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SR0078993
Environmental Health - Public
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4200/4300 - Liquid Waste/Water Well Permits
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SR0078993
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Entry Properties
Last modified
6/27/2018 2:04:40 PM
Creation date
5/16/2018 4:40:48 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0078993
PE
4213
FACILITY_NAME
JOSE VILLANUEVA MADRIZ
STREET_NUMBER
17888
Direction
S
STREET_NAME
WAGNER
STREET_TYPE
RD
City
RIPON
Zip
95366
APN
20507037
ENTERED_DATE
5/16/2018
SITE_LOCATION
17888 S WAGNER RD
RECEIVED_DATE
4/16/2018
P_LOCATION
99
P_DISTRICT
004
Tags
EHD - Public
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ADDRESS: <br />PARAMETER <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 />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 />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 />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 />SEPTIC SYSTEM INSPECTION CHECK LIST <br />rrr <br />PERMIT # b&,d 7"" <br />Check box <br />ACTUAL <br />MEETS SJC <br />if inspected <br />MEASUREMENT <br />STANDARDS? COMMENTS <br />zavv <br />N <br />N <br />N <br />/S7 <br />d7 <br />N <br />N <br />N <br />BS sa LID <br />N <br />N <br />�—_ <br />OP <br />N <br />L�/ <br />f�Y <br />N <br />6,1 -j <br />7' <br />GA <br />Y <br />/d0/� 8i <br />33 '® <br />121 -1) <br />Y <br />--� Y <br />3� <br />ZA -fy <br />YO ® <br />Y <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />Y <br />N <br />Y <br />N <br />Y <br />N <br />Y <br />N <br />Y <br />N <br />Y <br />N <br />Y <br />N <br />MISCELLANEOUS: <br />DOES PERMIT DRAWING REFLECT ACCURATE LOCATION OF SYSTEM? N <br />DOES PERMIT DRAWING SHOW SUFFICIENT DETAIL TO LOCATE IN FUTURE? N <br />ANY NO ANSWER ABOVE REQUIRES PERMIT TO BE REDRAWN. <br />COMMENTS: <br />INSPECTED BY: �nQA l.D DATE: tJtovg�- <br />
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