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SR0082447
EnvironmentalHealth
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FOREST LAKE
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4200/4300 - Liquid Waste/Water Well Permits
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SR0082447
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Last modified
3/3/2021 3:12:44 PM
Creation date
3/3/2021 3:05:36 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0082447
PE
4210
STREET_NUMBER
2934
Direction
E
STREET_NAME
FOREST LAKE
STREET_TYPE
RD
City
ACAMPO
Zip
95220
APN
00528014
ENTERED_DATE
8/11/2020 12:00:00 AM
SITE_LOCATION
2934 E FOREST LAKE RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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SJGOV\tsok
Tags
EHD - Public
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SEPTIC SYSTEM INSPECTION CHECK LIST <br /> ADDRESS: L4 PERMIT# 15 ICOO <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 <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: o-F.Qi <br /> DISTANCE FROM TANK? Y N <br /> DISTANCE TO NEAREST LEACH LINE? Li0 . s V N 0 rZQ�s� <br /> DOES SYSTEM HAVE EQUAL DISTRIBUTION? '' Y N <br /> C <br /> IS D-BOX LEVEL? �� *^^ N <br /> OTHER Y N <br /> LEACH FIELD: (LL=LEACH LINES) <br /> DISTANCE TO PROPERTY LINE? `/ s Y N <br /> DISTANCE TO ANY WATER WELLS? Y N <br /> DISTANCE TO NEAREST FOUNDATION? �� N <br /> DISTANCE OF SOIL BARRIER BETWEEN LL'S? V"* A-�iL Y N <br /> CORRECT DEPTH OF LL TRENCHES? 1;- 4 Y N , '� Q �'H. �✓ <br /> CORRECT DEPTH AND TYPE OF ROCK? Ll— 2 N, Y N t <br /> CORRECT WIDTH OF LL TRENCHES? v--- Y N <br /> CORRECT LENGTH OF LL TRENCHES? N <br /> CORRECT TYPE OF PIPING? N <br /> OTHER Y N <br /> SEEPAGE PITS: <br /> DISTANCE TO PROPERTY LINE? �'f JY <br /> N <br /> DISTANCE TO ANY WATER WELLS? N <br /> DISTANCE TO NEAREST FOUNDATION? �� N <br /> DISTANCE OF SOIL BARRIER TO PITS? t/ N <br /> CORRECT DEPTH AND TYPE OF ROCK? V/ 2 S N <br /> CORRECT WIDTH? t.� 2 n Y N <br /> OTHER Y N <br /> MISCELLANEOUS: <br /> DOES PERMIT DRAWING REFLECT ACCURATE LOCATION OF SYSTEM? Y <br /> DOES PERMIT DRAWING SHOW SUFFICIENT DETAIL TO LOCATE IN FUTURE? N <br /> ANY NO ANSWER ABOVE REQUIRES PERMIT TO BE REDRAWN. <br /> COMMENTS: 14 dl-4:CN �t ve, I O e <br /> ✓K an 1 r-l'c-L 1 - 1•5 1 K <br /> --Wo ` C2 SD -T LCf <br /> re <br /> s t"a v a o I <br /> ` r L <br /> A ?v o <br /> O p W 0. LOy� --�iVC` u a K ° <br /> INSPECTED BY: - <br /> r �— ^ �' n� /,/`�y 04.— DA E: : ,-7� �J^2-.-D S S <br />
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