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SR0079356
Environmental Health - Public
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4200/4300 - Liquid Waste/Water Well Permits
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SR0079356
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Last modified
7/30/2018 3:10:13 PM
Creation date
7/30/2018 2:49:57 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0079356
PE
4210
STREET_NUMBER
14820
Direction
S
STREET_NAME
HENRY
STREET_TYPE
RD
City
OAKDALE
Zip
95361
APN
20729036
ENTERED_DATE
7/6/2018 12:00:00 AM
SITE_LOCATION
14820 S HENRY RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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SEPTIC SYSTEM INSPECTION CHECK LIST <br />ADDRESS: r <br />PERMIT # 6WO07 3S <br />Check box <br />PARAMETER if inspected <br />ACTUAL <br />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 />(��Jv <br />�A► <br />5,0 R 3, <br />'® <br />CD <br />Y <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />N <br />�/ <br />,/ <br />�/ <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 />i <br />5 <br />,/ —+ <br />✓ <br />® <br />® <br />'P <br />47 <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 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 />$ <br />3 ' <br />I ` <br />�j(o'' <br />Z ' <br />S(� <br />Sp,Q 8 S <br />10 <br />19 <br />Y <br />419 <br />10 <br />0 <br />Y <br />N <br />N <br />N <br />N pd e 4o je— <br />N <br />N 2� �,�� ��4 ib f,S <br />N <br />N <br />N <br />N <br />f <br />✓ <br />,% <br />y/ <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 />,/ <br />f <br />LEI <br />ib 1 <br />&,f 1 <br />�jpbe-Y�' <br />&, & <br />Z,S' <br />It 21' <br />'® <br />-0 <br />0 <br />Q <br />10 <br />49 <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 />AP <br />N <br />N <br />INSPECTED BY: pl rj (-(/ /K t# #M eo DATE: Z <br />
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