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SR0080034
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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SR0080034
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Last modified
4/24/2019 3:37:24 PM
Creation date
4/24/2019 2:35:41 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0080034
PE
4210
STREET_NUMBER
20650
Direction
N
STREET_NAME
DUSTIN
STREET_TYPE
RD
City
ACAMPO
Zip
95220
APN
01713001
ENTERED_DATE
1/2/2019 12:00:00 AM
SITE_LOCATION
20650 N DUSTIN RD
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: 2 PERMIT# SkooC)() -DLI <br /> Check box ACTUAL MEETS SJC <br /> PARAMETER if inspected MEASUREMENT STANDARDS? COMMENTS <br /> SEPTIC TANK: <br /> CORRECT TANK CAPACITY? Y N <br /> DISTANCE TO FOUNDATION? Y N J <br /> DISTANCE TO PROPERTY LINE? Y N <br /> DISTANCE TO ANY WELLS? Y N <br /> TANK LEVEL AND ORIENTED CORRECTLY? N <br /> SANITARY TEES CORRECTLY INSTALLED? Y N <br /> CORRECT TYPE OF PIPING? Y N <br /> TANK VENTED? Y N <br /> ANY TANK ABNORMALITIES NOTED? Y N <br /> OTHER Y N <br /> DISTRIBUTION BOX: <br /> DISTANCE FROM TANK? L J N <br /> DISTANCE TO NEAREST LEACH LINE? 'V/ 5let © N <br /> DOES SYSTEM HAVE EQUAL DISTRIBUTION? V" Y N <br /> IS D-BOX LEVEL? V, QY N <br /> OTHER Y N <br /> LEACH FIELD: (LL=LEACH LINES) <br /> DISTANCE TO PROPERTY LINE? + N <br /> DISTANCE TO ANY WATER WELLS? I rj -F t © N <br /> DISTANCE TO NEAREST FOUNDATION? ✓ �q{ '—LZ) N <br /> DISTANCE OF SOIL BARRIER BETWEEN LL'S? Y N <br /> CORRECT DEPTH OF LL TRENCHES? LA 2 QC, j Y N <br /> CORRECT DEPTH AND TYPE OF ROCK? 11 C" Y N l vZ S i.— <br /> CORRECT WIDTH OF LL TRENCHES? V1.1 'L N <br /> CORRECT LENGTH OF LL TRENCHES? ✓ N <br /> CORRECT TYPE OF PIPING? S Y N <br /> OTHER Y N <br /> SEEPAGE PITS: <br /> DISTANCE TO PROPERTY LINE? T t U N <br /> DISTANCE TO ANY WATER WELLS? © N <br /> DISTANCE TO NEAREST FOUNDATION? jY N <br /> DISTANCE OF SOIL BARRIER TO PITS? 'G) N <br /> CORRECT DEPTH AND TYPE OF ROCK? ✓ 2-�5N 1 -2 i n J - <br /> CORRECT WIDTH? �3 36 McilLA ZD N <br /> OTHER lt�d 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 /> INSPECTED BY: n`�JL/� �tv,, DATE: <br />
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