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WP0038179
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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WP0038179
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Last modified
11/19/2024 1:59:17 PM
Creation date
1/11/2019 10:32:43 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0038179
PE
4381
STREET_NUMBER
13954
Direction
S
STREET_NAME
STATE ROUTE 99
STREET_TYPE
RD
City
MANTECA
Zip
95336-
APN
19712076
ENTERED_DATE
4/23/2018 12:00:00 AM
SITE_LOCATION
13954 S HWY 99 FRONTAGE RD
P_LOCATION
99
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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r <br /> 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: Permi : Inspection Date: <br /> `11 <br /> R E lfw7 f . i�A nS 1 la�11,y <br /> Parameter/Standard Meets SJC Standards? Comments/Measurements/ <br /> Recommendations <br /> CEMENT PEDESTAL: <br /> Dimensions of surface seal (2'x2'x4" minimum) Yes [ No ❑ INAD <br /> Casing extends at least 12" above grade Yes © No ❑ INA ❑ <br /> Casing extends at least 1" above pedestal Yes [Z No ❑ NA ❑ <br /> Free of cracks/contiguous with annular seal Yes ❑ No V NA ❑ do F� / <br /> Graded to allow drainage away from casing Yes © No ❑ NA ❑ <br /> SANITARY SEAL: <br /> Well is sealed between pump and casing Yes ❑ No ❑ NA ❑ <br /> Seal between all pipe columns and casing Yes ❑ No ❑ NA ❑ <br /> Sounding tube/air vents sealed properly Yes ❑ No ❑ NA ❑ <br /> Chlorination port available and sealed properly Yes ❑ No ❑ NA ❑ <br /> SAMPLE TAP AND BACKFLOW PREVENTION: <br /> Non-threaded sample tap between well head and a-nyhA',, <br /> check valve or within 3' of well head Yes ❑ No 0 NA ❑ <br /> Adequately installed check valve or BFP device Yes V1 No ❑ NA ❑ <br /> No cross connections (ex: chemical feeders <br /> hooked to distribution system/ag flood irrigation <br /> from domestic supply) Yes ❑ No ❑ NA 0 <br /> Air gap of at least 6" (same as pipe diameter) I Yes ❑ jNoD I NA 2 <br /> MAINTENANCE: <br /> Well/Pump visible and protected from damage Yes No ❑ NA ❑ <br /> Well/Pump free from excessive vegetation Yes 2 No ❑ NA ❑ <br /> MISCELLANEOUS: <br /> Permit drawing represents actual location of well Yes 9 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: n <br /> Inspected By: ( Title: <br /> Received By: Date: <br /> EH-4200- 8/31/2015 <br />
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