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4200/4300 - Liquid Waste/Water Well Permits
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WP0036461
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Last modified
9/29/2018 11:45:15 PM
Creation date
9/27/2018 2:46:50 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0036461
PE
4369
STREET_NUMBER
14184
Direction
S
STREET_NAME
CARROLTON
STREET_TYPE
RD
City
ESCALON
Zip
95320
APN
20511010
ENTERED_DATE
1/30/2017 12:00:00 AM
SITE_LOCATION
14184 S CARROLTON RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page I of 2 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95337 No-e0345031 <br /> Date Work Began 6/14/2017 Ended6/30/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health <br /> Permit No. 75402 Permit Date 8/4/2016 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) _V_VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Manda Properties L.P. <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 6721 Perrin Rd <br /> SURFACEDESCRIPTION Manteca CA 95337 <br /> Ft. to Ft. Describe material, grain, sue, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address 14184 Carrolton Ktl L LOCATIO <br /> 3 15 Clay Cit,Escalon CA 95320 <br /> 15 21 Sand County San Joaquin <br /> 21 45 Clay APN Book Page Parcel <br /> 45 49 Gravel Township Range Section <br /> 49 65 Shale Latitude I I <br /> 65 75 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 75 110 Clay LOCATION SKETCH ACTIVITY (✓) <br /> NORTH V NEW WELL <br /> 110 124 Gravel MODIFICATION/REPAIR <br /> 124 131 Clay —Deepen <br /> 131 150 Shale —other(Specify) <br /> 150 162 Sand <br /> 162 180 Shale — escribe <br /> ProcdOr s a0nd Materials <br /> Under"GEOLOGIC LOG' <br /> 180 187 Sand PLANNED USES() <br /> 187 190 Shale WATER SUPPLY <br /> 190 197 Sand Domestic— Public <br /> Q Irrigation _ Industrial <br /> 197 202 Shale uJ MONITORING- <br /> 202 217 Sand <br /> TEST WELL— <br /> 217 230 Shale ATHODIC PROTECTION- <br /> 230 236 Sand HEAT EXCHANGE- <br /> 236 283 Shale DIRECT PUSH_, <br /> 283 293 Black Sand and Gravel INJECTION— <br /> 293 296 Shale <br /> VAPOR EXTRACTION— <br /> SPARGING_ <br /> 296 312 Black Sand and Gravel SOUTH REMEDIATION_ <br /> Illustrate or Describe Distance of{Yell from Roads, Buildings, <br /> 312 318 Shale Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)_ <br /> 318 326 Black Sand necessary. PLEASE BE ACCURATE sr COMPLETE. <br /> 326 342 Shale WATER LEVEL&YIELD OF COMPLETED WELL <br /> 342 344 Black Sand DEPTH TO FIRST WATER— (FL)BELOW SURFACE <br /> 344 348 Shale DEPTH OF STAT C <br /> 348 357 Black Sand WATER LEVEL1 (Ft.)&DATE MEASURED 6/30/2017 <br /> TOTAL DEPTH OF BORING 500 ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL480 (Feet) May not be representative o a well's long-term yield <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE ✓ FROM SURFACE TYPE <br /> DIA. Y w a MATERIAL I INTERNAL GAUGE SLOT SIZE <br /> CE- BEN- <br /> (Inches) Z _ p aJ GRADE DIAMETER OR WALL IF ANY MENT TONI FILL FILTER PACK <br /> Ft. to Ft. to U LL (Inches) THICKNESS (Inches) Ft. to Ft. ✓ ✓ ✓ (fYPEISIZE) <br /> (_) U <br /> 0 280 24 <br /> 280 480 80 100 480 GRAVEL <br /> ATTACHMENTS ({) CERTIFICATION STATEMENT <br /> — Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief. <br /> — Well Construction Diagram NAME MASELLIS DRILLING IN <br /> Geophysical Log(s) (PERSON,FIRM I <br /> — Soil/Water Chemical Analysis -119 Albers7 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed08/24/17 668622 <br /> WELL DRILLER/AUTHORIZED RESE IVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.I1-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />
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