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SR0083031
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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SR0083031
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Last modified
6/7/2021 4:13:40 PM
Creation date
6/7/2021 3:07:54 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0083031
PE
4210
FACILITY_NAME
4676 E DAHLIA DR
STREET_NUMBER
4676
Direction
E
STREET_NAME
DAHLIA
STREET_TYPE
DR
City
MORADA
Zip
95212
APN
08606008
ENTERED_DATE
12/17/2020 12:00:00 AM
SITE_LOCATION
4676 E DAHLIA DR
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: <br />INSPECTED BY^ <br />oje� <br />te, PERMIT# <br />�Q <br />PARAMETER <br />Check box <br />if inspected <br />ACTUAL MEETS SJC <br />MEASUREMENT STANDARDS? COMMENTS <br />SEPTIC TANK: <br />CORRECT TANK CAPACITY? �%S <br />DISTANCE TO FOUNDATION? <br />DISTANCE TO PROPERTY LINE? <br />DISTANCE TO ANY WELLS? <br />TANK LEVEL AND ORIENTED CORRECTLY? <br />SANITARY TEES CORRECTLY INSTALLED? <br />CORRECT TYPE OF PIPING? <br />TANK VENTED ? <br />ANY TANK ABNORMALITIES NOTED? <br />OTHER <br />Y <br />Y <br />Y <br />Y <br />Y <br />Y <br />5 ^JS <br />Y <br />Y <br />Y <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />DISTRIBUTION BOX: <br />DISTANCE FROM TANK? <br />DISTANCE TO NEAREST LEACH LINE? <br />DOES SYSTEM HAVE EQUAL DISTRIBUTION? <br />IS D -BOX LEVEL? <br />OTHER <br />�� <br />L <br />S �-f QDY <br />Y <br />As Y <br />� <br />Y <br />N <br />N J <br />N <br />N <br />N <br />laW L L <br />LEACH FIELD: (LL = LEACH LINES) <br />DISTANCE TO PROPERTY LINE? <br />DISTANCE TO ANY WATER WELLS? <br />DISTANCE TO NEAREST FOUNDATION? <br />DISTANCE OF SOIL BARRIER BETWEEN LL'S?f <br />CORRECT DEPTH OF LL TRENCHES? <br />CORRECT DEPTH AND TYPE OF ROCK? <br />CORRECT WIDTH OF LL TRENCHES? <br />CORRECT LENGTH OF LL TRENCHES? <br />CORRECT TYPE OF PIPING? <br />OTHER <br />ti S -- <br />Y <br />(OY <br />p. r' r Y <br />--. 3 6 �� <br />N `r Y <br />4029 Y <br />tj CD <br />kq Y <br />Y <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />\� <br />.�- <br />1/ <br />SEEPAGE PITS: <br />DISTANCE TO PROPERTY LINE? <br />DISTANCE TO ANY WATER WELLS? <br />DISTANCE TO NEAREST FOUNDATION? <br />DISTANCE OF SOIL BARRIER TO PITS? <br />CORRECT DEPTH AND TYPE OF ROCK?NCORRECT WIDTH? <br />OTHER <br />1� <br />��N <br />Q) <br />'/(p Y <br />W4A <br />Y <br />N <br />N <br />N <br />N <br />N <br />MISCELLANEOUS: <br />DOES PERMIT DRAWING REFLECT ACCURATE LOCATION OF SYSTEM? <br />DOES PERMIT DRAWING SHOW SUFFICIENT DETAIL TO LOCATE IN FUTURE? <br />ANY NO ANSWER ABOVE REQUIRES PERMIT TO BE REDRAWN. <br />COMMENTS: C.�// <br />x► C �vl LL S U h <br />N <br />N <br />I� ` <br />�r � `�iL� <br />t <br />1 /7. J <br />J1.4 hal' 11 A04 <br />e <br />i��"J) <br />/ ) _ �O� DATE: <br />
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