HomeMy WebLinkAbout038-14-006 4706 7 Mile Ln 2025 OM& M INSPECTION SHEET 1.8.26Form revision: October 31, 2022
System Owner and Parcel Identification
System Owner: George Emmerson
APN:
System Address: 4706 7 Mile Lane, Durham, CA 95938
System Components (Check all that apply):
☐ A. Septic tank ☐ B. ATU/Packed Bed ☐ C. Gravity Dispersal, or
☐ D. Pressure Dispersal
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. ATU or Packed Bed (submit inspection checksheet approved by the Proprietor)
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.1. Control Panel (if applicable)
1. Timer/digital counter readings recorded during inspection for future reference?
Note: For control panels that record pump activity electronically, counter operation can be verified remotely.
Yes No N/A
☒ ☐ ☐
2. Pump cycle counter operation verified by manual operation of the pump
Note: For control panels that record pump activity electronically, counter operation can be verified remotely. ☐ ☐ ☐ ☒
3. Audible and visual alarms tested ☒ ☐ ☐ ☐
4. Run time checked if dispersal field demand-dosed ☒ ☐ ☐ ☐
5. Electrical box inspected for moisture and secure connections ☒ ☐ ☐ ☐
D.2. Pressure Dispersal Drainfield
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 ☐ ☒ ☐ ☐
OK PD N/A RS
Form revision: October 31, 2022
Constituent Analysis
Constituent Result Sample Date Lab
1. Influent BOD N/A N/A N/A
2. Influent TSS N/A N/A N/A
3. Effluent BOD N/A N/A N/A
4. Effluent TSS N/A N/A N/A
Inspector Comments
Upon arrival found the system in a “High Level” due to the owner having the system off. After testing all equipment,
turned system off again.
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.
R. Belcher 12/22/25
OM&M Specialist Signature Date of Inspection
Hydrotec Solutions Inc.
Company Name
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