WP0037355 - Laserfiche WebLink

Home Browse Search

i F J SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1.86.8-East-Nazeltan-Avv nue�Sfo�kto_o-. CA 95206-6232 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.orq/ehd PUMP 1 SPECTMUREUS I Address:I C00 {� STDc k-Tb-� Perini V 0 037 2S,� In6-,on Date: 11770GI. Parameter/standard Meets SJC Standards? Com me ntslMeaS Urem entsl Recommendations CEMENT PEDESTAL: Dimensions of surface seal 2'x2'x4" minimum) Yes KZ INon NAD NA ❑ _ Casing extends at least 12" above grade Yes 6a No ❑ NA ❑ Permit drawing sufficient to locate well in future Casing extends at least 1" above pedestal Yes 9 No ❑ NA ❑ No ❑ 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 V No ❑ NA ❑ Seal between all pipe columns and casing Yes Q No ❑_ NA ❑ Sounding tube/air vents sealed properly - Yes 9 No ❑ NA ❑ Chlorination pork available and sealed properly IYes ❑ 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 L4 No ❑ NA ❑ No cross connections (ex: chemical feeders hooked to distribution systemfag flood irrigation from domestic supply) Yes ❑ No ❑ NA Q Air gap of at least 6" (same as pipe diameter) Yes ❑ No ❑ NA [� MAINTENANCE: Well/Pump visible and protected from damage Yes No ❑ NA ❑ Well/Pump free from excessive vegetation YesV No ❑ NAD MISCELLANEOUS; . Permit drawing represents actual location of well . Yes V No ❑ If 'no' is selected, attach an accurate map to permit Permit drawing sufficient to locate well in future Yes [V No ❑ Photograph taken and attached to record Yes No ❑ OTHER: Comments: / nspected By: V � Title: V V A W k(41 K 141) r ?Weived Bv: Date: n1"1 -4c