to-4unctiota..satisfactorily if no physical damage occurs to any part of :the system and favorable soil conditions coiftioite:•.. Follow-ups: Date e Va. State Depf,'of Health LHS-141-50M New Installation Ll Repairs Date ' PERMIT TO INSTALL OR IREPA' WATER SUPPLY AND/OIL SEWAGE DISPOSA SYSTEM F Owner Address -L - (Mai ng Address Phone (Must be filled in)-0 d :? ) Occupant '# Address Phone " (Mailing Addtess) - Contractor Address Phone (Mailing Address) Locatioh° T>f Premises x'" �c > a T-+-" rfi `' i),t' �T' •� r'`F, is �"a'� .. ?~ - .`"a� ',w 1 .' `(Subdtvt Sacec o :. Namr". Nurnjer Secaioti Lot, o,) Directions OWNER ' DESIRES TO: nstall ❑ Repais ❑Water Supply Syste Type `.�, Sewage�Disposal System .ti �,Sep�t� �an)� �s�� �'` '� �''"'� ❑ Qther tt��a "" w a LOT SIDE: .. h '.�^�'^• ,�^ •.�' sthmated or Actual FOR . Single Unit • ` elling ❑ tiple Unit Dwelling,toZnLwion SEPTIC ;TANK. SYTrdsnaryy Housghi d " tort Waste ,motes _ to �,,. Garbage D„Lspos 1 FOR DI.�s?S"SF ,�: ,. Sewage & . OVastes . utomattc-.Washing a ne .�� $evtce Additional tirst�r'`'�""•ey''xripz°t3TY ., ". Living Quarters at" - ❑ Other �r1. (Explain) _ (Explain). HEALTH :. Recommends ❑=.Water Supply -System DEPARTMENT: ❑ Rejects [ a e Disposal System e g pos Reasons for Rejection _ and Recommended Alternatives DETAILS OF RECOMMENDED SEPTIC TANK SYSTEM r - ` ', .Kind of Material for Tank: n r'"Concreta �x ,,;u�, ❑Ocher (Explain) ,. Size of .. 9= .a Tank: Length Ft Width " Ft. Depth Ft. Capacity Gallons -Subsurface No. of y - Exact Length Al Width of Depth of Drainage Field: Ditches of Each Ditch - ` Ft. Ditches Ft. Ditches Inches Depth of Filter Material From Depth of Suea Drainage Linear Base to Cover Tile Inches Water Table Fe, Required ' ._'` r, Ft. No. of ❑ Percolation Tests Required Holes Results ig + r a Signed �- SICet o€�tetnlsCs $Lhtwtt1i Ltseat -Y/ rf an of Buildings, Water Supply System, Sewage Disposal System and other Perttn nt etails ter r ty I " t r 4`f ~ - Wn.,dar.'rn.'iP'wb4•gMRMy.N. ,F �,..i ri'Ja,R'atMit+dN4'*We_rX Wt0.tnMCiM�iIW�M 41 �11:/uMaYdnL.yAl9V/ah"N+6• •,: Depth Ft. Note; This is a Permit to Construct or Repair Subject to Inspection. (Owner or his Agent) must Notify �* Health Department when Installation is ready for Inspection. If any Septic Tank or Parr thereof is covered before being inspected by the t Health department, it shall be uncovered by the owner at. the direction of the Health Officer or his Agent. LHS 121-50M Virginia State Department of Health J11—