Laserfiche WebLink
SAN:JOAQUIN <br /> <br />Environmental Health Department <br />--COUNTY— <br />Well #2 Information <br />Use of Well: <br /> 0 Other: <br />0 Domestic 0 Irrigation 0 Small Public Water Supply 0 Municipal Public Water Supply 0 Industrial 0 Stock <br />Total Depth (ft): <br />0 Open Bottom or Screen Interval (ft): <br />To: From: <br />Casing Diameter (in): To: From: <br />Pumping Rate (gpm): To: From: <br />Annual Extraction Volume (acre-feet: 0 Estimated 0 Measured <br />Specific Capacity (gal/min/ft): <br />Other Pumping Tests Performed: Test Result: <br />Well #3 Information <br />Use of Well: <br /> 0 Other: <br />0 Domestic 0 Irrigation 0 Small Public Water Supply 0 Municipal Public Water Supply 0 Industrial 0 Stock <br />Total Depth (ft): <br />0 Open Bottom or Screen Interval (ft): <br />To: From: <br />Casing Diameter (in): To: From: <br />Pumping Rate (gpm): To: From: <br />Annual Extraction Volume (acre-feet: 0 Estimated 0 Measured <br />Specific Capacity (gal/min/ft): <br />Other Pumping Tests Performed: Test Result: <br />WATER TABLE INFORMATION <br />Depth (ft): Source of Reference: Date of Reference: <br />Current Water Table:i D, o.--1/. vr- 1...)41-1,1S :0 1-1-4., <br />Highest Water Table: i <br />Lowest Water Table: i 1( <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: r-ihi Transmission Lines: 44:‘ <br />Onsite Well: 4 Pond/Lake: h.s. /A <br />Sewer Lines: hrhi Stream/River: IV /4 <br />Animal of Fowl Enclosure: nifiq <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 treatment systems, 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 />I hereby certify th the in rmation I have provided is accurate and truthful to the extent reasonably known. <br />Signed: Date: <br />Information Provided By: —311 Well Driller 0 Well/Property Owner 0 Other: <br />EFID 4300 12-21-2017 <br />2 of 2