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SR0081624
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4200/4300 - Liquid Waste/Water Well Permits
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SR0081624
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Last modified
8/5/2021 3:53:56 PM
Creation date
8/5/2021 2:51:46 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0081624
PE
4211
FACILITY_NAME
16464 FOX RD
STREET_NUMBER
16464
Direction
N
STREET_NAME
FOX
STREET_TYPE
RD
City
LODI
Zip
95240
APN
05120007
ENTERED_DATE
1/13/2020 12:00:00 AM
SITE_LOCATION
16464 N FOX 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: PERMIT# <br /> Check box ACTUAL MEETS SJC <br /> PARAMETER if inspected MEASUREMENT STANDARDS? COMMENTS <br /> SEPTIC TANK: <br /> CORRECT TANK CAPACITY? N —� /y�Q t /fl <br /> DISTANCE TO FOUNDATION? Y N; <br /> DISTANCE TO PROPERTY LINE? �– Y N <br /> DISTANCE TO ANY WELLS? 3Bp LfOD Y N <br /> TANK LEVEL AND ORIENTED CORRECTLY? Y N <br /> SANITARY TEES CORRECTLY INSTALLED? <br /> CORRECT TYPE OF PIPING? 3�� <br /> TANK VENTED? Y N <br /> ANY TANK ABNORMALITIES NOTED? Y N <br /> OTHER Y N <br /> DISTRIBUTION BOX: ✓ 511 LA 0 <br /> DISTANCE FROM TANK? Y N <br /> DISTANCE TO NEAREST LEACH LINE? N <br /> DOES SYSTEM HAVE EQUAL DISTRIBUTION? <br /> IS D-BOX LEVEL? Y j 1r�C trv. tR P 1` <br /> A;-/ & <br /> OTHER Y N <br /> LEACH FIELD: (LL= S) ;yl <br /> DISTANCE TO PROPERTY LINE? f N <br /> DISTANCE TO ANY WATER WELLS? Y N <br /> DISTANCE TO NEAREST FOUNDATION? �_ ',��� N <br /> DISTANCE OF SOIL BARRIER BETWEEN LL'S? Y 6 <br /> ij ji 16 <br /> CORRECT DEPTH OF LL TRENCHES? Y <br /> CORRECT DEPTH AND TYPE OF ROCK? Y N <br /> CORRECT WIDTH OF LL TRENCHES? Y N <br /> CORRECT LENGTH OF LL TRENCHES? N <br /> CORRECT TYPE OF PIPING? k:ON <br /> OTHER Y N S <br /> SEEPAGE PITS: d <br /> DISTANCE TO PROPERTY LINE? Y N <br /> DISTANCE TO ANY WATER WELLS? Y N <br /> DISTANCE TO NEAREST FOUNDATION? Y N <br /> DISTANCE OF SOIL BARRIER TO PITS? Y N <br /> CORRECT DEPTH AND TYPE OF ROCK? Y N <br /> CORRECT WIDTH? YN <br /> OTHER 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 REQUIRFS PERMIT TO BE REDRAWN. i��� i �Q <br /> COMMENTS: 3�a, G. <br /> .12,644 (C <br /> INSPECTED BY: DATE: <br />
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