20221795 Ver 1_More Info Received_20230322 (2)

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Well Case: WEL 20/%' 6k,'&
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AUTHORIZATION FOR W EWATER SYSTEM CONSTRUCTIO, 3///WELL CONSTRUCTION
BUNCOMBE COUNTY ENVIRONMENTAL HEALTH 30 VALLEY STREET, ASHEVILLE, NC 28801 828-250-5016 (fax: [phone])
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Property Owner: 9"� �e Property Location: C /�G�3 �� Application Date:
Directions: �d�y �A,��` N� - �4/ ,� //r// A"- r!G,) '6" l 4XV lug
Subdivision: N/n Phase/section: Lot#
Well Design: leNew ❑ Repair ❑ Abandonment
Water Supply:-431rivate Well ❑ Spring ❑ Shared Well ❑ Public/Community Existing Wells Yes ❑ No
System Design; 1'J New System ❑ Repair ❑ Revision Multiple Unit Dwelling: # of Units # Bedrooms/per unit Max. # of occupants/per unit
Residential�l
House ❑ Mobile Home (❑ single ❑ double) Bedrooms! Max. # of occupants(S" Basement1dYes ❑ No Basement Plumbinipd Yes ❑ No
Commercial/Other:
Design Specifications Total Design Flow: LTAR: e�- -3:7 Soil Group Pump System Required>Z'Yes ❑ No
Trenches: Length-ft No, of Trenches Width: �in Spacing: ft Depth: � in (lower sidewall) Stone Depth: ti� in
Distribution: ❑ Equal Gravity )2/P'ressure Manifold ❑ Serial ❑ Dams/Step Downs Tank Size: Septic � Pump Tank Xl�y
(gallons) (gallons)
Minimum Separation Distance to Well (includes system and repair area):�Z—ft System Classification�.ss
System Tyne: ❑ Prefabricated Panel Block ❑ Conventional ❑ Large Diameter Pipehamber/EfExpanded Polystyrene Aggregate ❑ Other
Conditions: (1) No grading, filling or other site disturbance in the indicated septic area. (2). Install drainfield on contour of land. (3). Divert gutters and other
surface water away from septic system. (4) System is to be installed in accordance with the conditions of this permit and NC sewage rules. (5) Modifications to
the indicated desian must be approved in advance by the department. 6 Contractor is to contact office immediately if problems are encountered.
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Improvement Permit Date of Issuance: ❑ This
document shall be con idereddiissuance of an Improvement Permit with all required information.
This document authorizes the property owner to construct a ;7 0�� ' " ground Absorption Sewage Disposal System. The owner MAY
CONSIDER installing other types of accepted systems listed above�'Cfianges or modifications from the indicated design may result in revocation of the
Authorization to Construct. The installer of this system must have
a copy of this document on site during all phases of the i stallation and final inspection.
Issued By: �`�--���l�ae-� Date?`-Z /� Owner/Agent:A)�o ' �Ay�t� C/tu3 y,4hao,Ca Date:
*THE VALIDITY FOR THIS CONSTRUCTION AUTHORIZATION IS FOR 5 YEARS FROM THE DATE OF ISSUANCE. IF AN IMPROVEMENT PERMIT WAS*
PREVIOUSLY ISSUED ON A DIFFERENT DATE, THEN VALIDITY OF THE CONSTRUCTION AUTHORIZATION IS EQUAL TO 5 YEARS FROM THE
DATE OF ISSUANCE OF THE IMPROVEMENT PERMIT.
CA Form 01/16