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SR0079275
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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SR0079275
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Last modified
4/12/2019 10:37:25 AM
Creation date
4/12/2019 9:37:53 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0079275
PE
4211
FACILITY_NAME
22215 N DE VRIES RD
STREET_NUMBER
22215
Direction
N
STREET_NAME
DE VRIES
STREET_TYPE
RD
City
LODI
Zip
95240
APN
01302065
ENTERED_DATE
6/14/2018 12:00:00 AM
SITE_LOCATION
22215 N DE VRIES RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
DAfonskaia
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EHD - Public
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SEPTIC SYSTEM INSPECTION CHECK LIST <br /> ADDRESS: t PERMIT# <br /> Check box ACTUAL MEETS SJC <br /> PARAMETER if inspected MEASUREMENT STANDARDS? COMMENTS <br /> SEPTIC TANK: <br /> CORRECT TANK CAPACITY? L N <br /> DISTANCE TO FOUNDATION? N <br /> DISTANCE TO PROPERTY LINE? i/ Y N <br /> DISTANCE TO ANY WELLS? , Y N <br /> TANK LEVEL AND ORIENTED CORRECTLY? V, IIQNf Y N <br /> SANITARY TEES CORRECTLY INSTALLED? QS Y N <br /> CORRECT TYPE OF PIPING? 5 Y N <br /> TANK VENTED? S Y N <br /> ANY TANK ABNORMALITIES NOTED? N o N Cj Y N <br /> OTHER Y N <br /> DISTRIBUTION BOX: <br /> DISTANCE FROM TANK? N <br /> DISTANCE TO NEAREST LEACH LINE? Y N <br /> DOES SYSTEM HAVE EQUAL DISTRIBUTION? v Y N <br /> IS D-BOX LEVEL? jes Y. N <br /> OTHER Y N <br /> LEACH FIELD: (LL=LEACH LINES) qX <br /> DISTANCE TO PROPERTY LINE? Y N <br /> DISTANCE TO ANY WATER WELLS? Y N <br /> DISTANCE TO NEAREST FOUNDATION? Y N <br /> DISTANCE OF SOIL BARRIER BETWEEN LL'S? D . Y N <br /> CORRECT DEPTH OF LL TRENCHES? Y N <br /> CORRECT DEPTH AND TYPE OF ROCK? N <br /> CORRECT WIDTH OF LL TRENCHES? s Y N <br /> CORRECT LENGTH OF LL TRENCHES? Y N k Gj CA <br /> CORRECT TYPE OF PIPING? Y N <br /> OTHER N <br /> SEEPAGE PITS: <br /> DISTANCE TO PROPERTY LINE? Y N <br /> DISTANCE TO ANY WATER WELLS? Y N <br /> DISTANCE TO NEAREST FOUNDATION? Y N <br /> DISTANCE OF SOIL BARRIER TO PITS? Y N <br /> CORRECT DEPTH AND TYPE OF ROCK? Y N <br /> CORRECT WIDTH? Y N <br /> OTHER Y N <br /> MISCELLANEOUS: <br /> DOES PERMIT DRAWING REFLECT ACCURATE LOCATION OF SYSTEM? Y N <br /> DOES PERMIT DRAWING SHOW SUFFICIENT DETAIL TO LOCATE IN FUTURE? Y N <br /> ANY NO ANSWER ABOVE REQUIRES PERMIT TO BE REDRAWN. <br /> COMMENTS: <br /> naalfN Coa <br /> L <br /> INSPECTED BY: DATE: <br />
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