Laserfiche WebLink
WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 2945 French Camp Rd CIry/LP Manteca In <br /> D <br /> CROSS STREET APN 1771 00050 PARCEL SIZE '/LAND USE APPLICATION# p <br /> OWNER NAME rima Rossa Orchards LLC PHONE 209-479-8763 y <br /> OWNER ADDRESS 6464 Live Oak Rd CITY/STATE/ZIPL o d i CA 95240 <br /> CONTRACTOR Purviance Drillers , Inc PHONE 209-887-3554 <br /> CONTRACTOR ADDRESS P O R O X 64 CITY/STATEIZIP Linden ,C a 95236 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITY/STATEIZIP <br /> LICENSE LXC-57 L C-61 J D-09 U Other NUMBER 377923 EXPIRATION DATE 7/31/19 <br /> DOMESTIC WELL SAMPLING:11 General Mineral/Coliform Bacteria(4391)C Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE >rDomestic/Private lIrrigation/Agricultural L Industrial L Water Quality Monitoring L Soil Sampling/Characterization <br /> U Public Water System <br /> If different fmm Owner Water System Name Contact Name or Phone Number <br /> TYPE OF WORK "ew Well L Replacement Well C Well AlterationlModification ❑Other <br /> rl Monitoring Well(s) #of wells r Soil Boring(s) #of Wrings L Geotechnical u <br /> U Out-Of-Service Well C Out-Of-Service Well Renewal L Cross-Connection Repair <br /> L New Pump C Pump Replacement E Pump Repair ❑Raise Well Casing6� <br /> WELL CONSTRUCTION <br /> Drilling Method DR'fufud Rotary �-Air Rotary �i Auger "1 Cable Tool L Push Point F Other 1 23 2019 <br /> Proposed Well Depthj:p?b L� ft ExcavationL// 3/f in diameter Y Open Bottom L Gravel Pack/Gravel Size in V(N <br /> F)Conductor g ^)14 in diameter I Conductor Casing Depth ft H4 l N NTUNN <br /> Well Casing Diameter 8 Thickness/Gauge/ASTM Sched ,lFk L Steel L Plastic L Stainless Steel CI Other N , AL <br /> Grout Seal Depth Ba ft 11 Neat Cement(94/b bag/&10 gal water) ?(Sand Cement /�• 3 sack mix17 gal water PA�TMENT <br /> U Bentonite(20%solids) J Other <br /> Grout Placement Method V Pumped L Free Fall D Other -. Retardant/Accelerator(name) <br /> PEDESTAL Installed By YDriller -1 Pump Contractor I1 Other <br /> r i Concrete Pedestal FDimensions:Width ft Length ft Thick in -1 Christy Box U Stove Pipe <br /> PUMP 1 Submersible❑Turbine :1 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 I AM IN COMPLIANCE WITH ALL <br /> WORK NSATION LAPP . <br /> MINI U 24 H0 4��E NOTICE REQUIRED FOR I ISPFCTIONS-PI FASF cALL(209)953-7697 <br /> SIGN TITLE ATE <br /> Secretary DATE <br /> Syh <br /> 11 — -#— 11 <br /> I F— <br /> P RTMENT UrvE NLY <br /> Application Accepted By Date 23 Area Employee ID#� <br /> Grout Inspection By ! Date _ LVfl <br /> PECIA WBII Permit <br /> Pump Inspection By Date I WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received ,'thecUV Amount Date Permit/ Invoice# WellID# <br /> C flito emitted Service uest# <br /> EHD43-06 B/O7/16 WELL[PUMP PERMIT <br />