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SR0078253
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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SR0078253
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Entry Properties
Last modified
6/27/2018 2:03:42 PM
Creation date
3/1/2018 10:27:54 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0078253
PE
4214
FACILITY_NAME
BRUCE D & SUZANNE M COLLINS
STREET_NUMBER
14401
Direction
N
STREET_NAME
DAVIS
STREET_TYPE
RD
City
LODI
Zip
95242
APN
05524032
ENTERED_DATE
3/1/2018
SITE_LOCATION
14401 N DAVIS RD
RECEIVED_DATE
10/13/2017
P_LOCATION
99
P_DISTRICT
004
Tags
EHD - Public
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-C t <br />SEPTIC SYSTEM INSPECTION CHECK LIST <br />ADDRESS: jqq6f QbL,) � <br />X <br />PERMIT # 2 <br />Check box ACTUAL <br />PARAMETER if inspected MEASUREMENT <br />MEETS SJC <br />STANDARDS? COMMENTS <br />SEPTIC TANK: ex <br />CORRECT TANK CAPACITY? <br />DISTAN TO FOUNDATION? <br />DISTANCE NROPERTY LINE? <br />DISTANCE TOA WELLS? <br />TANK LEVEL AND OR TED CORRECTLY? <br />SANITARY TEES CORRE LY INSTALLED? <br />CORRECT TYPE OF PIPING?Y <br />TANK VENTED ? <br />ANY TANK ABNORMALITIES NOTED? <br />OTHER <br />Y <br />Y <br />Y <br />Y <br />Y <br />Y <br />Y <br />Y <br />Y <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />DISTRIBUTION BOX: <br />DISTANCE FROM TANK? <br />DISTANCE TO NEAREST LEACH LINE? <br />DOES SYSTEM HAVE EQUAL DISTRIBUTION? <br />IS D -BOX LEVEL? <br />OTHER <br />�/ $ 1 <br />3 <br />U <br />N <br />N <br />N <br />N <br />N <br />LEACH FIELD: (LL = LEACH LINES) <br />DISTANCE TO PROPERTY LINE? <br />DISTANCE TO ANY WATER WELLS? <br />DISTANCE TO NEAREST FOUNDATION? <br />DISTANCE OF SOIL BARRIER BETWEEN LL -S? <br />CORRECT DEPTH OF LL TRENCHES? <br />CORRECT DEPTH AND TYPE OF ROCK? <br />CORRECT WIDTH OF LL TRENCHES? <br />CORRECT LENGTH OF LL TRENCHES? <br />CORRECT TYPE OF PIPING?j <br />OTHER <br />`v1 <br />17�t <br />I l t <br />* . +.tlba <br />:2 t <br />SO <br />© <br />® <br />Y <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N 1,pae <br />N <br />N <br />SEEPAGE PITS: PIONe <br />DISTANCE TO PROPERTY LINE? <br />DISTANCE TO ANY WATER WELLS? <br />DISTANCE TO NEAREST FOUNDATION? <br />DISTANCE OF SOIL BARRIER TO PITS? <br />CORRECT DEPTH AND TYPE OF ROCK? <br />CORRECT WIDTH? <br />OTHER <br />Y <br />Y <br />Y <br />Y <br />Y <br />Y <br />N <br />N <br />N <br />N <br />N <br />N <br />MISCELLANEOUS: <br />DOES PERMIT DRAWING REFLECT ACCURATE LOCATION OF SYSTEM? <br />DOES PERMIT DRAWING SHOW SUFFICIENT DETAIL TO LOCATE IN FUTURE? <br />ANY NO ANSWER ABOVE REQUIRES PERMIT TO BE REDRAWN. <br />COMMENTS: <br />(2) <br />Q <br />N <br />N <br />INSPECTED BY: N q S& E n,,— Y+w"" -o DATE: 1111712017 <br />111,120/7 <br />
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