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SR0081624
Environmental Health - Public
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4200/4300 - Liquid Waste/Water Well Permits
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SR0081624
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Last modified
8/5/2021 3:53:56 PM
Creation date
8/5/2021 2:51:46 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0081624
PE
4211
FACILITY_NAME
16464 FOX RD
STREET_NUMBER
16464
Direction
N
STREET_NAME
FOX
STREET_TYPE
RD
City
LODI
Zip
95240
APN
05120007
ENTERED_DATE
1/13/2020 12:00:00 AM
SITE_LOCATION
16464 N FOX 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: E12 L CA- <br /> PERMIT# <br /> Check box ACTUAL MEETS SJC <br /> PARAMETER if inspected MEASUREMENT STANDARDS? COMMENTS <br /> SEPTIC TANK: <br /> CORRECT TANK CAPACITY? N <br /> DISTANCE TO FOUNDATION? N <br /> DISTANCE TO PROPERTY LINE? 0' N K <br /> DISTANCE TO ANY WELLS? O N <br /> TANK LEVEL AND ORIENTED CORRECTLY? Y N Of <br /> SANITARY TEES CORRECTLY INSTALLED? N <br /> CORRECT TYPE OF PIPING? 5 N <br /> TANK VENTED? Y N <br /> ANY TANK ABNORMALITIES NOTED? Y N <br /> OTHER &I(&— Y N V,411 i AS nb1 Lotte <br /> DISTRIBUTION BOX: <br /> DISTANCE FROM TANK? 2 C N <br /> DISTANCE TO NEAREST LEACH LINE? N <br /> DOES SYSTEM HAVE EQUAL DISTRIBUTION? t/ Y N <br /> IS D-BOX LEVEL? Y N <br /> OTHER Y N <br /> LEACH FIELD: (LL=LEACH LINES) <br /> DISTANCE TO PROPERTY LINE? f W2– <br /> CP N �,� %QDISTANCE TO ANY WATER WELLS? 1� D/ N YZO Wei ISDISTANCE TO NEAREST FOUNDATION? \/ n (DN <br /> DISTANCE OF SOIL BARRIER BETWEEN LUS? (�Y) N <br /> CORRECT DEPTH OF LL TRENCHES? Y ON <br /> CORRECT DEPTH AND TYPE OF ROCK? / Y N <br /> CORRECT WIDTH OF LL TRENCHES? N <br /> CORRECT LENGTH OF LL TRENCHES? �� Q Q N <br /> CORRECT TYPE OF PIPING? l/ 2 Y N <br /> OTHER Y N <br /> SEEPAGE PITS: Q I / L / <br /> DISTANCE TO PROPERTY LINE? '` / Y N S. �` LST Vr <br /> DISTANCE TO ANY WATER WELLS? 7 D N (N <br /> DISTANCE TO NEAREST FOUNDATION? `/ ti N <br /> DISTANCE OF SOIL BARRIER TO PITS? 13 l N <br /> CORRECT DEPTH AND TYPE OF ROCK? t/ a N — r y. ►rOC <br /> CORRECT WIDTH? l� 6 yt N <br /> OTHER Y N <br /> MISCELLANEOUS: <br /> DOES PERMIT DRAWING REFLECT ACCURATE LOCATION OF SYSTEM? Y <br /> DOES PERMIT DRAWING SHOW SUFFICIENT DETAIL TO LOCATE IN FUTURE? Y <br /> ANY NO ANSWER ABOVE REQUIRES ERMIT TO BE REDRAWN. <br /> COMMENTS: ''b <br /> Qe <br /> -7 Al oila <br /> INSPECTED B 1 DATE: /J ` _Z020 <br />
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