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Home My WebLink About058-190-182 EH Septic System Application and Design FormsPPRREESSSSUURREE DDIISSTTRRIIBBUUTTIIOONN AANNDD SSUUPPPPLLEEMMEENNTTAALL TTRREEAATTMMEENNTT DDEESSIIGGNN FFOORRMM Update: September 12, 2014 Staff Use Only Date Received: _________ Staff: _________________ A design will be reviewed when this form and design drawings are submitted with an On-Site Wastewater System Construction Permit application and fees are paid. Parcel Identification APN #: ______________________________ ______________________________________ Applicant Name ______________________________________ Parcel Address ______________________________________ City State Zip ______________________________________ Subdivision Name/Division/Block/Lot TrakIt #: ______________________________ ______________________________________ Designer Name ______________________________________ Designer Mailing Address ______________________________________ City State Zip ______________________________________ Designer Telephone Number Design Parameters Treatment Type Vertical Separation (inches) _______________ Closed Bottom Sandfilter Open Bottom Sandfilter Mound ATU _________________________ Make/Model Textile Filter _________________________ Make/Model Disinfect Unit_________________________ Make/Model Dispersal Type Gravity Pressure Trench Bed Drain Rock Gravelles Chamber Subsurface Drip Dispersal System Parameters Number of Bedrooms _______________ Daily Flow ____________gpd Septic Tank Capacity (gal) ____________gal. Receiving Soil Type (A-E) _______________ Receiving Soil Ap. Rt _________ gpd/ft2 Designed Vertical Separation _______________ Drainfield Square Footage _______________ Percent Reduction Taken _______________ Trench width _________inches Total lineal trench length _____________ft. Trench depth _________inches Depth of fill over drainfield _________inches Slope in drainfield area _____________% Pump Specifications Difference in Elevation Between Pump Shutoff and Uppermost Orifice: ft Uppermost Orifice is: Lower than Pump Shutoff Capacity @ Total Pressure Head: _______gpm Calculated Total Pressure Head: ft (Attach Pump Curve) Dosing and Pump Chamber Number of Doses/Day ___________ Dose Quantity _________gal Chamber Capacity _________gal Pump Controls: Timer (or) Elapse Time Meter (circle if required) If Timer: Pump On _______ Pump Off _______ Check the following components if they drain between doses: portThis section completed by Certified Designer Form DS N/A X 36 120 varies < 15% 18 X 5 X 39 20 N/A 420 1,500 24" 700 50% 946500 90sec 2hr 30min X X X Pressure Distribution and Supplemental Treatment System Design TrakIt #: ___________________ Update: September 12, 2014 Pressure Distribution System Parameters Laterals Schedule/Class _______________ Length (feet) _______________ Diameter (inches) _______________ Number _______________ Separation (feet) _______________ Orifices Total Number of Orifices _______________ Diameter (inches) _______________ Spacing (inches) _______________ Manifold Schedule/Class _______________ Length (feet) _______________ Preferred Manifold Configuration Used?  Yes  No Transport Pipe Schedule/Class _______________ Length (feet) _______________ Diameter (inches) _______________ Designer Certification The undersigned has submitted this design based observed site conditions and has designed the system as shown on this design form and the drawings attached thereto. _________________________________________ Designer Date 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. _________________________________________ Environmental Health Specialist Date Caution: This design approval is only valid when all the following conditions are met: The design is stamped “Approved” by Butte County Public Health Department The Construction Permit has not expired. The system is installed by a Certified Installer or homeowner authorized by the Butte County Public Health Department Drainfield site conditions have not been altered to adversely affect conditions of design approvalThis section completed by Certified Designer This section completed by EH Schedule 40 60 1.25 2 N/A Schedule 40 10  68 1/8" 21" Schedule 40 50 2.0 3/3/2022 Pressure Distribution and Supplemental Treatment System Design Design Drawing Checklist TrakIt #: ___________________ Update: September 12, 2014 Required Drawings Scaled Plot Plan  Test hole locations  Property lines  Existing and proposed wells within 100 ft of property lines  Critical distance measurements to cuts, banks, and surface water  Location and orientation of curtain drain and all absorption components  Location and dimension of primary system and reserve area  Buildings  Direction of slope indicator  Waterlines  Roads/easements/driveways/parking  Critical resource lands (if applicable)  North arrow and scale of drawing shown on scale bar Mound Systems Only Additional layout information for mound system:  Overall fill dimensions  Up-slope, downslope, and endslope fill width Additional cross-section information for mound system:  Settled cap depth at center and edge of bed  Sidewall slope  Up-slope and downslope bed elevation Scaled Layout Sketch  Drainfield orientation and layout  Trench/bed dimensions and critical distances within layout  D-Box/“T”/“L” locations  Septic tank/pump chamber location  Observation port location  Clean-out location  Manifold placement  Orifice placement  Lateral placement, with distances to edge of bed  Audible/visual alarm referenced  Scale of drawing shown on scale bar Cross-Section Sketch Referenced depth from original grade:  Septic tank lid and drainfield cover depth Reference depth from original grade and restrictive strata:  Laterals, trench/bed top and bottom  Curtain drain collector  Sand augmentation Other cross-section detail:  Observation ports and clean-outs This section completed by Certified Designer Pressure Distribution and Supplemental Treatment System Design TrakIt #: ___________________ Update: August 20, 2010 File Name:Plot Date:Date Issued:Sheet No.Project No.Drawn By:Checked By:Status:Sheet Title:Scale:The Architect in responsible charge has reviewed the systems,provisions and building components in this drawing for generalconformance with the design intent. This does not alleviate theLicensed Professional's responsibility for applicable codeconformance and to coordinate with other disciplines.LICENSE STAMP LICENSE STAMPC5RDGMKG20-028JANUARY 2022UTILITY PLANCONCOW VOLUNTEER FIRE STATION for COUNTY OF BUTTE 3595 SHUMAN LN, OROVILLE, CA 95965 APN: 058-190-182 Rev. Delta Revision Description Date100% CONSTRUCTION DOCUMENTS ·····File Name:Plot Date:Date Issued:Sheet No.Project No.Drawn By:Checked By:Status:Sheet Title:Scale:The Architect in responsible charge has reviewed the systems,provisions and building components in this drawing for generalconformance with the design intent. This does not alleviate theLicensed Professional's responsibility for applicable codeconformance and to coordinate with other disciplines.LICENSE STAMP LICENSE STAMPC7RDGMKG20-028DETAILS SHEETCONCOW VOLUNTEER FIRE STATION for COUNTY OF BUTTE 3595 SHUMAN LN, OROVILLE, CA 95965 APN: 058-190-182 Rev. Delta Revision Description Date100% CONSTRUCTION DOCUMENTSJANUARY 2022