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SR0078699
EnvironmentalHealth
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DIETRICH
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4200/4300 - Liquid Waste/Water Well Permits
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SR0078699
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Entry Properties
Last modified
6/27/2018 2:04:17 PM
Creation date
3/1/2018 11:52:21 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0078699
PE
4211
FACILITY_NAME
CHELSEY R & JOHN TIVALD
STREET_NUMBER
512
Direction
N
STREET_NAME
DIETRICH
STREET_TYPE
RD
City
LINDEN
Zip
95236
APN
10522044
ENTERED_DATE
3/1/2018
SITE_LOCATION
512 N DIETRICH RD
RECEIVED_DATE
2/6/2018
P_LOCATION
99
P_DISTRICT
004
Tags
EHD - Public
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SEPTIC SYSTEM INSPECTION CHECK LIST <br />ADDRESS: 5/2- N• A/e l-Yi`t,� A41 PERMIT# ,SX6,o5796 <br />4w, <br />Check box ACTUAL <br />MEETS SJC <br />PARAMETER <br />if inspected MEASUREMENT <br />STANDARDS? COMMENTS <br />SEPTIC TANK: <br />CORRECT TANK CAPACITY? <br />/u,� <br />'® <br />N <br />DISTANCE TO FOUNDATION? <br />y <br />(� <br />N <br />DISTANCE TO PROPERTY LINE? <br />ice It <br />� <br />N <br />DISTANCE TO ANY WELLS? <br />/Sall- <br />A <br />N <br />TANK LEVEL AND ORIENTED CORRECTLY? <br />N <br />SANITARY TEES CORRECTLY INSTALLED? <br />N <br />CORRECT TYPE OF PIPING? <br />%/ S0, yA <br />N <br />TANK VENTED ? <br />N <br />ANY TANK ABNORMALITIES NOTED? <br />N <br />OTHER <br />—v <br />N <br />DISTRIBUTION BOX: <br />DISTANCE FROM TANK?7 <br />!�% <br />N <br />DISTANCE TO NEAREST LEACH LINE? <br />VOS I <br />N <br />DOES SYSTEM HAVE EQUAL DISTRIBUTION? <br />N <br />IS D -BOX LEVEL? <br />—+ <br />N <br />OTHER <br />Y <br />N <br />LEACH FIELD: (LL = LEACH LINES) <br />DISTANCE TO PROPERTY LINE? <br />90 / <br />�D <br />N <br />DISTANCE TO ANY WATER WELLS? <br />N <br />DISTANCE TO NEAREST FOUNDATION? <br />N <br />DISTANCE OF SOIL BARRIER BETWEEN LL'S? <br />N <br />CORRECT DEPTH OF LL TRENCHES? <br />�j12 �� <br />-4) <br />N <br />V" <br />CORRECT DEPTH AND TYPE OF ROCK? <br />N <br />CORRECT WIDTH OF LL TRENCHES? <br />_ ► <br />N <br />CORRECT LENGTH OF LL TRENCHES? <br />ss <br />N <br />CORRECT TYPE OF PIPING? <br />N <br />OTHER <br />N <br />SEEPAGE PITS:"'SP off <br />s siy <br />DISTANCE TO PROPERTY LINE? <br />q0 U <br />a% <br />N <br />DISTANCE TO ANY WATER WELLS? <br />v ol sp` <br />N <br />DISTANCE TO NEAREST FOUNDATION? <br />�-r <br />N <br />DISTANCE OF SOIL BARRIER TO PITS? <br />v S f <br />N <br />CORRECT DEPTH AND TYPE OF ROCK? <br />2S l <br />N <br />CORRECT WIDTH? <br />41 <br />d> <br />N <br />OTHER <br />29 <br />N <br />MISCELLANEOUS: <br />DOES PERMIT DRAWING REFLECT ACCURATE LOCATION OF SYSTEM? <br />Y <br />N <br />DOES PERMIT DRAWING SHOW SUFFICIENT DETAIL <br />TO LOCATE IN FUTURE? <br />Y <br />NANY <br />NO <br />E��U�-7,S,MITTO�BERE�RA�� <br />COMMENTS: �i/` ► �.G�/ <br />COMMENNSWE��� <br />e� SCs��Z <br />I <br />INSPECTED BY: Adt DATE: 2/,f12,J1Y <br />
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