Loading...
HomeMy WebLinkAbout062-270-030 EHS24-030 DESIGN FORMSSTTAANNDDAARRDD GGRRAAVVIITTYY SSYYSSTTEEMM DDEESSIIGGNN FFOORRMM Update: September 12, 2014 Staff Use Only Date Received: __________ Staff: __________________ 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. 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 Dispersal Type: Drainrock Chamber Polystyrene Number of Bedrooms _____________ Daily Flow (gpd) __________gpd Septic Tank Capacity ___________gal Application Rate ________gpd/ft2 Designed Vertical Separation ________inches Ground Slope in Drainfield Area __________ % Drainfield Square Footage __________ Trench Width _____ inches Total Lineal Trench Length _________ ft Trench Depth _____ inches Depth of Fill over Drainfield (if applicable) _____ inches Curtain Drain Depth (if applicable) _________ f Certification of Design The undersigned Certified Installer or Certified Designer (circle one) has submitted this design based observed site conditions as shown on this design form and the drawings attached thereto. _________________________________________ System 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 Wastewater Construction Permit has not expired; the Permit Expiration Date is 2 years from the date of issuance 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 Installer or Designer This section completed by EH Form DG 062-270-030 Rhonda Berndt de Pineda for Phillip DeCann Berry Creek CA 95916 3 1500 .6 36 12 360 4/10/25 36 x 230 Rockerfeller 420 140 Update: September 12, 2014 WASTEWATER SYSTEM DESIGN CHECKLIST Owner’s name Assessor’s Parcel Number North arrow Property lines Any relevant site features such as cliffs, cut banks, irrigation canals, springs, rock outcrop, landslide areas, drainage ways, etc. within 200 ft of the primary and repair dispersal areas Any existing and/or proposed site improvements, such as buildings, pools, driveways, parking areas, easements, waterlines, etc. (please specify whether existing or proposed) Existing wastewater dispersal areas, if present Location and dimensions of designated primary and repair wastewater dispersal areas Test hole locations from Site Evaluation Existing and proposed wells within 200 ft of the primary and repair dispersal areas and neighboring wells within 100 ft of property lines Location and orientation of curtain drain Direction of slope in primary and repair dispersal areas Dispersal field orientation and layout Trench/bed dimensions and critical distances within layout D-Box/“T”/“L” locations Septic tank/pump chamber location Observation port location Scale of drawing shown on scale bar Cross Section Drawings: Dispersal trench Observation port Capping fill, if applicable Curtain drain, if applicable Note: Designer may use form attached for design drawing or may attached drawing on separate page, provided the elements identified in this checklist are included. This section completed by Certified Installer or Designer Update: November 8, 2010 Capping fill, if applicable Curtain drain, if applicable