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Home My WebLink About060-110-117 EHS24-0245 SEPTIC REPAIR 3 BEDButte County This section completed by applicant PUSLIC HEALTH This section completed 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 Environmental Health. Applicant Name (Please print) Applicant Mailing Address Paradise 530-SlY-432 City Applicant Telephone Number D New Construction D Expansion ON-SITE WASTEWATER CONSTRUCTION PERMIT State Comments/Conditions: Repair Tank Replacement Only ZResidential: Number of bedrooms: O Non-Residential (specify): D Tank Destructicn Environmental Health Specialist Zip 3 White-Environmental Health copy APPLICATION Traklt #: B6lcory Cauis dril Property Owner Environmental Health Specialist Date City PERMIT Certified Designer (if applicable) Appicant Signature DESIGN AND CONSTRUCTION APPROVAL Yellow -Customer copy: Final approval State Date of Issuance Date: Amount: Steve oneales Receipt No. 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. ¢ This permit will expire 2 years from the date of Design and Construction approval. CA 9g2 Lane Comments: Form CP This permit valid only for installation of attached design, stamped "Approved." Variation from the ap proved design must have prior approval by Environmental Health. This permit valid only if system is installed by the homeowner or by a contractor with valid Installer Certification issued by Environmental Health. Date Zip FINAL APPROVAL AND CERTIFICATE OF COMPLETION Installation by: O Homeowner O Certified Installer ] As-Built Attached ] Designer Sign-off Inspected by: Pink -Customer copy: Permit Update: December 14, 2020 OUR M1SsiON IS TO PROTECT THE PUBLIC THROUGH PROMOTING INDIVIDUAL, cOMMUNITY AND ENVIRONMENTAL HEALTH Butte County This section completed by Certifled Installer or Designer This section completed by EH PU8UC NEALTN APN #: ApplicantN Parcel Address 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. City Namddl Cane focst Ranch CA Dispersal Type: STANDARD GRAVITY SYSTEM Subdivision Name/Division/Block/Lot Daily Flow (gpd) Number of Bedrooms Application Rate State Drainrock Septic Tank Capacity Polystyrene Designed Vertical Separation DESIGN FORM Ground Slope in Drainfield Area Parcel ldentification 95942 3 Zip Chamber 360 gpd Design Parameters gal gpd/ft inches Traklt #: % System 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) State Environmental Health Specialist Date Received Staf. Date / The design is stamped 'Approved' by Butte County Putblic Health Department Date Staff Use Only Caution: This design approval is only valid when all the following conditions are met: The undersigned Certified Installer or Certified Designer (circle one) has submitted this design based observed site conditions as shown on thi_ design form and the drawings attached thereto. Zip 36 Form DG 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. inches 20 inches V The Wastewater Construction Permit has not expired; the Permit Expiration Date is 2 years from the date of issuance The system is installed by a certified instaler or homeowner authornzed by the Butte County Public Health Department /Drainfield site conditions have not been attered to adversely affect conditions of design approval inches Update: September 12, 2014 OUR MISSION 1S TO PROTECT THE PUBLIC THROUGH PROMOTING INDIVIDUAL. COMMUNITY AND ENVIRONMENTAL HEALTH WASTEWATER SYSTEM DESIGN E Owner's name Assessor's Parcel Number North arrow 4 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 O Any existing and/or proposed Existing wastewater dispersal areas, if present O ? Location and dimensions of designated primary and ropair wastewator dispersal areas est hole locations from Site Evaluation 4 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" Septic tank/pump chamber location Observation port location 7 Scale of drawing shown on scale bar Ø Cross Section Drawings: Dispersal trench This section comoleted bv Certified Installer or Desianer Observation P Capping fill, if applicable Curtain drain, if applicable Note: Designer may use Update: September 12, 2014 CHECKLIST site improvements, such as buildings, pools, driveways, parking areas, easements, waterlines, etc. (please specify whether existing or proposed) locations port form attached for design drawing or may attached drawing on separate page, provided the elements identified in this checklist are included. Permit #:. Assessor's Parcel Number: lol -00-00B SITE PLAN House Tank Barn Horse ocurate I certify thot the irformgtion in this site plan is and compl te to thç bestpf my knowledge. Lane Maddel bate Lorature Scale 1" = Bobl Cory Oavis Address / Phone:Z5ol Madrilllone tanst Rach cA Owner Name: Phone: 530-51/ Yy32 Same Gengale Site Location: Contact Name:Steve Confirmation Number: 13180243 California Butte County Environmental Health Transaction Details Facility Name 7501 Maddrill Lane Mailing Address 7501 Maddrill Lane City Forest Ranch State CA Zip Code (5 char) 95942 Owner First and Last Name Bob Davis Facility Phone Number 5305144432 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 13180243 PayGOVUS Order Number Customer Name Email Address Address Phone Number Credit Card Number Credit Card Type Expiration Date Operator Name Authorization Code Convenience Fee Authorization Code Transaction ID Purchase Type Transaction Time 8/27/2024 10:05:14 PM Steve A Gonzales Agency Total steve@eliteexcavatingandseptic.com 14772 Holmwood Drive Paradise, CA, CA 95969 (530) 514-4432 http://paygov.us 485638XXXXXX7419 Visa 0127 089381 089379 1006089381 488.00 Convenience Fee $12.20 Total Amount Charged to Card sale 500.20 ONE OR BOTH CHARGES WILL APPEAR AS PAYGOV.US ON YOUR CARD STATEMENT. For questions about this payment, please call (866) 480-8552. PayGov, LLC S144 E. Stop 11 Rd. Indianapolis, IN 46237 Disputinga charge with your credit card company may result in an additional S40.00 charge.