HomeMy WebLinkAbout042-310-003 EHS24-0209 UPGRADE TO REPAIRButte County
This
section
completed
by
Certfl d
Installer
or
Designer
This
section
completed
by
EH
PUBIC HEALTH
APN #;
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.
042-310-003
Appjsant Nam Aue
Parçel Address
City
Dispersal Type:
STANDARD GRAVITY SYSTEM
DESIGN FORM
Subdivision Name/Division/Block/Lot
Daily Flow (gpd)
Number of Bedrooms
Application Rate
State
Drainrock
Septic Tank Capacity
Polystyrene
Designed Vertical Separation
Ground Slope in Drainfield Area
Parcel ldentification
Zip
Chamber
3
t
gal
gpd/
I8 inches
Design Parameters
Traklt #:
%
8ystem Designer
Designer Name
Designer Mailing Address
City
Designer Telephone Number
Drainfield Square Footage
Trench VWidth
Total Lineal Trench Length
Trench Depth
Depth of Fill over
Drainfield (if applicable)
Certification of Design
Curtain Drain Depth (if applicable)
730-24
Environmental Health Specialist
State
Date Received:
Staff:
Date
/ The design is stamped"Approved" by Butte County Public Health Department
Date
Staff Use Only
The undersigned Certified Installer or Certified Designer (circle one) has submitted this design based
observed site conditions as hown on this design form and the drawings attached thereto.
Caution: This design approval is only valid when all the following conditions are met:
Form DG
Z6_inches
Zip
3 inches
The undersigned has reviewed this design on behalf of Butte County Public Health Department and
determined it to be in compliance with state and local on-site regulations and ordinances.
30
The Wastewater Construction Permit has not expired, the Permit Expiration Date is 2 years from the date of issuance
Y The system is instaled by a certified installer or homeowner authorized by the Butte County Public Heath Department
Drainfield site conditions have not been altered to adversely affect conditions of design approval
inches
Update: September 12, 2014
OUR MISsiON IS TO PROTECT THE PUBLIc THROUGH PROMOTING INDIVIDUAL, COMMUNITY AND ENvIRONMENTAL HEALTH
WASTEWATER
SYSTEM
DESIGN
CHECKLIST
wner's name
Assessor's Parcel Number
D 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
Any
existing
and/or
propOsed
site
improvements,
such
Existing 4Location
and
dimensions of
designated
primary
and
repair
wastewater
dispersal
areas
Test
hole
locations
from
Site
Evaluation
Existing
and
proposed
wells
within
200 ft of
the
primary
and
repair
dispersal
areas
and
neighboring
wells
within
100 ft
of
property
lines
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
This section conmpleted bv Certified Installer or Desianer
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
as
buildings,
pools,
driveways,
parking
areas,
easements,
waterlines,
etc.
(please
specify
whether
existing
or
proposed)
wastewater
dispersal
areas,
if
present
trench Observation port
Site Location: Contact Name:2feue
ongales
Phone: 3jo-S7{-52
Owner Name:Jes5jea Address
/ Phone:
{e7 Sam
ord Aue Willans
Chico
CA
5875 Scale 1" =
Siorature
bote
Ave
and
pplete
to
the,bestpf
my
knowledge.
I certify
thot
the
informatior
in
this
site
plan
is
cccurate
N.
3G
KTant Eishs
asse
ed
SITE PLAN
Assessor's
Parcel
Number:
D0-000-00O
Permit
#:
Confirmation Number: 13048563
California
Butte County
Environmental Health
Transaction Details
Facility Name
2867 Nord Ave
Mailing Address
2867 Nord Ave
City
Chico
State
CA
Zip Code (5 char)
95973
Owner First and Last Name
Steve Gonzales
Facility Phone Number
530-514-4432
Butte EH Payment For
NA
Invoice Number (IN#### ##)
0000
Record ID #
0000
Any changes to the facility info on file?
NA
Credit Card Payment Address Information
13048563
PayGOV.US
Order Number
Customer Name
Email Address
Address
Phone Number
Credit Card
Number
Expiration Date
Operator Name
Authorization
Code
Credit Card Type Visa
Convenience Fee
Authorization
Code
Transaction ID
Transaction Time 7130/2024 6:43:51 PM
Purchase Type
Agency Total
Steve A Gonzales
steve@eliteexcavatingandseptic.com
Total Amount
Charged to Card
14772 Holmwood Dr
Magalia, CA, CA 95954
(530) 514-4432
485638)XXXXXX7419
http://paygov.us
0127
584902
584901
227.00
Convenience Fee $5.68
1004584902
sale
232.68
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