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SR0078811
Environmental Health - Public
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EHD Program Facility Records by Street Name
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HENRY
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21992
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4200/4300 - Liquid Waste/Water Well Permits
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SR0078811
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Last modified
6/27/2018 2:04:28 PM
Creation date
3/19/2018 3:09:40 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0078811
PE
4210
FACILITY_NAME
FERNANDEZ, FELIPE & NUVIA
STREET_NUMBER
21992
Direction
S
STREET_NAME
HENRY
STREET_TYPE
RD
City
ESCALON
Zip
95320
APN
24908005
ENTERED_DATE
3/19/2018
SITE_LOCATION
21992 S HENRY RD
RECEIVED_DATE
3/5/2018
P_LOCATION
99
P_DISTRICT
004
Tags
EHD - Public
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SrPTjC SYSTEM INSPECTION CHECK LIST <br />INSPECTED BY: DATE: <br />ADDRESS: , y\f OfRMIT # '. <br />Ch k box A A L MEETS SJC <br />PARAMETER Ifinspeded MEASUREMENT 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 />OTI{ER <br />,�.,^'� <br />o l� c.- N <br />9- % N <br />_ Y N <br />t N <br />N <br />N o.S % !% M �.., " < <br />N 0 <br />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 />_ <br />,:� 1 N <br />N <br />N <br />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 />1 <br />N <br />N <br />t N - <br />Y N <br />N <br />'z' `�� N <br />`, N <br />' N <br />— N <br />N <br />L/ <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 />CORRECTWIDTH? <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? Y N <br />DOES PERMIT DRAWING SHOW SUFFICIENT DETAIL TO LOCATE IN FUTURE? Y N <br />ANY NO ANSWER ABOVE REQUIRES PERMIT TO BE REDRAWN. 0) <br />COMMENTS: t I f <br />6o r AA <br />INSPECTED BY: DATE: <br />
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