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SR0078169
Environmental Health - Public
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4200/4300 - Liquid Waste/Water Well Permits
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SR0078169
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Last modified
6/27/2018 2:03:35 PM
Creation date
3/5/2018 9:51:58 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0078169
PE
4211
FACILITY_NAME
ALFIERI, CYNTHIA R TR
STREET_NUMBER
18155
Direction
S
STREET_NAME
WAGNER
STREET_TYPE
RD
City
RIPON
Zip
95366
APN
24506037
ENTERED_DATE
3/5/2018
SITE_LOCATION
18155 S WAGNER RD
RECEIVED_DATE
9/18/2017
P_LOCATION
99
P_DISTRICT
004
Tags
EHD - Public
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SEPTIC SYSTEM INSPECTION CHECK LIST <br />ADDRESS:f (,(,JL'1 1/1 me. <br />PERMIT # S:406 % <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 />Y <br />Y <br />Y <br />Y <br />Y <br />Y <br />Y <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 />l <br />— <br />Y <br />Y <br />N <br />N <br />N <br />N <br />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 LUS? <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 />Z{Xjl �- <br />14 <br />25 <br />I q ` <br />?{j' ` <br />3. $ <br />Q <br />Y <br />® <br />Y <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />SEEPAGE PITS: Moot - <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 <br />Y <br />Y <br />Y <br />Y <br />Y <br />Y <br />N <br />N <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: <br />Y3 <br />N <br />N <br />INSPECTED BY: /I Ally e&o f //71,et) DATE: 1014 3 V <br />
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