WP0037327 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.orq/ehd PUMP INSPECTION CHECK LIST Ad ess: Permit#: spection Dat W 4 L 2 IJ LI ND " Ine: ParameterlStandard- Meets SJC Standards? I Comments/Measurements/ Recommendations CEMENT PEDESTAL: Dimensions of surface seal (2'x2'x4" minimum) Yes [jZ No ❑ NA ❑ Casing extends at least 12" above grade Yes 0 No ❑ NA ❑ Casing extends at least 1" above pedestal Yes [2 No ❑ NA ❑ Free of cracks/contiguous with annular seal Yes 2 No ❑ NA ❑ Graded to allow drainage away from casing I Yes No ❑ NA ❑ NA [>� SANITARY SEAL: M4 n'3nn nna »na � Well is sealed between pump and casing Yes 0 No ❑ NA ❑ Seal between all pipe columns and casing Yes ® No ❑ NA ❑ Sounding tube/air vents sealed properly Yes V No ❑ NA ❑ Chlorination port available and sealed properly Yes ❑ No ❑ NA ❑V 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 MAINTENANCE: Well/Pump visible and protected from damage Yes L6 No ❑ NA ❑ Well/Pump free from excessive vegetation Yes No ❑ NA ❑ MISCELLANEOUS: Permit drawing represents actual location of well Yes L2 No ❑ lf'no' is selected, attach an accurate map to permit Permit drawing sufficient to locate well in future Yes ® No ❑ Photograph taken and attached to record Yes [Z No ❑ OTHER: Comments _ Inspected By: Title: &v ✓1 %tiyr4 (1 Q�J Received By: Date: M4 n'3nn nna »na �