WP0038103 - Laserfiche WebLink

Home Browse Search

I I - SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT -- 1-868_East_Hazelton_Av_eaue,_atQcktooD-, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.s►gov.orq/ehd PUMP INS PECTF0N—GHECK-LfST_._._ Pd sr, �l ' f,' J�b J I (J GI� �/ lJ PSm .� (�q Ins b' 'D Parameter/Standard Meets SJC Standards? Comments/Measurements/ Recommendations CEMENT PEDESTAL: Dimensions of surface seal (2'x2'x4" minimum) Yes ❑v' No ❑ NA ❑ Casing extends at least 12" above grade Yes [0 No ❑ NA ❑ Casing extends at least 1" 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 No ❑ NA ❑ Sounding tube/air vents sealed properly - Yes ❑ No ❑ NA Rr Chlorination port available and sealed properly Yes No ❑ NA ❑ SAMPLE TAP AND BACKFLOW PREVENTION: Non -threaded sample tap between well head and check valve or within 3' of well head Yes No ❑ NA ❑ Adequately installed check valve or BFP device Yes No ❑ NA ❑ No cross connections (ex: chemical feeders hooked to distribution system/ag flood irrigation from domestic supply) Yes ❑ No ❑ NA Air gap of at least 6" (same as pipe diameter) Yes ❑ No ❑ NA [0 MAINTENANCE: Well/Pump visible and protected from damage iYes KA I -No ❑ I NA ❑ Well/Pump free from excessive vegetation I Yes 14 INoF] INA ❑ MISCELLANEOUS: Permit drawing represents actual location of well Yes D No ❑ If 'no' is selected, attach an accurate map to permit Permit drawing sufficient to locate well in future Yes U.No ❑ Photograph taken and attached to record Yes ff No ❑ OTHER: Comments: rj f �f "p'Sol7 �/ V�/ ' �.c/1 W ' % ' ✓" _ W )f l l t �+ � � L j � `.1 `� m -e.. '� c e / U I d'- ' Inspected By: Title: Received By: Date: —4 t-4 c