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WP0042167
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4200/4300 - Liquid Waste/Water Well Permits
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WP0042167
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Entry Properties
Last modified
10/12/2022 4:33:13 PM
Creation date
4/1/2022 1:42:10 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0042167
PE
4370
STREET_NUMBER
8000
Direction
N
STREET_NAME
PODESTA
STREET_TYPE
LN
City
LINDEN
Zip
95236-
APN
09135027
ENTERED_DATE
6/18/2021 12:00:00 AM
SITE_LOCATION
8000 N PODESTA LN
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\tsok
Supplemental fields
CYEAR
2021
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.sogov.org/ehd <br /> PUMP INSPECTION CHECK LIST <br /> Address: 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 in No ❑ NA ❑ <br /> Graded to allow drainage away from casing Yes,] No ❑ NA ❑ <br /> SANITARY SEAL: <br /> Well is sealed between pump and casing Yes 0 No ❑ NA ❑ <br /> Seal between all pipe columns and casing Yes 0 No ❑ NA ❑ <br /> Sounding tube/air vents sealed properly Yes No El NA El <br /> Chlorination ort available and sealed properly 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.B No ❑ NA ❑ <br /> Adequately installed check valve or BFP device Yes,2 No ❑ NA ❑ <br /> Any cross connections? (ex: chemical feeders <br /> hooked to distribution system/ag flood irrigation <br /> from domestic supply) Yes ❑ No ❑ NA,EJ <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 Ej No ❑ NA ❑ <br /> Well/Pump free from excessive vegetation Yes No ❑ NA ❑ <br /> MISCELLANEOUS: <br /> Permit drawing represents actual location of well YesO No ❑ <br /> Permit drawing sufficient to locate well in future Yesff No ❑ If'no'is selected, attach an accurate map to permit <br /> Photograph taken and attached to record Yes ❑ lNo <br /> OTHER: bC�a����L�. t,✓L,1 vlwt� vz ,rti �,�, � <br /> Comments: <br /> Inspected By: kDa <br /> ti z F <br /> Received By: �� 1-3 <br /> EH-4200- 8/31/2015 <br />
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