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WP0037764
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4200/4300 - Liquid Waste/Water Well Permits
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WP0037764
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Last modified
2/12/2019 1:58:56 PM
Creation date
9/27/2018 8:37:06 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0037764
PE
4366
STREET_NUMBER
18626
Direction
E
STREET_NAME
COPPEROPOLIS
STREET_TYPE
RD
City
LINDEN
Zip
95236-
APN
18321001
ENTERED_DATE
1/3/2018 12:00:00 AM
SITE_LOCATION
18626 E COPPEROPOLIS RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
AMeuangkhoth
Supplemental fields
CYEAR
2018
Tags
EHD - Public
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SAN DJ OAQ V I N Environmental Health Department <br /> COUNTY <br /> Well#2 Information <br /> Use of Well: ❑ Domestic ❑ Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Total Depth(ft): To: From: <br /> Casing Diameter(in): ❑ Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate pm : To: From: <br /> Annual Extraction Volume(acre-feet: ❑ Estimated ❑ Measured <br /> Specific Capacity gal/min/ft <br /> Other Pumping Tests Performed:1 Test Result: <br /> Well#3 Information <br /> Use of Well: ❑ Domestic ❑ Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Total Depth ft: To: From: <br /> Casing Diameter(in): ❑ Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate pm : To: From: <br /> Annual Extraction Volume(acre-feet: ❑ Estimated ❑ Measured <br /> Specific Capacity (gal/min/ft):, <br /> Other Pumping Tests Perfor ed:1 Test Result: <br /> WATER TABLE INFORMATION _ <br /> Depth(ft): Source of Reference: Date of Reference: <br /> Current Water Table: <br /> Highest Water Table: <br /> Lowest Water Table: <br /> Recharge Area: Recharge Rate: <br /> SITING INFORMATION <br /> Distance To Nearest(ft): Onsite: Offsite: Distance To Nearest ft): Onsite: Offsite: <br /> Wastewater Treatment System: Transmission Lines: <br /> Onsite Well: Pond/Lake: <br /> Sewer Lines: Stream/River: <br /> Animal of Fowl Enclosure: <br /> MAP INFORMATION _ <br /> A map of the well location must be attached to this form and shall include the following information: <br /> • Legal lot and parcel dimensions. <br /> • All well locations on legal lot and parcel with type and use information shown for each well. <br /> • Distance from proposed well to any potential sources of pollution onsite and on adjacent properties, including: <br /> o Existing or proposed onsite sewage treatments stems,wells, animal or fowl enclosures,transmission lines,sewer lines. <br /> o Distance from ponds, lakes, and streams within 300 feet. <br /> o For wells below Corcoran clay, map must show location of canals,ditches, pipelines, utility corridors, and roads within two miles. <br /> EHD 4300 12-21-2017 2 of <br />
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