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WP0041651
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4200/4300 - Liquid Waste/Water Well Permits
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WP0041651
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Last modified
12/15/2021 11:37:11 AM
Creation date
6/7/2021 2:53:35 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0041651
PE
4381
STREET_NUMBER
20550
Direction
E
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95240-
APN
05318015
ENTERED_DATE
1/27/2021 12:00:00 AM
SITE_LOCATION
20550 E KETTLEMAN LN
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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Tags
EHD - Public
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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 . sugov . org/ehd <br /> PUMP INSPECTION CHECK LIST <br /> Address : 0 C Permit# : Inspection Date : <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 [� l No ❑ NA ❑ <br /> Graded to allow drainage away from casing Yes 21 No ❑ NA ❑ <br /> SANITARY SEAL : <br /> Well is sealed between pump and casing Yes E2� No ❑ NA ❑ <br /> Seal between all pipe columns and casing Yes 2 No ❑ NA ❑ <br /> Sounding tube/air vents sealed properly Yes Z' No ❑ NA ❑ <br /> Chlorination port available and sealed proper) Yes 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 0 No ❑ NA ❑ <br /> Adequately installed check valve or BFP device Yes No ❑ NA ❑ <br /> Any cross connections ? (ex : chemical feeders <br /> hooked to distribution system/ag flood irrigation <br /> from domestic supply) Yes ❑ No ❑ NA <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 Z� INo ❑ INA ❑ <br /> Well/Pump free from excessive vegetation Yes �1 No ❑ INA ❑ <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 : <br /> Inspected By : f I .10 , si J Title : tom. <br /> Received By : Date : Z / o z <br /> EH-4200- 8/31 /2015 <br />
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