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SAN�sJ0A0UIN Environmental Health Department <br /> ...... COU NTY— <br /> :; Gr-eotness graws here. <br /> Water Usage Information <br /> PROJECT INFORMATION . <br /> Application Number: Application Type: site Approval <br /> Project Address: 14250 S.Jack Tone Road,Ripon,CA Project APN: 203-050-290 <br /> Applicant Name: Rick Van Unen,Jr. Title: CEO <br /> Applicant Address: 1671 Dickey Ct. Ci /ZI : Ripon,95366 <br /> Applicant Phone: 209-480-1102 Email: rick@windmiilind.com <br /> Property Owner Name:Windmill Septic,LLC <br /> Property Owner Address: 20504 S.HwY 99 Frontage Road,Ripon,California Ci 21 : Ripon-95366 <br /> PropertyOwner Phone: 209-623.1315 Ernail:1 rick@windmillind.com <br /> :.. .... .:.. : .:...:.:;:: ::SERVICES INFORMATION.:'.:;"'' <br /> Please provide description below: Private well <br /> Water Supply: Private Well ❑ Surface Water(Affach Water Rights Information) <br /> Domestic Wastewater Disposal: onsite Septic system <br /> Process Wastewater Discharge: Ponds: I o Applicable WDR: I None <br /> Storm Drainage System: Natural Drainage <br /> :> WATER:USAGE:DATA <br /> Provide for total water usage at full buildout Number Persons/Da Gallons/Person/Da Total Gallons/Da <br /> Domestic Water Usa e by Em to eestCustomers: 5 120 Ina <br /> Type of Process/Irrigated Lands Total GallonslDa <br /> Process Water Usage: Truck washing 200-300 <br /> Process Water Usage: <br /> Irrigation Water Usage: <br /> Total Gallons Per Da : goo-400 <br /> PROPOSED:WELL LOCATION <br /> Well Location Address: Ci <br /> Well Location APN: <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: Well Elevation: <br /> < �iRtt®POSED WELL INFORMATION': <br /> Well Total De th(ft):1 Acres to be Served by Well: <br /> Use ofWeli: 11 Domestic ❑Irrigation O Small Public Water Supply ❑Municipal Public Water Supply ❑ Industrial 13 Stock <br /> ❑Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity (gal/ft): Estimated Pumping Rate (gal/min): <br /> Anticipated Pumping Schedule altda : Estimated Annual Extraction Volume acre-feet <br /> Estimated Cumulative Extraction Volume before January 1,2020?(acre-feet): o <br /> ...:.:..:..:...;..:.,...: :. : :..... ..:.,.. :... ..,,..,::::' :::°SITINGINFORMATION.::°: ..,.,,,.: ...: :::.. : . <br /> Distance To Nearest ft: Onsite: Offsite: Distance To Nearest(ft): Onsite: Offsite: <br /> Wastewater Treatment System: Sources of Contamination: <br /> Other Wells: Pond/Lake: <br /> Sewer Lines: Stream/River: <br /> Animal or Fowl Enclosure: Navigable Waterway: <br /> Storm Drainage System:j System: Potential Recharge Features: <br /> GROUNDWATER INFORMATION:'..`.`t:';::'.<::`;::. ;`< :• . `: :.. : ..:.. <br /> Depth ft: Source/Date of Reference: Groundwater Subbasin: <br /> Current Depth to Water: ❑Cosumnes Subbasin(2-22.16) <br /> Highest Depth to Water: ❑ Eastern San Joaquin Subbasin(5-22.01) <br /> Lowest Depth to Water: ❑Tracy Subbasin(5-22.15) <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 l www.sicehd.com <br /> 1 of 2 <br />