Laserfiche WebLink
WELUPUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-6232 (209)468-3420 <br /> NON-REFUNDABLE PERMIT www.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 415 Oregon Street CmILP Ripon,CA 95366 w <br /> �D <br /> CROSS STREET Oak Ave APN 26118018 PARCEL SIZE10.36 aCLAND USE APPLICATION# o <br /> c } in <br /> A <br /> OWNER NAME RIP U r.i�1 eC) Sc,k of �rS I/ ) t PHONE <br /> OWNER ADDRESS CITY/STATEMP <br /> CONTRACTOR Neil O'Anderson and Associates PHONE (209)588-2219 <br /> CONTRACTOR ADDRESS 902 Industrial Way CRY/STATE/ZIP Lodi,CA 95240 <br /> SUBCONTRACTOR/CONSULTANT H1 Drilling Company,LLC PHONE(916)213-7231 <br /> SUBCONTRACTOR/CONSULTANT ADDRESS 1400 Kitchner Rd CRY/STATE/ZIP Sacramento CA 95822 <br /> LICENSE <C-57 C-61 D-09 Other NUMBER #1006095 EXPIRATION DATE 08/31/2021 <br /> BILLING PARTY: OWNER xCONTRACTOR SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE Domestic/Private i Irrigation/Agricultural Industrial i Water Quality Monitoring kf Soil Sampling/Characterization <br /> Public Water System <br /> If different from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK New Well Replacement Well Well Alteration/Modification Other <br /> Monitoring Wallis) #of wells Soil Boring(s) #of borings ){Geotechnical 3 #of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> New Pump i Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary Air Rotary X Auger Cable Tool Push Point Other <br /> Proposed Well Depth 5 to 50 It Excavation 4 t0 8 In.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 Steel Plastic Stainless Steel Other <br /> Grout Seal Depth S t o S O It X Neat Cement(94 lb bag/5-10 gal water) Sand Cement sack mix/7 gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method k Pumped Free Fall - Other Retardant/Accelerator(name) <br /> PEDESTAL Installed By Driller Pump Contractor Other <br /> Concrete Pedestal Dimensions:-Width—ft Length ft Thick in 1 Christy Box i Stove Pipe <br /> PUMP Submersible i Turbine i 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 /> WORKERS COMPENSATION LAWS. <br /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED _ _ TITLE Staff Engineer DATE 11/23/2020 <br /> NONNI <br /> NONNINONNI <br /> NONNI <br /> ACENjFNT <br /> MMMMI IMMEMMEMEMEMEN �VEQ <br /> NONNI <br /> NONNIEMIL <br /> 2 y 2020 <br /> NONNIMMMMI rMINE MEN MMUT,E V/N <br /> NONNI P MAC rY <br /> ENT <br /> NONNI <br /> ��EPARTMENT SE ONLY <br /> Application Accepted By G � Date I t �y ��o�o Area LI/R;FJO Employee lD# A <br /> Grout Inspection By — Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection B Date Con ructet Well De th ft <br /> CO MENTS , C , L 1 ! 2 t <br /> t\ it 00 a OttkilA • r v iZ � w <br /> PE Sc Received hec Amount Date Permitl Invoice# Well ID# <br /> Codes Info Remitted ervic Request# <br /> L)3 l a so 60 <br /> EHD43-06 6/11/2019 WELL/PUMP PERMIT <br />