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SR0078615
Environmental Health - Public
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4200/4300 - Liquid Waste/Water Well Permits
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SR0078615
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Last modified
9/25/2018 8:56:54 AM
Creation date
9/25/2018 8:56:10 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0078615
PE
4210
STREET_NUMBER
22275
Direction
N
STREET_NAME
JOHNSON
STREET_TYPE
RD
City
CLEMENTS
Zip
95330
APN
02309003
ENTERED_DATE
1/11/2018 12:00:00 AM
SITE_LOCATION
22275 N JOHNSON 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:oZ J p Ii1V\5Ot/L P1Cj- ` <br />I e1M� 5 <br />PERMIT # <br />Check box ACTUAL MEETS SJC <br />PARAMETER if inspected MEASUREMENT STANDARDS? COMMENTS <br />SEPTIC TANK: e>(,[ s+i n c <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 />Y <br />Y <br />Y <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 />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 />SEEPAGE PITS: <br />DISTANCE TO PROPERTY LINE? Gj R <br />DISTANCE TO ANY WATER WELLS? / 00 +- Y <br />DISTANCE TO NEAREST FOUNDATION? `/ ?� C� % a? <br />DISTANCE OF SOIL BARRIER TO PITS? <br />CORRECT DEPTH AND TYPE OF ROCK? o40 , Y <br />CORRECT WIDTH? / Y <br />OTHER Y <br />N <br />N <br />N <br />N <br />N 0 5 - <br />/'M <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 />Y <br />Y <br />N <br />N <br />INSPECTED BY -.M a V C+ yl �,-- I3 Pivl,4 6i r✓\- ; ✓A -e- DATE: 7 /' -?/ <br />
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