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SR0080292
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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SR0080292
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Last modified
4/24/2019 3:55:37 PM
Creation date
4/24/2019 2:38:52 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0080292
PE
4210
STREET_NUMBER
12198
Direction
S
STREET_NAME
CARROLTON
STREET_TYPE
RD
City
ESCALON
Zip
95320
APN
20514013
ENTERED_DATE
3/5/2019 12:00:00 AM
SITE_LOCATION
12198 S CARROLTON RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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SEPTIC SYSTEM INSPECTION CHECK LIST <br /> ADDRESS: 0 yC PERMIT# <br /> Check box ACTUAL MEETS SJC <br /> PARAMETER if inspected MEASUREMENT STANDARDS? COMMENTS <br /> SEPTIC TANK: S L•�,p <br /> CORRECT TANK CAPACITY? EX U /y Y N <br /> DISTANCE TO FOUNDATION? Y N <br /> DISTANCE TO PROPERTY LINE? Y N <br /> DISTANCE TO ANY WELLS? Y N <br /> TANK LEVEL AND ORIENTED CORRECTLY? Y 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 TANKOY N <br /> DISTANCE TO NEAREST LEACH LINE? vY N <br /> DOES SYSTEM HAVE EQUAL DISTRIBUTION? N <br /> IS D-BOX LEVEL? N <br /> OTHER Y N <br /> LEACH FIELD: (LL=LEACH LINES) V; �'�1 <br /> DISTANCE TO PROPERTY LINE? + N "� `. �� <br /> DISTANCE TO ANY WATER WELLS? N <br /> DISTANCE TO NEAREST FOUNDATION? © N <br /> DISTANCE OF SOIL BARRIER BETWEEN LUS? 7 (D N (o f4 t-a 2 x,Sk,r" <br /> CORRECT DEPTH OF LL TRENCHES? 1/ LAr (JY N _ <br /> CORRECT DEPTH AND TYPE OF ROCK? Y N r, ' — 2— <br /> �`/t /'✓C <br /> CORRECT WIDTH OF LL TRENCHES? a N <br /> CORRECT LENGTH OF LL TRENCHES? L Y N <br /> CORRECT TYPE OF PIPING? S ¢ 3 5 N <br /> OTHER Y N <br /> SEEPAGE PITS: L <br /> DISTANCE TO PROPERTY LINE? �1 Y N T �0 (/ ✓� , <br /> DISTANCE TO ANY WATER WELLS? N <br /> DISTANCE TO NEAREST FOUNDATION? N <br /> DISTANCE OF SOIL BARRIER TO PITS? \/ l% N _ <br /> CORRECT DEPTH AND TYPE OF ROCK? _� N (;5— 2 n V�(Lr, <br /> CORRECT WIDTH? vY N <br /> OTHER ✓ rM �Y N (O �f S0� o.��`�r e.rreafi fJf <br /> MISCELLANEOUS: <br /> DOES PERMIT DRAWING REFLECT ACCURATE LOCATION OF SYSTEM? N <br /> DOES PERMIT DRAWING SHOW SUFFICIENT DETAIL TO LOCATE IN FUTURE? Y N <br /> ANY NO ANSWER ABOVE REQUIRES PERMIT TO]BE REDRAWN. l ^ o new <br /> �� <br /> COMMENTS: X( S ✓r' L- L 44 1 / C a- /l�Y/"(/ <br /> e Y1�G H <br /> INSPECTED BYr ,/,'C�_ A�D�C V DATE: / �/ <br />
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