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SR0083341
EnvironmentalHealth
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ELDERBURY
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4200/4300 - Liquid Waste/Water Well Permits
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SR0083341
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Last modified
6/15/2021 1:39:34 PM
Creation date
6/15/2021 12:58:38 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0083341
PE
4209
STREET_NUMBER
13063
Direction
N
STREET_NAME
ELDERBURY
STREET_TYPE
CT
City
LODI
Zip
95242
APN
05806019
ENTERED_DATE
3/1/2021 12:00:00 AM
SITE_LOCATION
13063 N ELDERBURY CT
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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SJGOV\dsedra
Tags
EHD - Public
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SEPTIC SYSTEM INSPECTION CHECK LIST <br />ADDRESS: )"-.1) 0 6-3 /V; E aeLeA,40,,t r—t _ 6. 1-7- PERMIT # •5r...00 cg --6 —&—f / <br />< Check box ACTUAL <br />PARAMETER ' if inspected MEASUREMENT <br />MEETS SJC <br />STANDARDS? COMMENTS <br />SEPTIC TANK: <br />CORRECT TANK CAPACITY? <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 />cID N 1 .- 12-oo yal <br />t/- Ili -r-l- Y N <br />1.."-- Q1 . 5 4?4- Y N <br />1./- ^- IIR -r+ N Or) Si .le we-11 <br />1.--*---- 0 N <br />(./.--- N w e_c. r I i ,t _ -(-.;' I <br />1./ —oS _-"() N <br />1 /4.-- C—Th N <br />Y N <br />Y 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 />Y N <br />Y N <br />Y N <br />Y N <br />Y N <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? <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 />Y N <br />Y N <br />Y N <br />Y N <br />Y N <br />Y N <br />Y N <br />Y N <br />Y N <br />Y N <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? <br />CORRECT WIDTH? <br />OTHER <br />Y N <br />Y N <br />Y N <br />Y N <br />Y N <br />Y N <br />Y 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 TQBE REDRAWN. <br />COMMENTS: 0 I 4 s C- -6.41 11.0 rie,516/0/12_ <br />Y <br />_ <br />N <br />N <br />INSPECTED BY:(-- <br />C <br /> DATE: I
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