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SR0078625
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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4200/4300 - Liquid Waste/Water Well Permits
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SR0078625
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Entry Properties
Last modified
6/27/2018 2:04:11 PM
Creation date
5/16/2018 4:23:41 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0078625
PE
4210
FACILITY_NAME
DAMBACHER, ALECK
STREET_NUMBER
27445
Direction
N
STREET_NAME
NEW HOPE
STREET_TYPE
RD
City
THORNTON
Zip
95686
APN
00121033
ENTERED_DATE
5/16/2018
SITE_LOCATION
27445 N NEW HOPE RD
RECEIVED_DATE
1/16/2018
P_LOCATION
99
P_DISTRICT
004
Tags
EHD - Public
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SEPTIC SYSTEM INSPECTION CHECK LIST <br />ADDRESS: <br />P¢ <br />PERMIT # 5,e <br />Up 7 1'6 2 <br />Check box <br />PARAMETER if inspected <br />ACTUAL <br />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 />1200 <br />(o <br />zc) "L <br />/ 51 yl <br />— <br />SoR 6.f <br />10 <br />Q <br />Y <br />71:� <br />Y <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />,/./j <br />�/1' <br />✓' <br />DISTRIBUTION BOX: A$ <br />DISTANCE FROM TANK? <br />DISTANCE TO NEAREST LEACH LINE? <br />DOES SYSTEM HAVE EQUAL DISTRIBUTION? <br />IS D -BOX LEVEL? <br />OTHER <br />LEACH FIELD: (LL = LEACH LINES) r7 <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 />24 �'%- <br />/y g r <br />fb f.� <br />($p�Q <br />Y <br />Y <br />Y <br />Y <br />Y <br />2V <br />& <br />Y <br />Y <br />Y <br />Y <br />Y <br />Q <br />Y <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />✓ <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 />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 />40 <br />1D <br />N <br />N <br />6L <br />,� L <br />r CM <br />INSPECTED BY: ,-Qat DATE: 3/Q/fly <br />M7 <br />
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