Laserfiche WebLink
va <br />WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 -6232 (209) 468-3420 <br />PIVPI-f%tFUNUAULt 1"tHMll <br />www.stgov.orgrena CAYIRCJ l TtAH 1 -HUM UAIt Ibb UtU <br />JOB ADDRESS <br />770 Frontage Road <br />ClTy21P Ripon 95366 <br />CROSS STREET <br />Arc Way <br />APN 261-050-01 PARCEL SIZE 1 55 acres LAND USE APPLICATION # <br />OWNER NAME <br />Jaswant S. Sekhon <br />PHONE <br />OWNER ADDRESS <br />P.O. Box 466 <br />CITYISTATE/ZJP Salida. CA 95368 <br />RMA Geoscience, Inc. <br />PHONE (559)708-8865 <br />CONTRACTOR ADDRESS 3897 North Ann <br />Avenue <br />CITY/STATE/ZJP <br />Fresno, CA 93727 <br />SUBCONTRACTOR/CONSULTANT Salem <br />Engineering Group <br />PHONE <br />SUBCONTRACTOR/CONSULTANT ADDRESS <br />4729 W. Jacquelyn Avenue <br />CITY/STATE/Zip <br />Fresno. CA 93722 <br />LICENSE X C-57 C-61 D-09 <br />Other <br />NUMBER 970772 <br />EXPIRATION DATE 03/31/2022 <br />BILLING PARTY: OWNER <br />X CONTRACTOR <br />SUBCONTRACTOR/CONSULTANT <br />DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria (4391) Dibromochloropropane (4392) Arsenic (4393) <br />4TENDED USE Demestic/Private Irrigabon/Agricultural Industrial Water Quality Monitoring Soil Sampling/Charactenzation <br />Public Water System <br />II -,Re, t from Owner Water System Name Contact Name or Phone Number <br />TYPE OF WORK New Well Replacement Well Well Alterationl.lodifcation X Other Geotechnical Investigation <br />Monitoring Well(s) # of wells Soil Bodng(s) a o1 `0 J" X Geotechnical 2 to 20' a of bonngs <br />Out -Of -Service Well Out -Of -Service Well Renewal Cross -Connection Repair <br />New Pump a Pump Replacement Pump Repair Raise Well Casio <br />WELL CONSTRUCTION No wells will be installed. Just two (2) geotechnical borings to 20'. <br />Drilling Method Mud Rotary ' Air Rotary X Auger Cable Tool Push Point Other <br />Proposed Well Depth 20 ft Excavation 7 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 Sched Steel Plastic Stainless Steel Other <br />Grout Seal Depth 2 ?) It X Neat Cement (94 to bag/5-10 ga! water) Sand Cement sack mix/7 gal water <br />Bentonite (20% solids) Other <br />Grout Placement Method X Pumped Free Fall Other Retardant / Accelerator (name) <br />PEDESTAL Installed By Driller Pump Contractor Other <br />n/a Concrete Pedestal Dimensions. Width ft Length ft Thick in Christy Box Stove Pipe <br />�PuMP n/a Submersible Turbine Othel HP Pump Set ft Standing Water Level fl <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 />AQMjIMU HOU ANCE NOTICE REQUIRED FOR INSPECTIONS <br />IINNSPECTIOON9S - PLEASE CALL (209) 953-7697 <br />SIGNED TITLE -i / �rC, lTr"1 DATE 2__,23 `-z� <br />In <br />DEPARTMENT UEQ NLY ��}} <br />Application Accepted By �/� �'� Date S� �`J / Area `i Employee ID#r i C <br />Grout Inspection By Date SPECIAL Well Permit <br />Pump Inspection By Date WAIVER Received <br />Soil Boring Inspection By Date Constructed Well Depth ft <br />COMMENTS <br />EMD i]-06 6171(1019� f2-/ <br />1-1.z / / o� WELL RUMP PF'n MiT <br />