SU0014297 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN Cou NT Y Environmental Health Department PA 2100093 EXISTING WELLS INFORMATION Total Number Existing Wells on Property: D..) Please complete the information below for every well on property. Use extra paper if needed. Well #1 Information Use of Well: El Domestic 0 Irrigation 0 Small Public Water Supply 0 Municipal Public Water Supply X Industrial 0 Stock El Other: F 1 ez --PeorEur lo 0 Total Depth (ft): 1.-1 Li 0 Screen Interval (ft): To: '1-7 G-- From: 2--t i Casing Diameter Diameter (in): if) PVC- To: From: Pumping Rate (gpm): 11 6- To: From: Annual Extraction Volume (acre-feet: j ,5'....i: 'i-1 - N'Estimated 0 Measured Specific Capacity (gal/min/ft): p. / ft Other Pumping Tests Performed: — Test Result: Well #2 Information Use of Well: 0 Domestic 0 Irrigation 0 Small Public Water Supply 0 Municipal Public Water Supply E Other: (Industrial 0 Stock Total Depth (ft): C 2..L.f 4.1- Screen Interval (ft): To: From: Casing Diameter (in): C.: PVC- To: j; kiq From: Pumping Rate (gpm): ,2 p To: From: Annual Extraction Volume (acre-feet: .- . i ,3 10 Estimated 0 Measured Specific Capacity _Wafting* N./A Other Pumping Tests Performed: _ Test Result: Well #3 Information Use of Well: 0 Domestic 0 Irrigation 0 Small Public Water Supply 0 Municipal Public Water Supply 0 Other: 0 Industrial 0 Stock Total Depth (ft): Screen Interval (ft): To: From: Casing Diameter (in): To: From: Pumping Rate (gpm): To: From: Annual Extraction Volume (acre-feet: 0 Estimated 0 Measured Specific Capacity (gal/min/ft): Other Pumping Tests Performed: Test Result: MAP INFORMATION A project site map must be attached to this form and shall include the following information: • Legal lot and parcel dimensions. • All well locations on legal lot and parcel with type and use information shown for each well. • All onsite sewage treatment systems, stormwater ponds, process water ponds, and other sources of potential contamination. • Distance from proposed well to any potential sources of pollution onsite and on adjacent properties, including: Existing or proposed onsite sewage treatment systems, wells, animal or fowl enclosures, transmission lines, sewer lines. Distance from ponds, lakes, rivers and streams within 300 feet and navigable water ways within one mile. For wells below Corcoran clay, map must show location of canals, ditches, pipelines, utility corridors, and roads within two miles. jr71.", t--• 0 D 1.--rt 10 4:“. t2-8(1) 0_ Th5 0-C3S&O c6a L C)0--0 ‘04_9 2 of 2