WP0038043 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fox: (209) 468-3433 Web: www.sjgov.orq/ehd PUMP INSPECTION CHECK LIST Address: s O` i SO C kPerini O 0 �316pe 1 Parameter/Standard Meets SJC Standards? Comments/Measurements/ Recommendations CEMENT PEDESTAL: Dimensions of surface seal (2'x2'x4" minimum) Yes L] No ❑ NA ❑ Casing extends at least 12" above grade Yes No ❑ NA ❑ Casing extends at least V above pedestal Yes No ❑ NA ❑ Free of cracks/contiguous with annular seal Yes No ❑ NA ❑ Graded to allow drainage away from casing Yes ® No ❑ NA ❑ SANITARY SEAL: Well is sealed between pump and casing Yes No ❑ NA ❑ Seal between all pipe columns and casing Yes [2 No ❑ NA ❑ Sounding tube/air vents sealed properly Yes ❑ No ❑ NA Ear Chlorination pori available and sealed properly Yes EO No ❑ NA ❑ SAMPLE TAP AND BACKFLOW PREVENTION: Non -threaded sample tap between well head and check valve or within 3' of well head Yes V1 No ❑ NA ❑ Adequately installed check valve or BFP device Yes RI No ❑ NA ❑ No cross connections (ex: chemical feeders hooked to distribution system/ag flood irrigation from domestic supply) Yes ❑ No ❑ NA [f Air gap of at least 6" (same as pipe diameter) MAINTENANCE: Yes ❑ No ❑ NA Well/Pump visible and protected from damage Yes M No ❑ NA ❑ Well/Pump free from excessive vegetation IYes No ❑ NA ❑ MISCELLANEOUS: Permit drawing represents actual location of well Permit drawing sufficient to locate well in future Photograph taken and attached to record OTHER: Yes No ❑ Yes [] No ❑ Yes [1f No ❑ If 'no' is selected, attach an accurate map to permit Comments/: l Inspected By: cul s Received By: Title: (4. Date: