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WP0039687
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DURHAM FERRY
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4200/4300 - Liquid Waste/Water Well Permits
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WP0039687
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Entry Properties
Last modified
7/31/2019 10:11:34 AM
Creation date
7/31/2019 9:53:32 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0039687
PE
4381
STREET_NUMBER
2250
Direction
E
STREET_NAME
DURHAM FERRY
STREET_TYPE
RD
City
TRACY
Zip
95304-
APN
25520022
ENTERED_DATE
6/11/2019 12:00:00 AM
SITE_LOCATION
2250 E DURHAM FERRY RD
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
Scanner
TSok
Tags
EHD - Public
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DwIR)ONIMENITIAL HEAL.TF: DEPARTMENT <br /> 1868 East Hazelton AvenLie, Stockton, CA 95201--)-6232 <br /> Tefepi-iol?9:(209)468-3420 Fax: (209)468-3433 1,11114ab: vivAiv.sigov, iqLehd <br /> PUNTIP R4SPECTiOl\1 CHEC1',,,( W.ST' <br /> E-, <br /> x1dress: Permit#,-: inspertion Date. <br /> CA <br /> C) 6c� bj <br /> ParanieterlStandard Itheets SJC'S"Mridards? Coii-�rlic-11,�sImeasLireill6n-�cI I 7_ <br /> iI Re com ni en dati oils <br /> I—CEPOENT PEDES ALS <br /> biniensions Of Surface seal (2'x2'x` minimum) IYes [t I NOD NA El I <br /> lCasing extends at least 12" above grade I Yes I No Fj NA El I <br /> Casing eXtends at leasi V above pedestal Yes No [:1 INA[] I <br /> Free of CraCkSlCoritigUOUS with annular seal I Yes No 0 NIA El <br /> Graded to allow drainage away from casing 1 ,,,es Ej INo 0 INA El I <br /> SANI*FAF-,'Y SEAL: Ii <br /> Well is sealed between pump and casing Yes I No El INA E:1 I <br /> Seal between all pipe columns and casing Yes j I No 0 INA 0 1 <br /> Il Soundingtllbe/2ir vents sealed properly IYes [A I No 07 NA El I <br /> Chlorination port available and sealed properly iYes 9 1 No ❑ NA[I I <br /> SAMPLETAP', JkNtl) BACKIFLOIN PREVENITION: <br /> Non-threaded sample tap between well head and <br /> check valve or within 3' of well head � (esNo [:1 NAEl <br /> Adequately installed check valve or BFP de trice Y <br /> ice [ 's N, o El NA El j j 1, <br /> No cross connections (ex: chemical feeders <br /> hooked to distribution systern/ag flood irrigation <br /> Tlon-i domesiic supply) Yes El No [j NA El <br /> -Air cap of at least 67' (same as pipe diameter) <br /> Yes El INo [1 ,NA I li <br /> i <br /> MAIN ff1E NANCE: <br /> .vVell/Pump visible and protected from dairnage Yes No ❑ NA ❑ <br /> Well/Pump free frorn excessive vegetation IYes No El INA [1:1 <br /> tOESCELL.AN1 0 U 8 <br /> Permit drawing represents actual location of well Yes No D <br /> iPermit drawing sufficient to locate well in future Yes [I No El ff"n 'is selected.attach an accurate map to permit <br /> PhofogralDh taken and aitached to record Yes No <br /> OT Hi E R: <br /> C o rn ni e n t's <br /> -Inspected By: Title: <br /> Received By: Date. <br />
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