The URL can be used to link to this page

Home My WebLink AboutSEPTIC APPLICATION - 21-00346 - M-21-00075 - 3511 E Hwy 33 - County Shop/Living space4 y. APPLICATION-Subsurface Sewage Disposal Public HecilUi Prevent. Promote. Protect. Parcel #: Property Address (!f available): Lecial Descrintinn•Tn�n�nchir,- r 11% o..��._. LIh ■ �! i i i �E i i !� f i ■� 60. 4M i i i' ! � iI !• i• i i i i �1! i � � � i r r r Site Fee: r r r r r � r Permit Fee:• � met . � r r � i Receit P. (Official use Only) i � � � i i i' i i i i � i � i �� ■■� i7o (O/Vt � i i i � i i i � i i i i � � i i # i � i � i � i i i � i � i �� i i ■ 01 fo 31) City: S •r .._... � .... � �.�� t,r. err iyC. T V l 6eCtion: de rnI il'1+ • Acres; 0 Subdivision; )YA WE Lot:, Block: Directions (nearest crossroad 0 "-07 4= ff& % - Applicant's Nam Mailing Address: City: Applicant is: Owner's flame: Mailing Address: City: andowner r &rX 1 r% -Cl L Co rac or % %e v -T - n 92 7 ❑ Installer 04._C.:77,J date: Phone Mo?0 State.- ZT/ Zip Code: El Other: Phone #; State: ZipCode: 50.'/ 3 y ZPiq SIGNATURE: — 0010 DATE: By my signature above, I certify that all answers and statements on th is application are true and co my knowledge. I understand that should evaluation disclose untruthful or misleading answers complete to the best of rejected or m g my application may be 1 y permit canceled. I accept the responsibility to notify the Health District of any changes to the above information if performed prior to completion of the Perma itted system. ! hereby authorize the Health District to to this property for the purpose of conducting asite-evaluation. I understand that this application and theh ubseave c access permit ;s non-transferrable between property owners and/or project sites. I understand that the application will expire ent (1) year from date of purchase. The permit, when issued, may be renewed if the renewal is aplied for on r pe one expiration date. po before the Revision i date 5120/201 a 6W Eastern Idaho Public Health Prevent. Promote. Protect. LETTER OF INTENDED USE ENVIRONMENTAL HEALTH 1 250 Hollipark Drive Idaho Falls, ID 83401 OFFICE (208) g23-5382 FAX (208) 528-0857 As described in the Technical Guidance Manual for Individual and Subsurface Sewage Disposal Systems (TGM)s3.3.1, all nonresidential septic permit applica#ions need to inciude a letter of intended use that provides information rsection the type of establishment served, nature and quantify of wastewater the system will receive, and documentationgarding substantiates that the proposed system will comply with 1DAPA 58.01.03. that Applicant Name: l7 1 G) 1e&)K (.,1r Type of Use/Business: b,1Q. s �� Will the structure be used for Tenial lodging? Y N Description of all wastewater generation sources (water fixtures, Equipment, appliances, etc.} IP & L-70 &Y r7%" Aft qk , r-cil �1 Will there be any floor drains in the structure? � N If yes, where are they located and what will these drains accept: Lo Ck7l Will there be any employees? Y N Maximum number of customers/clients/renters per day: Public restrooms provided: Signature: Y ( N If so, maximum numberper day: If so, approximate number served per day., OFFICE USE ONLY Projected Gallons of wastewater produced per day (Per IDAPA 58.01.03.007 or TGM 3.3.2) Dates —` -1'7 —X� Note: If the wastewater flews that are sent to the septic system drainfield are determined to n non-domestic wastewater checklist must be completed and submitted before the septic application an be domestic strength, a engineer is usually needed to complete this checklist. Please discuss this with the Environmental Heal processed. An processing your application.th Specialist that is TENON I www•EIPH.Idaho.gov 9 a Eastern Idaho Public Health Prevent. Promote. Protect. ENVIRONMENTAL HEALTH 1254 HoIlipark Drive Idaho fia;fs. ID 834p1 OF ME (208) 523,5382 FAx (208) 528 0857 SEPTIC PERMIT INFORMATION SHEET FEES. 700.0 Individual System Permit (New) $ 500.00 individual System Permit (Expansion, Remodel) $ 540.04 Individual System