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BAN JOAQUIN COUNTY %• ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 o = P Office. (209) 468-3420 Fax:(209) 464-0138 Web:www.sigg/ehd_., - '9�IFORN` r ov.or WATER WELL NOTICE TO ABATE !~ - San Joaquin County Ordinance Code, Title 9 and Title 8,section 5-5100: i It is a violation for any propertyowner to maintain a nuisance in his property. '' } LOCATION: y CITY: - DATE: PROPERTY OWNER NAME: V RECORD ID#: TYPE OF INSPECTION: ®COMPLAINT QSTATUS CHECK ❑OTHER NATURE ((OF COMPLAINTNIOLATION ; r{ r1 �w VIOLATIONS: It shall be unlawful to maintain or use any residence or place of business which is not in compliance with the 1- ❑ requirements of SJC Ordinance Code,Title 9, Chapter 9-1115, or the SJC Water Well Standards, SJC Ord.Code,Title 9,Section 9-1115.9—Compliance Required. Abandoned Well-not in use; no power source to well; open and unsecured; approved out-of-service well not being 2 ❑ maintained; in a state of disrepair; or well casing buried. CA Health&Safety code,Section 115700(a)(b)(d);CA Health&Safety Code,Section 115710;SJC Ord.Code,Title 9,Section 9-1115.5—Well Regulations,SJC Water Well Standards,Section 6.1. Approved Out-of-Service Well not being Maintained Properly-well has defects;well acting as conduit for 3• ❑ contamination of groundwater; well is not properly sealed;well is not marked;well is not kept clear of brush or debris. CA Health&Safety Code,Section 115700(d);SJC Water Well Standards,Section 5.1.—Out of Service Wells. 4• ❑ Provision of Water from Separate Parcel, Use of a Well Pit. SJC Ord.Code,Title 9,Section 9-1115.8—Prohibited Uses 5• ❑ Lack of or Inadequate Sanitary Seal at Wellhead. SJC Ord.Code,Title 9,Section 9-1115.5—Well Regulations 6. ❑ Lack of or Inadequate Surface Seal around Well Casing.SJC Water Well Standards, Section 4.10. —Surface Seal 7• ❑ Sounding Tube or Air Vent not Sealed. SJC Water Well Standards,Section 4.12.—Sounding Tube/Air Vent Pipe 8. ❑ Lack of or Inadequate Sampling Tap. SJC water well Standards,Section 4.13.—Sampling Tap 9• ❑ Lack of or Inadequate Backflow Prevention. SJC Water Well Standards,Section 4.14.—Backflow Prevention 10. ❑ Work being Conducted without a Permit-construction; destruction; pump; repair; sanitary seal broken; or cross- connection repair. SJC Ord.Code,Title 9,Section 9-1115.3—Well Permit Required CORRECTIVE ACTIONS/ORDERS: ❑ Cease work and obtain an approved permit as indicated below. ❑ Cover well with a watertight, secure well cover. 01-"`.Obtain permit as indicated: ❑Destruction ❑Construction ❑ Pump ❑Well Repair/Cross Connection ❑ Out of Service Well 'COMPLIANCE DATE: ❑ IMMEDIATELY❑ 24 HOURS ❑ 48 HOURS ❑ 7 DAYS ❑ 14 DAYS ❑ COMMENTS: COST RECOVERY:All EHD staff time associated with resolving this complaint will be billed at the current hourly rate(8139). FAILURE TO COMPLY: Failure to Comply with this Notice May Result in Formal Enforcement Action. APPEAL PROCESS:Any owner or person in possession who objects to the finding of violations cited on this notice may request an office hearing by filing a written request with the San Joaquin County Environmental Health Department within 30 days of receipt of this notice. INSPECTED BY: SIGNATURE OF REGISTERED ENVIRONMENTAL HEALTH SPECIALIST PHONE: RECEIVED BY: " DATE: SIGNATURE OF OWNER(rENANT ,. EHD 43-12 8/1/16 WATER WELL NOTICE TO ABATE