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SR0082414
Environmental Health - Public
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JACK TONE
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4200/4300 - Liquid Waste/Water Well Permits
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SR0082414
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Last modified
9/1/2020 4:48:16 PM
Creation date
9/1/2020 4:45:06 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0082414
PE
4211
FACILITY_NAME
23811 S JACK TONE RD
STREET_NUMBER
23811
Direction
S
STREET_NAME
JACK TONE
STREET_TYPE
RD
City
RIPON
Zip
95366
APN
22817034
ENTERED_DATE
8/4/2020 12:00:00 AM
SITE_LOCATION
23811 S JACK TONE RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
TSok
Tags
EHD - Public
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SEPTIC SYSTEM INSPECTION CHECK LIST <br /> ADDRESS: �l r� PERMIT# 5 P00 $a <br /> Check box ACTUAL MEETS SJC <br /> PARAMETER if inspected MEASUREMENT STANDARDS? COMMENTS <br /> SEPTIC TANK: <br /> CORRECT TANK CAPACITY? l �pZ QQ G`� OY N <br /> DISTANCE TO FOUNDATION? ' Y N <br /> DISTANCE TO PROPERTY LINE? N <br /> DISTANCE TO ANY WELLS? -t Y N <br /> TANK LEVEL AND ORIENTED CORRECTLY? Y N <br /> SANITARY TEES CORRECTLY INSTALLED? Y N k <br /> CORRECT TYPE OF PIPING? l/ ?� S N <br /> TANK VENTED? Y N <br /> ANY TANK ABNORMALITIES NOTED? Y N <br /> OTHER I/t SSS Y N Sri i I r.0 Vt--- <br /> DISTRIBUTION BOX: /� ,�, <br /> DISTANCE FROM TANK? / ' o Y - Y N <br /> DISTANCE TO NEAREST LEACH LINE? Y N <br /> DOES SYSTEM HAVE EQUAL DISTRIBUTION? Y N <br /> IS D-BOX LEVEL? Y N <br /> OTHER Y N <br /> LEACH FIELD: (LL=LEACH LINES) 1_i <br /> DISTANCE TO PROPERTY LINE? lY , ' Y N <br /> DISTANCE TO ANY WATER WELLS? ✓ Y N <br /> DISTANCE TO NEAREST FOUNDATION? �/ l Y N <br /> DISTANCE OF SOIL BARRIER BETWEEN ILLS? Y N <br /> CORRECT DEPTH OF LL TRENCHES? �j g— (o j y. Y © 4p-,V,, <br /> CORRECT DEPTH AND TYPE OF ROCK? v CY) N <br /> CORRECT WIDTH OF LL TRENCHES? � N <br /> CORRECT LENGTH OF LL TRENCHES? �/ Y N <br /> CORRECT TYPE OF PIPING? &L2�2 Y N <br /> OTHER Y N <br /> SEEPAGE PITS: <br /> DISTANCE TO PROPERTY LINE? Y N <br /> DISTANCE TO ANY WATER WELLS? Y N <br /> DISTANCE TO NEAREST FOUNDATION? Y N <br /> DISTANCE OF SOIL BARRIER TO PITS? Y N <br /> CORRECT DEPTH AND TYPE OF ROCK? Y N <br /> CORRECT WIDTH? Y N <br /> OTHER 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 ANSWE BOVE EQUIRES PERMIT TO BE R DRAWN, () I <br /> COMMENTS: ?/yz(�I-� k S <br /> INSPECTED B DATE: Z©?� <br />
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