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SR0078587
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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SR0078587
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Entry Properties
Last modified
6/27/2018 2:04:08 PM
Creation date
3/1/2018 11:42:15 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0078587
PE
4211
FACILITY_NAME
MICHAEL W & THERESA L DIXON TR
STREET_NUMBER
18509
Direction
N
STREET_NAME
CHERRY
STREET_TYPE
RD
City
LODI
Zip
95240
APN
05102038
ENTERED_DATE
3/1/2018
SITE_LOCATION
18509 N CHERRY RD
RECEIVED_DATE
1/5/2018
P_LOCATION
99
P_DISTRICT
004
Tags
EHD - Public
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SEPTIC SYSTEM INSPECTION CHECK LIST <br />ADDRESS: — <br />PERMIT # -- <br />Check box <br />ACTUAL <br />MEETS SJC <br />PARAMETER if <br />inspected <br />MEASUREMENT <br />STANDARDS? COMMENTS <br />SEPTIC TANK: <br />CORRECT TANK CAPACITY? <br />N <br />-%,/ <br />DISTANCE TO FOUNDATION? <br />crj S <br />® <br />N <br />DISTANCE TO PROPERTY LINE? <br />32 <br />N <br />v <br />DISTANCE TO ANY WELLS? <br />%D _ <br />N <br />TANK LEVEL AND ORIENTED CORRECTLY? <br />N <br />SANITARY TEES CORRECTLY INSTALLED? <br />VN <br />CORRECT TYPE OF PIPING? <br />SQa 3.5- <br />® <br />N <br />TANK VENTED ? <br />Qj <br />N <br />ANY TANK ABNORMALITIES NOTED? <br />N <br />OTHER <br />® <br />N <br />DISTRIBUTION BOX: <br />DISTANCE FROM TANK? <br />rj <br />N <br />DISTANCE TO NEAREST LEACH LINE? <br />N <br />DOES SYSTEM HAVE EQUAL DISTRIBUTION? <br />N <br />IS D -BOX LEVEL? <br />N <br />OTHER <br />N <br />LEACH FIELD: (LL = LEACH LINES) <br />DISTANCE TO PROPERTY LINE? <br />N <br />DISTANCE TO ANY WATER WELLS? <br />N <br />DISTANCE TO NEAREST FOUNDATION? <br />, 3' <br />® <br />N <br />DISTANCE OF SOIL BARRIER BETWEEN LL'S? <br />;/ <br />N <br />CORRECT DEPTH OF LL TRENCHES? <br />N <br />CORRECT DEPTH AND TYPE OF ROCK?% <br />'� <br />C7Y <br />N <br />CORRECT WIDTH OF LL TRENCHES? <br />Vol' <br />21 <br />N <br />CORRECT LENGTH OF LL TRENCHES? <br />All,L/O <br />N <br />CORRECT TYPE OF PIPING? <br />N <br />OTHER <br />Y <br />N <br />SEEPAGE SLS <br />DISTANCE TO PROPERTY LINE? <br />P <br />N <br />DISTANCE TO ANY WATER WELLS? <br />SSS r <br />N <br />DISTANCE TO NEAREST FOUNDATION? <br />Y <br />N <br />DISTANCE OF SOIL BARRIER TO PITS? <br />Y <br />N <br />CORRECT DEPTH AND TYPE OF ROCK? <br />Y <br />N <br />CORRECT WIDTH? <br />Y <br />N <br />OTHER <br />Y <br />N <br />MISCELLANEOUS: <br />DOES PERMIT DRAWING REFLECT ACCURATE LOCATION OF SYSTEM? <br />CYi <br />N <br />DOES PERMIT DRAWING SHOW SUFFICIENT DETAIL <br />TO LOCATE IN FUTURE? <br />GS? <br />N <br />ANY NO ANSWER ABOVE REQUIRES PERMIT TO BE REDRAWN. <br />COMMENTS: <br />INSPECTED BY: �Uj4DATE: <br />
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