Fillable APPLICATION FOR ONSITE WASTEWATER TREATMENT SYSTEM (OWTS)

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APPLICATION FOR ONSITE WASTEWATER TREATMENT SYSTEM (OWTS)

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The APPLICATION FOR ONSITE WASTEWATER TREATMENT SYSTEM (OWTS) form is 1 page long and contains:

  • 1 signature
  • 16 check-boxes
  • 71 other fields

Country of origin: OTHERS
File type: PDF

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APPLICANT INSTRUCTIONS
1. For the proposed structure, submit with this application:
a. A Zoning Clearance issued by RMA/Planning for the proposed construction.
b. One copy of the floor plan.
c. One copy of a soils report.
d. Three copies of a plot plan with system design specifications.
e. An EHD “Bedroom Equivalent and Fixture Unit Worksheet.”
f. County Service Area 32 offer to grant easement agreement (Alternative OWTS only).
2. THIS APPLICATION EXPIRES 180 DAYS FROM THE DATE FEES ARE RECEIVED.
FOR OFFICE USE ONLY
Recd by ___________________________
Date Recd _________________________
Amt. Recd _________________________
Receipt Number_____________________
Check Number______________________
1. Job address _________________________________________________________________________________________________
Number Street City/Town/Area
2. Assessor’s parcel number __________ - ___ - ________ - __________ Zone Clearance No.: _____________________________
3. Owner’s name_______________________________________ 4. Telephone No. ( ) _______________ ( ) _______________
5. Mailing address ______________________________________________________________________________________________
Number Street City State Zip
Email Address ___________________________________________________
6. Applicant’s Name ________________________________________________ 7. Telephone No. ( ) ________________________
(if different than owner)
8. Applicant’s Mailing Address _____________________________________________________________________________________
Number Street City State Zip
Email Address ___________________________________________________
9. Residential Development:
o
Main Residence
o
Secondary Residence (explain) _______________________________
o
Other (explain) ___________________________________________________________________
Total number of bedroom equivalents ________________
Total number of plumbing fixture units ________________
Commercial Development: Total number of plumbing fixture units ________________
Total number of employees and visitors _______________
10. Water supply:
o
Public: Name of water company ________________________________________________________________
o
Private
11. Distance from nearest water well: Septic tank ______________________________feet
Sewage disposal system ___________________feet
12. Distance from springs, streams, lakes, ocean waters, and natural drainage courses: Septic tank ______________________________feet
Sewage disposal system ___________________feet
13. Type of disposal system:
o
Conventional:
o
Alternative: [see 1.f) above]
o
Leach Line
o
Mound System
o
Seepage Pit
o
Subsurface Sand Filter:
Length_______ft. x Width_______ft. = _______Sq. ft.
14. Size of septic tank _______________________________gallons
15.
Surface slope in area of disposal system ________________________percent
16. Leach line installation
Number of trenches__________on__________ foot centers Length of each trench _____________________________feet
Depth of each trench _________________________inches Bottom width of trench __________________________inches
Earth cover over drainline______________________inches Filter material under drain line ____________________inches
Square feet/Lineal feet of trench______________________ Absorption area provided ____________________square feet
17. Seepage pit installation:
Number of pits____________________________________ Diameter of each pit ______________________________feet
Earth cover over pits ____________________________feet Total depth of each pit ____________________________feet
Absorption area provided __________________square feet Effective depth of each pit _________________________feet
18. Signature of applicant or representative ________________________________________________ Date ______________________
FOR OFFICE USE ONLY
Application:
o
Approved
o
Denied By ________________________________________________ Date ______________________
Conditions of Approval:_____________________________________________________________________________________
