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SR0079183
Environmental Health - Public
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EHD Program Facility Records by Street Name
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12382
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4200/4300 - Liquid Waste/Water Well Permits
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SR0079183
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Entry Properties
Last modified
7/19/2018 11:27:58 AM
Creation date
7/19/2018 11:27:28 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0079183
PE
4210
FACILITY_NAME
12382 N HIBBARD RD
STREET_NUMBER
12382
Direction
N
STREET_NAME
HIBBARD
STREET_TYPE
RD
City
LODI
Zip
95240
APN
06323019
ENTERED_DATE
5/29/2018 12:00:00 AM
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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AMeuangkhoth
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EHD - Public
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SEPTIC SYSTt=1V1'iNSPEGT10N CHECK LIST <br />ADDRESS:_ H ' b I , Y PERMIT if ,S L -i-c <br />Check box ACTUAL MEETS SJC <br />PARAMETER if inspected MEASUREMENT STANDARDS? CQMMENTS <br />SEPTIC TANK: <br />CORRECT TANK CAPACITY? Y N <br />DISTANCE TO FOUNDATION? _ Y <br />DISTANCE TO PROPERTY LINE? _ N ` <br />DISTANCE TO ANY WELLS? Y N <br />TANK LEVEL AND ORIENTED CORRECTLY? n Y N <br />SANITARY TEES CORRECTLY INSTALLED? <br />CORRECT TYPE OF PIPING? <br />TANK VENTED 7 Y N <br />ANY•TANKABNORMALITIES N N r <br />OTHER <br />DISTRIBUTION BOX: <br />DISTANCE FROM TANK? N <br />DISIANCETONEAREST LEACH LINE? L/ N <br />DOES SYSTEM HAVE EQUAL DISTRIBUTION? / --�� N <br />ISD -BOX LEVEL? N <br />OTHER Y N <br />LEACH FIELD: (LL= LEACH LINES) <br />DISTANCE TO PROPERTY LINE? , <br />1 <br />N <br />DISTANCE TO ANY WATER WELLS? <br />i o(2 M1 I <br />N <br />DISTANCE TO NEAREST FOUNDATION? <br />�7 <br />N - <br />DISTANCE OF SOIL BARRIER BETWEEN LL'S? <br />N <br />CORRECT DEPTI I OF LLTRENCHES? <br />) <br />N <br />CORRECT DEPTH AND TYPE OF ROCK? <br />/ <br />/ <br />N <br />CORRECT WIDTH OF LL TRENCHES?'x <br />- <br />N <br />CORRECT LENGTH OF LL TRENCHES? <br />I <br />"4 1 <br />CORRECT TYPE OF PIPING? <br />5�J <br />N _ <br />OTHER <br />SEEPAGE PITS: <br />DISTANCE TO PROPERTY LINE? <br />�. <br />Y 1) <br />N <br />DISTANCE TO ANY WATER WLUS? <br />DISTANCETONEAREST FOUNDATION? <br />Y� <br />N <br />N <br />DISTANCE OF SOIL BARRIER TO PITS? <br />CORRECT DEPTH AND TYPE OF ROCK? <br />Y <br />N <br />• ' <br />CORRECTWIDTH? <br />Y <br />i— <br />N <br />OTHER <br />Y <br />N <br />MISCELLANEOUS: <br />DOES PERMIT DRAWING REFLEGTACCURATE LOCATION OF SYSTEM? Y <br />N <br />DOES PERMIT DRAWING SHOW SUFFICIENT DETAIL TO LOCATE IN FUTURE? Y <br />N <br />ANY NO ANSWER ABOVE REQUIRES PERMIT TO BE REDjZA <br />COMMENTS: <br />j <br />rA <br />INSPECTED BY: DATE: <br />
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