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WP0039112
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SOLARI RANCH
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4200/4300 - Liquid Waste/Water Well Permits
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WP0039112
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Last modified
1/9/2019 11:02:19 AM
Creation date
1/9/2019 10:39:40 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0039112
PE
4381
STREET_NUMBER
5541
Direction
N
STREET_NAME
SOLARI RANCH
STREET_TYPE
RD
City
STOCKTON
Zip
95215-
APN
08718235
ENTERED_DATE
12/13/2018 12:00:00 AM
SITE_LOCATION
5541 N SOLARI RANCH RD
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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r SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209)468-3433 Web:www.sigov.org/ehd <br /> PUMP INSPECTION CHECK LIST <br /> Address: Pe Inspectio Date: <br /> 55 I >J -so1�( R�cc �TbC-k is S e ©v� -76W. <br /> Parameter/Standard Meets SJC Standards? Comments/Measurements/ <br /> Recommendations <br /> CEMENT PEDESTAL: <br /> Dimensions of surface seal (2'x2'x4" minimum) Yes ® No ❑ NA ❑ <br /> Casing extends at least 12" above grade Yes ® No ❑ NA ❑ <br /> Casing extends at least 1" above pedestal Yes No ❑ NA ❑ <br /> Free of cracks/contiguous with annular seal Yes ❑ No ' NA ❑ i`�P �Tc�!<-� <br /> Graded to allow drainage away from casing Yes No ❑ NA ❑ <br /> SANITARY SEAL: <br /> Well is sealed between pump and casing Yes EA. No ❑ NA ❑ <br /> Seal between all pipe columns and casing Yes K No ❑ NA ❑ i + t1.�'� <br /> Sounding tube/air vents sealed properly Yes ❑ No ❑ NA <br /> Chlorination port available and sealed properly Yes Vt No ❑ NA ❑ <br /> SAMPLE TAP AND BACKFLOW PREVENTION: <br /> Non-threaded sample tap between well head and <br /> check valve or within 3' of well head Yes No ❑ NA ❑ <br /> Adequately installed check valve or BFP device Yes f. No ❑ NA ❑ <br /> No cross connections (ex: chemical feeders <br /> hooked to distribution system/ag flood irrigation <br /> from domestic supply) Yes ❑ No ❑ NA 14 <br /> Air gap of at least 6" (same as pipe diameter) Yes ❑ No ❑ NA <br /> MAINTENANCE: <br /> Well/Pump visible and protected from damage Yes No ❑ NA ❑ <br /> Well/Pump free from excessive vegetation Yes No ❑ NA ❑ <br /> MISCELLANEOUS: <br /> Permit drawing represents actual location of well Yes No ❑ <br /> Permit drawing sufficient to locate well in future Yes No ❑ if'no'is selected,attach an accurate map to permit <br /> Photograph taken and attached to record Yes ® No ❑ <br /> OTHER: <br /> Comments: CLAJ <br /> Inspected By: ^ Title: &kjl <br /> c hr'nj4j`''.)( 42111 PU ' <br /> Received By: Date: <br /> EH-4200- 8/31/2015 <br />
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