Installation approved by _________________________________________________________ Date ______________________
DISTRIBUTION: White and Canary - Environmental Health Div. Pink - Division of Building and Safety Goldenrod - Applicant
SEE REVERSE FOR MORE INFORMATION
APPLICATION FOR ONSITE WASTEWATER TREATMENT SYSTEM (OWTS)
0
Ventura County Environmental Health Division
800 S. Victoria Ave., Ventura CA 93009-1730
TELEPHONE: 805/654-2813 or FAX: 805/654-2480
Web Site Address: www.vcrma.org/
divisions/environmental-health
EHD ON #:____________________
Accela #:_______________________________
h
Please take a moment to provide feedback. An opinion form can be completed at
http://www.vcrma.org/customer-service-evaluation-form-field-inspection. You can
find it on our website under Services and Resources by scanning this QR code:
125576_12827-App for sewage disp rev 9/11/13 3:40 PM Page 1
o
o
Leaching Chamber
Leach Bed
o
Advanced Treatment Unit
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Ventura County Environmental Health Division
800 S. Victoria Ave., Ventura CA 93009-1730
TELEPHONE: 805/654-2813 or FAX: 805/654-2480
W
eb Site Address: www.vcrma.org/divisions/environmental-health
PROCEDURES FOR COMPLETING AN APPLICATION FOR
ONSITE WASTEWATER TREATMENT SYSTEM (OWTS)
STEP 1 Obtain a zoning clearance verification from the RMA/Planning Division.
STEP 2 Complete an EHD form, "Bedroom Equivalents and Fixture Units Worksheet".
STEP 3 Submit a completed "APPLICATION FOR ONSITE WASTEWATER TREATMENT
SYSTEM" form.
Provide the information requested on lines 1 through 18 on the application. Make
sure the mailing address and telephone numbers are current.
STEP 4 Submit one copy of the floor plan of the structure(s).
STEP 5 Submit one copy of the soil engineering report containing percolation data, boring logs,
and system design, recommendations. Include any other pertinent data. All soils reports
are required to have been completed within a 12-month period prior to submittal of the
application.
STEP 6 Submit three copies of a scaled plot plan (1 in. = 20 ft., 1 in. = 40 ft., or 1 in. = 50 ft.)
depicting the proposed system. The plot plan must include:
1. All existing and proposed structures (including garage)
2. Septic tank(s)
3. Distribution box(es) - if required
4. Primary disposal system
5. 100% expansion area
6. Water wells within 300 feet of the sewage disposal system
* 7. Property lines and easements
8 Trees
9 Test holes and borings
10. Lakes and streams (intermittent or live)
11. Rock outcroppings
12. Road cuts (with approximate height)
13. Contour lines or other indication of slope
14. Paved areas (including driveway)
15. Water lines (public mains and on-site distribution lines)
16. Existing on-site sewage systems
* 17. Public sewer lines
* It is the applicant's responsibility to determine the location of the nearest public
sewer line. The appropriate local sewer agency should be contacted for this
information. It is also the applicant's responsibility to determine the exact
location of all property lines and easements.
STEP 7 If you are proposing a subsurface sand filtration system, submit the form,
"SUBSURFACE FILTER BED WITH SEWAGE DISPOSAL PIT" or the form, "BASAL
SUBSURFACE FILTER BED".
STEP 8 Pay the application fee which is determined by the OWTS type and the size of the septic tank.
***** PRECAUTIONS *****
The following are common problems which result in application processing delays:
1. Failure to fill in the application completely.
2. Failure to provide a current (less than one year old) soils report.
3. Failure to pay the correct fee for the system proposed (alternate systems such as sand
filters require an additional fee).
4. Application filled out with incorrect information (wrong address, incorrect fixture units,
wrong pit, or trench sizes).
5. Illegible plot plans or insufficient detail provided, i.e., water lines and driveways not
identified, contour lines without elevations.
6. Inadequate lot size for the proposed system.
7. Systems proposed under pavement.
8. Improperly designed systems proposed in bedrock.
9. Failure to provide the owner’s address and phone number.
JA G:\Admin\Tech Services\Office Forms\Forms\Applic for OWTS revised 4-26-18 Page 2
125576_12827-App for sewage disp rev 9/11/13 3:40 PM Page 2
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APPLICATION FOR ONSITE WASTEWATER TREATMENT SYSTEM (OWTS)

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Completed 12 March 2021

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