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SR0084250
Environmental Health - Public
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EHD Program Facility Records by Street Name
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4200/4300 - Liquid Waste/Water Well Permits
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SR0084250
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Entry Properties
Last modified
11/22/2021 3:43:38 PM
Creation date
11/22/2021 1:46:56 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0084250
PE
4211
STREET_NUMBER
13750
Direction
E
STREET_NAME
VICTOR
STREET_TYPE
RD
City
LODI
Zip
95240
APN
05303019
ENTERED_DATE
9/22/2021 12:00:00 AM
SITE_LOCATION
13750 E VICTOR 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: ) '7 9-0 <br />PERMIT # <br />S Q O 2 D <br />Check box ACTUAL <br />PARAMETER if inspected 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 />D A <br />50 <br />Ono, <br />ot?' <br />N �_ <br />/y.0 <br />Q 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 />6 <br />�_ <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 />Gj <br />p p' <br />'Z Com' <br />` 24 of <br />Zy i <br />43' <br />L_ p�(LF <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? <br />DISTANCE TO ANY WATER WELLS? <br />DISTANCE TO NEAREST FOUNDATION? <br />DISTANCE OF SOIL BARRIE ;PITS <br />CORRECT DEPTH AND TY OCaj <br />F ROCfC? <br />CORRECTWIDTH? <br />OTHER <br />5 <br />/VD' <br />6' <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 />�j' Am <br />a <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 />N <br />N <br />P <br />P f 9-t"i (--o P RLc to v-. A v v 9- <br />N--- <br />INSPECTED BY: DATE: <br />C y\\p \ 4b t l I 2A2\ <br />
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