Permit (Repair, Failed) $1,500.00 Centrad/Large Soil Absorption System Permit (New) $ 750.00 Central/Large Soil Absorption System Permit (Repair) $ 350.00 Tank Only & Vault Privy Permit $ 50.00 Permit Renewal $ 300.00 Speculative Site Evaluation (Evaluation of property when permit is not requested; i.e. forpotentialpurchase of property.) The flee may ae credited toward the permit fee if requested within oeyear. NOTE -- ND APPLICATION WILL BE PROCESSED WITHOUT SCALED OR DIMENSIONAL PLOT PLAN AND BUILDINGPLAN. ( Board of Heath poI CY) ALL documents submitted in the application package are considered pari of thepermit andare enforceable. PROCESS: 1. SubmiLApplication for Permit: Completely fill out applicMW ation, submit with plot plan and building plan, Applications cannot be processed without payment of fee. No payments can be taken in the field.2. Schedule Site EvafUation: An EnvFronmentai Health Specialist (EHS) mustgoo- site in order to evaluate the application and to assess the situation before issuing the permit. A representative must meet the E S at the site to answer any questions, (Test holes may be required to determine soil type, limiting layer, or water level, etc. Plan on a minimum of ten to I've working days for processing of application, For nonr}e sidial applications, additional paperwork maybe necessary and could extend the processin time. 3. Permit Issuance: When the permit is ready, the applicant will be called and can come to the office to pick up the permit. The septic permit will be required to get a building permit from Planning and Zoning. A co must also be given to the licensed installer, who will then be able to install the system.(The ermitcopy °� the permit year. It can be renewed prior to the anniversary date at an additional cost of $'50,00. p is valid for one 4. Construction of Septic System: When a licensed instalfer has a copy of thepermit, con system must be installed in accordance with the issued permit. Any changes must be a Srove�n can begin. The Public Health prior to changes being made. Pp d by Eastern Idaho 5. Final Insnection Mandato It is necessary to have the system inspected by an Environmental Healthto covering in order to determine if the system was installed in accordance with the issued ermitSpecialist prior installer's responsibility to call for final inspection. Systems covered prior to final inspection � �S ��e owner's or uncovered for final inspection,will be required to be 6. Permit is transferrable within the first year (not applicable on renewed permits). Eastern ldainformed of the transfer immediately.ho Public Heath must be THINGS TO REMEMBER: 1. Septic systems MUST be installed by a licensed installer a s<r „f i t.,n,.... afstrict office. Homeowners can only insfa�� tnA�r.,«,� ca�,�;,, ....��= �"�r'�.J��r�C'? `a" °e ogtained from yourloca ealth 2. No changes to the system specifications stated on the permi can be made w'thouts a dprior �am rPublic Health.approval from 3. 0 5. Eastern Idaho Septic systems (tank and drainfieid) MUST BE INSPECTED PRIOR TO COVERING. if the system is not inspected prior to covering, the installer or owner will be asked to uncover inspection- This may cause more expense as system m7y become damaged if disturbed. the system for PERMIT MAY BE RENEWED it not completed within one year(see PROCESS # responsibility to remember to renew the permit rior to the anniversary date. 3 above). It is your SAVE TIME: 1. Avoid unnecessary delays by f�EEi�,n n� �+ +wor_____ - � - aNN114dL1Un rvrm compietely. Be sure #o include a mailing address and phone number for the owners andwif applicable, a phone number for the contact 2. Eastern Idaho Public Health re uires 48 hours' ll0tice to crhorliaie �M :P (builder and/or installer). I have received, read, Signed: E-mail Address: BONNEVILLE and understand the above information., c�e yelc,Or�rcn�C3 CLARK CUSTER n FREMONT JEFFERSON - - a- 1 ww1Wa 11%&%41 AL1 1 !f f Cb r�r action. Date: *3d'- / 3 @0- %z! LEMH1 MADISON TETOw.ElPN.idaho.gov