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SR0078264
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4200/4300 - Liquid Waste/Water Well Permits
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SR0078264
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Entry Properties
Last modified
6/27/2018 2:03:44 PM
Creation date
3/1/2018 10:56:41 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0078264
PE
4210
FACILITY_NAME
ROBERT PACELLA
STREET_NUMBER
25338
Direction
N
STREET_NAME
DUSTIN
STREET_TYPE
RD
City
ACAMPO
Zip
95220
APN
00704001
ENTERED_DATE
3/1/2018
SITE_LOCATION
25338 N DUSTIN RD
RECEIVED_DATE
10/16/2017
P_LOCATION
99
P_DISTRICT
004
Tags
EHD - Public
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SEPTIC SYSTEM INSPECTION CHECK LIST <br />ADDRESS: 215.1- <br />;,� <br />PERMIT # s d!1 Z <br />Check box ACTUAL <br />PARAMETER if inspected MEASUREMENT <br />MEETS SJC <br />STANDARDS? COMMENTS <br />SEPTIC TANK: 'eX 06}6'OVY <br />CORRECT TANK CAPACITY? r <br />DISTANCE TO FOUNDATION? <br />DISTANCE TO PROPERTY LINE? <br />DISTANCE TO ANY WELLS? <br />TANK LEVEL AND ORIENTED CORRECTLY? <br />SANITARY TEES CORRECTLY INSTALLED? <br />CORRECT TYPE OF PIPING? <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 />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' i1 <br />(Z <br />_ <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? <br />OTHER <br />1 <br />2q <br />LOa .�- <br />for SZ -1 <br />Lr�— <br />�" <br />$ <br />Iz iS <br />® <br />'� <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />V7N <br />SEEPAGE PITS: <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 />$' <br />��.7 .i-- <br />S •1 <br />1 <br />g2,11 <br />(4� <br />N <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 />© <br />© <br />N <br />N <br />INSPECTED BY: tvi A—m I�'Lrn DATE: /1,412ov <br />
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