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SR0079436
EnvironmentalHealth
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12 (STATE ROUTE 12)
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4200/4300 - Liquid Waste/Water Well Permits
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SR0079436
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Last modified
11/19/2024 3:48:03 PM
Creation date
9/26/2018 1:14:05 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0079436
PE
4210
STREET_NUMBER
209
Direction
E
STREET_NAME
STATE ROUTE 12
City
LODI
Zip
95242
APN
02705019
ENTERED_DATE
7/25/2018 12:00:00 AM
SITE_LOCATION
209 E HWY 12
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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DAfonskaia
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EHD - Public
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SEPTIC SYSTEM INSPECTION CHECK LIST <br /> ADDRESS: Lo 1R/ PERMIT# R0 t`� -7� ;3 <br /> Check box ACTUAL MEETS SJC <br /> PARAMETER if inspected MEASUREMENT STANDARDS? COMMENTS <br /> SEPTIC TANK: <br /> CORRECT TANK CAPACITY? IP N <br /> DISTANCE TO FOUNDATION? Z p m N <br /> DISTANCE TO PROPERTY LINE? 5-91 N <br /> DISTANCE TO ANY WELLS? toy/ 67 N <br /> TANK LEVEL AND ORIENTED CORRECTLY? N <br /> SANITARY TEES CORRECTLY INSTALLED? N <br /> CORRECT TYPE OF PIPING? N <br /> TANK VENTED? N <br /> ANY TANK ABNORMALITIES NOTED? CZ) N <br /> OTHER Y N <br /> DISTRIBUTION BOX: <br /> DISTANCE FROM TANK? 3%j ® N <br /> DISTANCE TO NEAREST LEACH LINE? -6 N <br /> DOES SYSTEM HAVE EQUAL DISTRIBUTION? — 69 N <br /> IS D-BOX LEVEL? 4::' N <br /> OTHER Y N <br /> LEACH FIELD: (LL=LEACH LINES) <br /> DISTANCE TO PROPERTY LINE? 30' ® N <br /> DISTANCE TO ANY WATER WELLS? /Z 2 1 40 N <br /> DISTANCE TO NEAREST FOUNDATION? i y i d) N <br /> DISTANCE OF SOIL BARRIER BETWEEN LL'S? U l 8 N <br /> CORRECT DEPTH OF LL TRENCHES? v _V�nd Z) N <br /> CORRECT DEPTH AND TYPE OF ROCK? f16"0 0 N <br /> CORRECT WIDTH OF LL TRENCHES? v2 N <br /> CORRECT LENGTH OF LL TRENCHES? v tez ® N <br /> CORRECT TYPE OF PIPING? ® N <br /> OTHER Y N <br /> SEEPAGE PITS: <br /> DISTANCE TO PROPERTY LINE? /.7 ® N <br /> DISTANCE TO ANY WATER WELLS? m N <br /> DISTANCE TO NEAREST FOUNDATION? N <br /> DISTANCE OF SOIL BARRIER TO PITS? (� ' (� ® N <br /> CORRECT DEPTH AND TYPE OF ROCK? Z S N <br /> CORRECT WIDTH? N <br /> OTHER Y N <br /> MISCELLANEOUS: <br /> DOES PERMIT DRAWING REFLECT ACCURATE LOCATION OF SYSTEM? �P N <br /> DOES PERMIT DRAWING SHOW SUFFICIENT DETAIL TO LOCATE IN FUTURE? ® N <br /> ANY NO ANSWER ABOVE REQUIRES PERMIT TO BE REDRAWN. <br /> COMMENTS: <br /> INSPECTED BY: �Qs����� /1_/ � Q DATE: <br />
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