Botetourt Septic Application

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First Name(Required)

Last Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

When was the last time your septic system was pumped?(Required)

Below is the 80% Annual Median Income by Household Size and Locality guidelines by the Department of Housing and Urban Development. Priority will be given to households with an income at or below these guidelines.

How many people are in your household?(Required)

What is your annual household income?(Required)

Are you renting the property?(Required)

If you answered yes to the above, are you responsible for maintenance of the property's septic system?

Applicant Acknowledgements(Required)

I certify that all information provided to the Regional Commission and Botetourt County is true and accurate to the best of my knowledge.

I acknoweldge that the program will only pay for the cost associated with uncovering a septic tank up to $150.

I agree to allow the program staff to take pictures of, video record, or interview me about the work completed on my property as part of the program outreach efforts.

Please acknowledge the information below by checking the boxes below.

This field is for validation purposes and should be left unchanged.

Empowering Regions through Data-Driven Solutions

Roanoke Valley-Alleghany Regional Commission
P.O Box 2569, Roanoke, VA 24010

General Info: rvarc@rvarc.org
Media: Elizabeth Elmore, eelmore@rvarc.org

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Empowering Regions through Data-Driven Solutions

Empowering Regions through Data-Driven Solutions

Empowering Regions through Data-Driven Solutions

Empowering Regions through Data-Driven Solutions