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Home My WebLink About065-206-002 EHS24-0112 SEPTIC REPAIR APPLICATIONButte County This section completed by applicant This secton compieted by Environmental Health APN #: This application will be accepted with payment of permit fee and the permit will be issued when system design is submitted by a Certified Designer (or Certified Installer for Standard Gravity System) and approved by Énvironmental Health. oS20-02_ Applicant Name (Please print) elite Elcavatinç and Seghie Applicant Mailing Address Masalia City S30-S74-4B2 New Construction Expansion Applicant Telephone Number Tank Replacement Only ON-SITE WASTEWATER CONSTRUCTION PERMIT CA 59SY State Repair Xesidential: Number of bedrooms: D Non-Residential (specify): D Tank Destruction Environmental Health Specialist Comments/Conditions: Zip Inspected by: APPLICATION White-Environmental Health copy Traklt #: Rieh Peatt Property Owner Name G59 Pemy Installation by: LJ Horneowner J Certified Installer Environmental Health Specialist Date Construction Site Address City Certified Designer (if applicable) PERMIT Applicant Signature DESIGN AND CONSTRUCTION APPROVAL Certified Installer (if applicabBÁ) Rd State SfeveGogales Date of Issuance Date: Arnount: This permit is issued based on review of the attached design and has determined that it meets the re quirements of Butte County Code Chapter 19 On-Site Wastewater Systems. Receipt No. This permit valid only for installation of attached deslgn, stamped "Approved." Varlation from the ap proved design must have prior approval by Environmental Health. This permit will expire 2 years from the date of Design and Construction approval. Comments: This permit valid oniy íf system is installed by the homeowner or by a contractor with valid lnstaler Certification issued by Environmental Health. FINAL APPROVAL AND CERTIFICATE OF COMPLETION Yellow-Customer copy: Final approval Pink-Customer copy: Permit Form CP 43e/24 Zi Date As-Bult Altached LI Designer Sign-oft Update: IDecember 14, 2020 OUR M$SION S TO PROTECT THE PUBLIC THROUGH PROMOTING INDIVIDUAL, COMMUNITY AND ENVIRONMENTAL HEALTH Butte County This section completed by Gertified Installer or Designer This section completed by EH PURLIC HEALTH APN #: O6S-206o02. elite Bxcaiain Appjcart Naery Parcel Address City A design will be reviewed when this form and the design drawings are submitted with an On-Site Wastewater System Construction Permit application and fees are paid. Dispersal Type: Subdivision Name/Division/Block/Lot STANDARD GRAVITY SYSTEM DESIGN FORM Number of Bedrooms Daily Flow (gpd) Septic Tank Capacity Application Rate State Designed Vertical Separation LDrainrock LChamber LPolystyrene Ground Slope in Drainfield Area Parcel ldentification 3 Sephe Zip 360 gpd Design Parameters gal gpd/t inches Traklt #: % System Designer Designer Name Designer Mailing Address City Designer Telephone Number Drainfield Square Footage Trench Width Total Lineal Trench Length Trench Depth Depth of Fill over Drainfield (if applicable) Certification of Design State Curtain Drain Depth (if applicable) Date Received: Staff: Date Environmental Health Specialist Dale Staff Use Only The undersigned Certified Installer or Certified Designer (circle one) has submitted this design based observed site conditions as shown on this design form and the drawings attached thereto. Cautlon: This deslgn approval is only valid when all the followlng conditions are met: The design is starmped "Approved" by Butte County Publlc Health Department Form DG Zip inches /20 ft .32-inches The undersigned has reviewed this design on behalf of Butte County Public Health Department and deterrnined it to be in cornpliance with state and local on-site regulations and ordinances. 2 inches VThe Wastewater Construction Permit has not expired; the Permit Expiration Date js 2 years from the date of issuance The system is instaled by a certifled installer or homeowner authorlzed by the Butte County Pubilc Health Department Drainfield site conditions have not beer1 altered to adversely affect conditions of design approval Update: September 12, 2014 OUR MISSION IS To PROTECr THE PUBLIC THROUGH PROMOTING INDIVIDUAL, cOMMUNIrY AND ENVIRONAKNIAL HEAL M WASTEWATER SYSTEM DESIGN CHECKLIST OAssessor's Parcel Number ,Owner's name .North arroW ,Property lines Any relevant site features such as cliffs, cut banks, irrigation canals, springs, rock outcrop, landslide areas, drainage ways, etc. within 200 ft of the primary and repair dispersal areas d Any existing and/or proposed site improvements, such as buildings, pools, driveways, parking areas, easements, waterlines, etc. (please specify whether existing or proposed) Existing wastewater dispersal areas, if present ILocation and dimensions of designated primary and repair wastewater dispersal areas d Existing and proposed wells within 200 ft of the primary and repair dispersal areas and neighboring wells within 100 ft of property lines A,Location and orientation of curtain drain Direction of slope in primary and repair dispersal areas Dispersal field orientation and layout Trench/bed dimensions and critical distances within layout D-Box/"T"/"L" locations /Septic tank/pump chamber location /Observation port location /Scale of drawing shown on scale bar Cross Section Drawings: Dispersal trench This section completed bv Certified Installer or Desianer Observation port Capping fill, if applicable Curtain drain, if applicable Note: Designer may use form attached for design drawing or may attached drawing on separate page, provided the elements identified in this checklist are included. Update: September 12, 2014 Test hole locations from Site Evaluation Assessor's Parcel Number: -2- Permit #:. SITE PLAN Teees House I certify that the information in this site plan is cccurate and complete to the, best gf my knowledge. Perr Date Signature Scale 1" = Rieh Peatt Address / Phone: 54 feny R asel CA 53 Owner Name: Phone: 550 -S74-YS sonyales Site Location: Contact Name:>euc Confirmation Number: 12625374 California Butte County Environmental Health Transaction Details Facility Name 6564 Perry Rd Mailing Address 6564 Perry Rd City Magalia State CA Zip Code (5 char) 95954 Owner First and Last Name Rich Pratt Facility Phone Number 5305144432 Butte EH Payment For NA Invoice Number (IN#### ##) 00000 Record ID # 00000 Any changes to the facility info on file? NA Credit Card Payment Address Information PayGOVUS Order Number Customer Name Email Address Address Phone Number Credit Card Number Credit Card Type Operator Name Authorization Code Convenience Fee Authorization Code Expiration Date 0127 Transaction ID Purchase Type 12625374 Transacion Time 4/30/2024 9:51:24 AM Agency Total Steve A Gonzales steve@eliteexcavatingandseptic.com 14772 Holmwood Dr Magalia, CA 95954 (530) 514-4432 http://paygov.us 4XXXXXXXXXXX7419 Visa 404244 404240 2146404244 sale 488.00 Convenience Fee $12.20 Total Amount Charged to Card 500.20 ONE OR BOTH CHARGES WILLAPPEAR AS PAYGOV.US ON YOUR CARD STATEMENT. For questions about this payment, please call (866) 480-8552. PayGov, LLC 5144 E. Stop 11 Rd. Indianapolis, IN 46237 Disputing a charge with your credit card company may result in an additional $40.00 charge.