HomeMy WebLinkAbout064-630-039 EH-WWOP-25-000082 OM&M INSPECTIONForm revision: December 29, 2015
System Owner and Parcel Identification
System Owner: Caitlin Campbell
APN:
System Address: 14779 Via de Maia, Magalia, CA 95954
System Components (Check all that apply):
☒ A. Septic tank ☐ B.1. Pump to Sand Filter ☐ C. Gravity Dispersal, or
☒ B.2. Sand Filter ☐ D. Pressure Dispersal
☐ B.3. Pump to Drainfield
Inspection Checklist
Problem detected,
additional service required
Component inspected and
in satisfactory condition
Routine service provided
during service call
Component not present
or not inspected
Wastewater System Component PD OK RS N/A
A. Septic Tank
1. Scum and sludge level measured ☐ ☒ ☐ ☐
2. Tank inspected for integrity ☐ ☒ ☐ ☐
3. Effluent filter checked ☐ ☐ ☐ ☒
B.1. Pump and Dosing Chamber
1. Tank inspected for integrity ☐ ☐ ☐ ☒
2. Risers checked for indication of leaks ☐ ☐ ☐ ☒
3. All floats inspected ☐ ☐ ☐ ☒
4. Pump cycle verified ☐ ☐ ☐ ☒
5. Float cords wrapped and orderly ☐ ☐ ☐ ☒
6. Biotube inspected ☐ ☐ ☐ ☒
B.2. Intermittent Single-Pass Sand Filter
1. Inspected for effluent ponding over sand ☐ ☒ ☐ ☐
2. Inspected for effluent breakout or discharge to surface of the ground ☐ ☒ ☐ ☐
3. Area free from roads, structures, vehicular traffic ☐ ☒ ☐ ☐
4. Surface water drainage and down spouts diverted from sand filter area ☐ ☒ ☐ ☐
5. Observation ports accessible and maintained ☐ ☒ ☐ ☐
6. Equal distribution confirmed by measuring distal end orifice pressure head ☐ ☒ ☐ ☐
7. Orifices condition inspected ☐ ☒ ☐ ☐
B.3. Pump Well within Single-Pass Sand Filter
1. Tank inspected for integrity ☐ ☐ ☐ ☒
2. Risers checked for indication of leaks ☐ ☐ ☐ ☒
3. All floats inspected ☐ ☐ ☐ ☒
4. Pump cycle verified ☐ ☐ ☐ ☒
5. Float cords wrapped in orderly ☐ ☐ ☐ ☒
6. Biotube inspected ☐ ☐ ☐ ☒
OK PD N/A RS
Form revision: December 29, 2015
Company Name
C. Gravity Dispersal Drainfield (if applicable)
1. Depth of effluent ponding within trench: ☐ ☐ ☐ ☒
2. Inspected for indication of effluent breakout or discharge to surface of the ground ☐ ☐ ☐ ☒
3. Observation ports accessible and maintained ☐ ☐ ☐ ☒
4. Area free from roads, structures, vehicular traffic ☐ ☐ ☐ ☒
5. Surface water drainage and down spouts diverted from drainfield area ☐ ☐ ☐ ☒
D. Pressure Dispersal Drainfield (if applicable)
1. Trench/bed checked for excessive ponding ☐ ☐ ☐ ☒
2. Dispersal area check out for effluent breakout or surfacing ☐ ☐ ☐ ☒
3. Observation ports accessible and maintained ☐ ☐ ☐ ☒
4. Dispersal area free from roads, structures, vehicular traffic ☐ ☐ ☐ ☒
5. Surface water drainage and down spouts diverted from dispersal area ☐ ☐ ☐ ☒
6. Equal distribution confirmed by measuring distal end orifice pressure head ☐ ☐ ☐ ☒
7. Orifices in good condition and not in need of hydroflushing ☐ ☐ ☐ ☒
Constituent Analysis
Constituent Result Sample Date Lab
1. Influent BOD N/A
2. Influent TSS N/A
3. Effluent BOD N/A
4. Effluent TSS N/A
Inspector Comments
We found no problems at this time.
Certification
I certified that I am an OM&M Specialist certified by Butte County Environmental Health (LEA) and the
information provided in this report is based on my observations and is true to the best of my knowledge.
A.Sievers 12/9/25
OM&M Specialist Signature Date of Inspection
Hydrotec Solutions Inc.
Return to Butte County Environmental Health with completed Operating Permit application and fee.
Mailing address: 202 Mira Loma Drive
Oroville, CA 95965
530-538-7281