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SR0083165
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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SR0083165
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Last modified
9/13/2021 7:57:37 AM
Creation date
9/9/2021 1:52:45 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0083165
PE
4211
FACILITY_NAME
4040 W KINGDON RD
STREET_NUMBER
4040
Direction
W
STREET_NAME
KINGDON
STREET_TYPE
RD
City
LODI
Zip
95242
APN
05525021
ENTERED_DATE
1/15/2021 12:00:00 AM
SITE_LOCATION
4040 W KINGDON 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 #Q ?j <br />C <br />ck box ACTUAL MEETS SJC <br />PARAMETER if <br />inspected MEASUREMENT STANDARDS? COMMENTS <br />SEPTIC TANK: <br />CORRECT TANK CAPACITY?�Q <br />Y <br />N <br />DISTANCE TO FOUNDATION? <br />\/ Y <br />N <br />DISTANCE TO PROPERTY LINE? <br />V ti3 LA .{'. t Y <br />N <br />DISTANCE TO ANY WELLS? <br />(o �'.� <br />N <br />TANK LEVEL AND ORIENTED CORRECTLY? <br />N <br />SANITARY TEES CORRECTLY INSTALLED? <br />Y! <br />N Wa r <br />CORRECT TYPE OF PIPING? <br />3 Y <br />N <br />TANK VENTED ? <br />, <br />N <br />ANY TANK ABNORMALITIES NOTED? <br />Y <br />N <br />OTHER <br />Y <br />N <br />DISTRIBUTION BOX: <br />DISTANCE FROM TANK? <br />'( Y <br />N <br />DISTANCE TO NEAREST LEACH LINE? <br />Y <br />N <br />DOES SYSTEM HAVE EQUAL DISTRIBUTION? <br />1/ Y <br />N <br />IS D -BOX LEVEL? <br />9 <br />N <br />OTHER <br />Y <br />N <br />LEACH FIELD: (LL = LEACH LINES) <br />DISTANCE TO PROPERTY LINE?>�� <br />$ <br />� <br />N <br />DISTANCE TO ANY WATER WELLS? I' <br />Q'L <br />N <br />DISTANCE TO NEAREST FOUNDATION? <br />% to <br />N <br />DISTANCE OF SOIL BARRIER BETWEEN LL'S?�o <br />CORRECT DEPTH OF LL TRENCHES? <br />� <br />L{ " (fY <br />N <br />N <br />CORRECT DEPTH AND TYPE OF ROCK? <br />jL4_ <br />N <br />CORRECT WIDTH OF LL TRENCHES? <br />W <br />N <br />CORRECT LENGTH OF LL TRENCHES? <br />N <br />CORRECT TYPE OF PIPING?N <br />OTHER <br />Y <br />N <br />SEEPAGE PITS: <br />DISTANCE TO PROPERTY LINE? <br />Y <br />N <br />DISTANCE TO ANY WATER WELLS? <br />Y <br />N <br />DISTANCE TO NEAREST FOUNDATION? <br />Y <br />N <br />DISTANCE OF SOIL BARRIER TO PITS? <br />Y <br />N <br />CORRECT DEPTH AND TYPE OF ROCK? <br />Y <br />N <br />CORRECT WIDTH? <br />Y <br />N <br />OTHER <br />Y <br />N <br />MISCELLANEOUS: <br />DOES PERMIT DRAWING REFLECT ACCURATE LOCATION OF SYSTEM? ey <br />N <br />DOES PERMIT DRAWING SHOW SUFFICIENT DETAIL <br />TO LOCATE IN FUTURE? <br />N <br />ANY NO ANSWER ABOVE RE UIRES PERMIT TOBE <br />COMMENTS: <br />REDRAWN. <br />C0{q i 0 Yl <br />C <br />^L J <br />r- C h <br />dlAq. H 42-1 L <br />INSPECTED I ,,,S/g�" 1 `/ DATE: �� O /�o <br />
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