WP0039000 - 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.si_ov.orq/ehd PUMP INSPECTION CHECK LIST Address: bo k fi �e A'7z36 Permit#: 0 j Inspection Date: C\ � -7 (\ � Parameter/Standard Meets SJC Standards? Comments/Measurements/ Recommendations CEMENT PEDESTAL: Dimensions of surface seal (2'x2'x4" minimum) Yes No ❑ NA ❑ Casing extends at least 12" above grade Yes No ❑ NA ❑ Casing extends at least V above pedestal Yes No ❑ NA ❑ Free of cracks/contiguous with annular seal Yes [j No ❑ NA ❑ Graded to allow drainage.away from casing Yes 4 No ❑ NA ❑ SANITARY SEAL:Well is sealed between pump and casing Yes F4 No ❑ NA ❑ Seal between all pipe columns and casing Yes E4 No ❑ NA ❑ Sounding tubelair vents sealed properly Yes No ❑ NA ❑ Chlorination port available and sealed properly Yes ❑ No ❑ NA 56_ SAMPLE TAP AND BACKFLOW PREVENTION: Non -threaded sample tap between well head and check valve or within 3' of well head Yes ❑ No ❑ NA [J 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 No ❑ NA ❑ Well/Pump free from excessive vegetation Yes No ❑ INA ❑ MISCELLANEOUS: Permit drawing represents actual location of well Yes INo ❑ If'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 No ❑ OTHER: Comments: Inspected By: Title: Received By: Date: