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SR0078268
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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SR0078268
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Entry Properties
Last modified
6/27/2018 2:03:45 PM
Creation date
3/1/2018 11:03:31 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0078268
PE
4211
FACILITY_NAME
PHILLIP & KRISTINE MAXWELL
STREET_NUMBER
745
Direction
E
STREET_NAME
DUDLEY
STREET_TYPE
RD
City
FRENCH CAMP
Zip
95231
APN
17706003
ENTERED_DATE
3/1/2018
SITE_LOCATION
745 E DUDLEY RD
RECEIVED_DATE
10/17/2017
P_LOCATION
99
P_DISTRICT
001
Tags
EHD - Public
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SEPTIC SYSTEM INSPECTION CHECK LIST <br />ADDRESS: < <br />PERMIT # Z <br />Check box ACTUAL <br />PARAMETER if inspected MEASUREMENT <br />MEETS SJC <br />STANDARDS? COMMENTS <br />SEPTIC TANK: <br />CORRECT TANK CAPACITY? <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 />l �j((� <br />7,3' <br />�/7 I <br />I y Gi <br />(y� <br />', <br />® <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 />,/ S <br />S <br />© <br />l J <br />Y <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 />rr -- <br />I �P'6j <br />12-7' <br />20 <br />?� j -z,,j 3 <br />7 <br />fm <br />U r( <br />//ll <br />(D <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 />�/ <br />SEEPAGEPITS: �jp1e <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 />Y <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 />Y <br />N <br />N <br />INSPECTED BY: . I set f� , /'q ffm (- ID DATE: /0 j/1 <br />YV TT'y /g0 7 <br />
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