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WP0039125
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4200/4300 - Liquid Waste/Water Well Permits
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WP0039125
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Entry Properties
Last modified
6/10/2019 1:36:23 PM
Creation date
5/24/2019 3:47:40 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0039125
PE
4372
STREET_NUMBER
1700
Direction
N
STREET_NAME
UNION
STREET_TYPE
RD
City
MANTECA
Zip
95336-
APN
216120001
ENTERED_DATE
12/21/2018 12:00:00 AM
SITE_LOCATION
1700 N UNION RD
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
Scanner
AGooderham
Tags
EHD - Public
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a <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 96205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1700 Union Road CIrr/ZIP Mat teca,CA 95336 to <br /> CROSS STREET Northgate Drive APN -D PARCEL SIZ -S- AND USE APPLICATION# p <br /> OWNER NAME Manteca Unified School District-Contact:Justin Geer,Constr./Energy Tech PHONE 209.858.0716 ee1i <br /> OWNER ADDRESS 2271 W.Louise Avenue CITY/STATE/LPManteca,CA 95337 0 <br /> CONTRACTOR V&W DrillingContact:Karli Stroin o <br /> ' B PHONECe11:209.981.7755 3 <br /> CONTRACTOR ADDRESS 1133 Blackhurst Drive CITY/STATE/ZIP Galt,CA 95632 <br /> p�p <br /> SUBCONTRACTOR PHONE W <br /> d <br /> SUBCONTRACTOR ADDRESS CITY/STATE/ZIPy <br /> 7 <br /> LICENSE X C-57 J C-61 L D-09 ❑Other NUMBER 720904 EXPIRATION DATE 04/30/2020 <br /> Q' <br /> DoMEsnc WELL SAMPLING:L General Mineral/Coliform Bacteria(4391)0 Dibromochloropropane(4392)FI Arsenic(4393) n <br /> INTeNoeO UsE F Domestic/Private s InigatioNAgricultural0 Industrial D Water Quality Monitoring i',Soil Sampling/Characterization <br /> C Public Water System w <br /> If different from Owner. Water System Name Contact Name or Phone Number w <br /> O <br /> TYPE OF WORK New Well 0 Replacement Well �]Well Alteration/Modification ❑Other <br /> Monitoring Well(s) #of wells c Soil Boring(s) #of bodngs X Geotechnical 2 #of borings <br /> Out-Of-Service Well G Out-Of-Service Well Renewal Cross-Connection Repair <br /> New Pump D Pump Replacement 0 Pump Repair Raise Well Casino <br /> WELL CONSTRUCTION <br /> Drilling Method X Mud Rotary -�Air Rotary X Auger ❑Cable Tool Push Point Other <br /> Proposed Well Depth 25 ft Excavation 4 1/2 in diameter Open Bottom -,Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Schad 0 Steel 'Plastic r;Stainless Steel Other <br /> Grout Seal Depth full depth ft X Neat Cement(94 Ib bag/5-10 gal water) Sand Cement sack mix/7 gal water <br /> ii Bentonite(20%solids) _.Other <br /> Grout Placement Method C Pumped _Free Fall .Other 0 Retardant/Accelerator(name) <br /> PEDESTAL Installed By �j Driller ❑Pump Contractor Other <br /> 0 Concrete Pedestal L'Dimensions:Width ft Length ft Thick in 0 Christy Box Stove Pipe <br /> PUMP 0 SubmersibleP Turbine -,Other HP Pump Set ft Standing Water Level ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL <br /> WORKERS �ENSATION LAWS. <br /> M fMU IOU DVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED J' PE GE#2295 TITLEVice President,Engineering Services DATE 12/18/18 <br /> LVI <br /> ANT <br /> IVSD <br /> 1 2018 <br /> ' cou <br /> ENTAL 7Y <br /> 7E 75�RTMENT <br /> PA TMENT US ON <br /> Application Accepted By Date Or Area ployee ID# <br /> Grout Inspection By Date LLL444 <br /> WS"11CIA&LW,4lIF <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth It <br /> COMMENTS <br /> PE SC Received C ec Amount Permit/ <br /> Codes Info By ash a itted Date Service Re uest# Invoice# Well ID# <br /> H10-7 <br /> ALS 1 E3 <br /> EHO 43-06 revised 4/14/18 WELL/PUMP PERMIT <br />
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