The URL can be used to link to this page

Home My WebLink About065-320-011 EHS24-0246 SEPTIC REPAIR SITE PLANButte County PUBLIC HEATH SEPTIC TANK DESTRUCTION PERMITTING PROCESS Public Health Department Environmental Health Division 202 Mira Loma Drive Oroville, California 95965 14754 PROPERTY ADDRESS 1. Complete and submit an On-Site Wastewater Construction Permit application, identifying "Tank Destruction" as the requested activity when completing the application form. PROPERTY OWNER's NAME CONTRACTOR NAME Note: On-Site Wastewater Construction Permit applications are multi-purpose forms used for permitting septic tank destruction as well as septic system installation, modification, and repair. 2. Submit with the application the following: (a) Scaled plot plan showing the location of the septic tank to be destroyed and the location of the replacement septic tank, if applicable, (b) Completed and signed Declaration of Septic Tank Destruction, and (c) Application fee of $261. DESCRIBE FILL USED: DECLARATION OF SEPTIC TANK DESTRUCTION Note: If the proposed septic tank destruction is part of an on-site wastewater system repair, modification, or replacement for which another On-Site Wastewater Construction Permit is being issued, the septic tank destruction will be permitted under that application and no additional application or fee will be reguired for the septic tank destruction other than completion of this Declaration of Septic Tank Destruction. COMMENTS: Danette York, M.P.H, Director T: 530.552.3880 3. Follow the Septic Tank Destruction Procedure on the reverse side of this form. DESCRIBE METHOD OF DESTRUCTION: Dr. David Canton, D0, MPH, JD, Health Officer F 530.538.5339 SIGNATURE OF PERSON PERFORMING WORK buttecounty. net/publichealth CiTY PRINT NAME obs3z0-D() AsSESSOR PARCEL NUMBER CA COMPANY NAME Z1P TANK BOTTOM PERFORATED? O No s/a7hy DATE Butte County This section completed by Certifled Installer or Designer This section completed by EH PUBC NEATN APN # O5-320 -oll ERt Excavoias and Seplic Parcel Addre_s 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. ST Goldcone masala Gty STANDARD GRAVITY SYSTEM Subdivision Name Division/Block Lot Number of Bedrooms Daitly Flow (god) Dispersal Type Drainrock CA Septic Tank Capacty Application Rate State Polystyrene DESIGN FORM Designed Vertical Separaton Ground Siope in Drainfeld Area Parcel ldentification Zip Chamber 2 240 gpd Design Parameters gal Linches Traklt #: Designer Name System Designer Designer Maiing Address City Designer Telephone Number Drainfieid Square Footage Trench Width Total Lineal Trench Length Trench Depth Depth of F over Drainfed (tf applcable) Certification of Design Curtain Drain Depth (f applicable) State Environmental Heaith Specaist Date Receved Staf Date The designs stamped 'Approved by Buse County Putic Heaith Decament Date Staff Use Only The undersigned Certifed Instalier or Certified Designer (aircle one) has submted this design based obsenved ste condtions as shown on this design fom and the drawings attached thereto Caion This design apgroval is only vaid when all the following conibions are met Form DG The undersgred has reviewed this design on behaf of Butte County Putblic Health Department and determined t to be in complance with state and iocal on-ste regulations and ordinances Zp 3 nches 3bnces The Wassewzer Consrucor Permt has nct expired the Permt Epration Date s 2 years from he cate of ssane The ssseis nstalled by a certfies rstaler or hormeoarer atorzed by the Bute Cauty Ptiic Heat Decaet Drairted ste condions have not been ahered to acverseily afect conditons of desgn apçrowai nches Updste Septemer 12 2014 LRN ss O s TO PROTECY THE PUBLIC THROUGH PROMOTING INDIVIDUAL COMMUNITY AND ENVIRONMENTAL HEALTH Update: September 12, 2014 centified in this Curtain drain, f applicable Capping fi, if appicabie Ooservation port This seation comnleted hy Certified Installer or Deslaner Dispersal trench Cross Sectiog Drawings Scale of drawing shown on scale bar Ooservtion port ocaton J Septic tankpump chamber location D-BoxTL" locations Trenchbed dimensions and oritical distances wtin layout Dscersa feld orientation and layout Directon of siope in primary and repair dispersal aeas Locaton and onientation of curn dan Erstng and proposed wels witin 200 ñof the primary and repair dspersal areas and neighboring wels within 100ftof property lines Test hoie locatios from Ste Evauaton Location nd dimensions of desigrated primary and repair wastewater d'spersal areas Exstng wastewater disoersal aas oresent Secy wheter estng r prooosec) Ay exstng andor proocsed ste improvements, such as buadings, pools, driveways, parking areas, easements, watertines, etc. (please e ary anc ear oert ines Wor TOW Assessor's Oaner s nare WASTEWATER SYSTEM DESIGN CHECKLIST checklist are incuded. Nicte: Designer may use form attached for design drawing o may attached drawing on separate page, provided the elements dSesa arsas Ay eevant ste eatures such as s cut banks imgaton canals sorings, rock outtrop, landslide areas, drainage ways, etc. within 200 ft of Parca Nunter Contact Name:5fee Gonalos Phone: 3o -574-432 Site Location: Address / Phone:/Y754 Gold Owner Name: araSulliJan Cone CA Scale 1" = Date Goldcon and corplcte to the best gf my knowledge I certify that the irfornction this site plan is accurate Tart To Be Tont ondened tehde SITE PLAN Assessor's Parcel Number: ol e S-3 2] 0 UU Permit #:. Confirmation Number: 13180191 California Butte County Environmental Health Transaction Details Facility Name 14754 Goldoone Dr Mailing Address 14754 Goldcone Dr City Magalia, CA State CA Zip Code (5 char) 95954 Owner First and Last Name Sara Sullivan Facility Phone Number 5305144432 Sutte 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 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 13180191 Transaction Time 8/27/2024 9:40:40 PM Agency Total Steve A Gonzales steve@eliteexcavatingandseptic.com 14772 Holmwood Drive Paradise, CA, CA 95969 http://paygov.us (530) 514-4432 485638XXXXXX7419 Visa 0127 089081 089080 1006089081 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 paynent, please call (S66) 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.