OWTS Professional Contractor (Installers and Cleaners) Yearly License Application and Exam Application (if applicable)

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Individual's name representing the business *

Business name (DBA) *

Physical location of business: *

Business phone number *

Cell phone number

Email address *

Mailing address *

I am applying for: (check one or two that apply) *please note that licenses are yearly and a current exam is considered from 2019 on and must be completed every five years *

OWTS Installer license and *exam ($75 )

Renewing OWTS Installer/Contractor with current passing *exam ($37)

New OWTS Cleaner and *exam ($75)

Renewing OWTS Cleaner with *current passing exam ($37)

Required

Please indicate how the license fee will be paid (payment must be received before a license can be issued): *

I will mail a check to "Eagle County Environmental Health (ECEH)", PO Box 179, Eagle, CO 81631

I will drop off a check to the Department of Public Health and Environment, Old Court House Building, 550 Broadway in Eagle

I will drop off a check to the Eagle County Building in El Jebel, to be interoffice mailed to ECEH

I will pay online (a 2.5% convivence fee will be applied) https://client.pointandpay.net/web/eaglecoenvhealth

Required

For Installers (Check all that may apply. Please note that a license will not be issued until staff have confirmed the applicant has passed the required 2019 exam with a 75%):

I have taken the State OWTS Contractor Exam after 2019 and passed with a 75% or higher

I have not taken the State OWTS Contractor Exam and would like an online form emailed to me

I have not taken the State OWTS Contractor Exam and would like to pick up a paper copy from Eagle County

I have not taken the State OWTS Contractor Exam and would like a paper copy mailed to me

I have passed the State OWTS Contractor Exam but in an different county.

Unsure

I would like to request the exam in Spanish

For Installers:

I understand that I must have an active OWTS permit with my name listed onsite and "in-hands" when installing an OWTS and that I will not begin installing a OWTS if the permit is not issued in my name. Installations without a permit may result in class-1 misdemeanor or loss of license for up to one year.

For Cleaners: (check all that apply)

I acknowledge that regulations require that I submit pumping reports to Eagle County within one week for OWTS showing signs of failure, within 14 days for OWTS with recommended repairs, and 30 days for all OWTS in good repair.

I have passed the OWTS Cleaner exam for Eagle County within the passed five years

I have not passed the Cleaners exam within the passed five years (this exam will be emailed)

Unsure

For Cleaners: Primary Disposal Site/s

For Cleaners: Number of Pumping Trucks and license plate numbers

For all applicants: *

I hereby certify that I will comply with all requirements of the Eagle County Public Health Agency On-site Wastewater Treatment System Regulations and any requirements provided by authorized inspectors of the Eagle County Environmental Health Department.

I hereby understand that in the event I or my employees do not comply with the Eagle County Public Health Agency On-site Wastewater Treatment System Regulations, the license to conduct business as a Licensed Systems Contractor is subject to revocation.

I understand that submittal of this form does not constitute a license, and that my OWTS Professional license is not active until it has been officially reviewed and issued by Eagle County EHS staff.

Required

Comments or Questions: (optional)

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