20230645 Ver 1_SectionG4-Q4a_20230502

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AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION/////WELL CONSTRUCTION
,,,BUNCOMBE COUNTY ENVIRONMENTAL HEALTH 30 VALLEY STREET,ASHEVILLE,NC 28801828-250-5016(fax:[phone])
CODES:
r Property Location: Z t Application Date:
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Property Ovrner: P y �'`���,��'
e
Dir actions: j A11W,4'f
Subdivision: Phase/section: Lot#
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Well Design: New ❑ Repair ❑ Abandonment
Water Supply: �2-lrivate Well ❑Spring ❑ Shared Well ❑ Public/Community Existing Wells: Oyes ❑ No
System Desi n ew System ❑ Repair 0 Revision Multiple Unit Dwelling:#of Units_ >#Btdrooms/per unit /_—!?Max.#of occupants/per unit
Residential: R40use 0 Mobile Home(❑ single ❑double) Bedrooms? Max.#of occupantst7 Basement:❑Yc4a,' o Basement Plumbing:❑Yes ❑No
Commercial/Other:(Describe)
Design Specifications Total Design Flow: 6-1) LTAR:�Soil Group: Pump System Required: ,Id'Yes ❑ No
GPD)
Trenches. Length,J�tt No.of Trenches _Width: '),41 in Spacing: ft Depth: n(lower sidewall)Stone Depth: '" in
Distribution: ual Gravity ❑ Pressure Manifold al ❑ Dams/Step Downs Tank Size:Septic�C[4.� Pump Tank__'/��
f .-� y (gallons) (gallons)
Minimum Sep t o Dist n eo Well(in� es system and repair area): System Classification:
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System Type: ❑Prefabricated Panel Block ❑Conventional Cl Large Diameter Pipe 2-Chamber ❑Expanded 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
ated desip must be aDDroved 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: is document shall be considered issuance of an Improvement Permit with all required inform on.
1
This document authorizes the property owner to construct a lt`.Kes+ lZ ground Absorption Sewage Disposal System. The owner MAY
CONSID*11itypes of accepted systems listed ve. Changes or modifications from the indicated design may result in revocation of the
Authorizathis system must have a copy of this document on site during all phases of the installation and final inspection•
Issued ByDate: Owner/Agent: Date:
*THEVAON AUTHORIZATION IS FOR 5 YEARS FROM THE DATE OF ISSUANCE. IF AN IMPROVEMENT PERMIT WAS*
PREVIOUSLY ISSUED ON A DIFFERENT DATDE THEN
VALIDITY
OF OF THE IMPROVEMENT PE�ORIZATION IS EQUAL TO 5 YEARS FROM THE