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SR0083415_SSNL ADDENDUM
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SR0083415_SSNL ADDENDUM
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Last modified
2/24/2022 1:21:10 PM
Creation date
2/23/2022 5:06:40 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
FileName_PostFix
SSNL ADDENDUM
RECORD_ID
SR0083415
PE
2602
FACILITY_NAME
88 MARKET & GRILL
STREET_NUMBER
21850
Direction
E
STREET_NAME
LIBERTY
STREET_TYPE
RD
City
CLEMENTS
Zip
95227
APN
02120024
ENTERED_DATE
3/16/2021 12:00:00 AM
SITE_LOCATION
21850 E LIBERTY RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\tsok
Tags
EHD - Public
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PUBLIC WATER SYSTEM DESCRIPTION REPORT <br /> Water System Name:88 Market Water System <br /> Date: 03/18/2020 <br /> Source Information <br /> ALL DATA <br /> (Use one sheet for each we//) <br /> Well Name: Well 1 <br /> Well ID Number: <br /> Well Location: 21850 E Liberty Road Clements Ca. 95227 <br /> a) Distance to Sewer: Septic Tank(s): 100 Ft Leach lines: 150 Ft <br /> b) Distance to Other Wells: N/A Abandoned wells: <br /> c) Distances to property Lines: Front 360 Ft Rear 360 Ft Side 1 180 Ft Side 2 180 Ft <br /> ATTACHA COPY OF YOUR WELL COMPLETION REPORT(WATER WELL DRILLER'S <br /> REPORT)AND COMPLETE THE FOLLOWING.- <br /> Depth of Well (from ground surface to lowest point of excavation): <br /> Casing: Depth Diameter: <br /> a) Casing Material: Gauge or Thickness: <br /> b) Annular Seal Depth: Material: <br /> c) Is the well gravel-packed? Depth: <br /> d) Is the well wall perforated? Depth: <br /> e) Impervious Strata: Thickness: Depth: <br /> f) Water Level: First Water Level: Static Water Level: <br /> When Pumping: <br /> g) Maximum Sustained Yield: <br /> Pump: Make: Model Number: <br /> a) Type (submersible,jet, turbine, centrifugal): <br /> Capacity: Gallons per minute: <br /> b) Lubrication (oil, water, sealed, etc.): <br /> c) Power (electric, gas, diesel, etc.): Electric <br /> d) Controls (automatic or manual): Automatic <br /> e) Discharges to: Distribution System &Waste <br /> f) Frequency of use: Dailey <br /> g) Flood hazard: Cement slab around well? Dimensions & Height: <br /> DESCRIBE ANY TREATMENT PERFORMED: N/A <br /> /Users/samhedge/Desktop/88 MKT Water System Description Report 03-2020.doc Page 4 of 5 <br />
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