Laserfiche WebLink
WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 -6232 (209) 468-3420 <br />NON-REFUNDABLE PERMIT www.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESE V 0 q j 38.021040°, Log: -121.363676° Cm•/zIP Stockton, CA, 95206 <br />CROSS STREET Mariners Dr/Hammer Ln APN 071-260-150 PARRCELSIZE 9.0 LAND USE APPLICATION# Unknown <br />OWNER NAME Tom McKean (Representatives) SIZE 1"t- 1104G1 ftlr Peld "i 00"2PHONE (209) 957-5707 <br />OWNER ADDRESS 8035 Mariners Drive Pa FS vx A' OF CIN/STATE/ZIP Stockton, CA 95219 c h I alk �, <br />iT' <br />CONTRACTORGregg Drilling, LLC PHONE (925) 313-5800 <br />CONTRACTOR ADDRESS 950 Howe Road CIN/STATE/ZIP Martinez, CA 94553 <br />SUBCONTRACTOR/CONSULTANT Kleinfelder, Inc <br />SUBCONTRACTOR/CONSULTANT ADDRESS 2001 Arch Airport Rd, Suite 100 CITY/STATE/ZIP <br />_ PHONE (209)993-2269 <br />Stockton, CA 95206 <br />LICENSE E C-57 I C-61 0-09 C Other NUMBER 1044456 EXPIRATION DATE 09/30/2022 <br />BILLING PARTY: _I OWNER -. CONTRACTOR 0 SUBCONTRACTOR/CONSULTANT <br />DOMESTIC WELL SAMPLING: Ll General Mineral/Coliform Bacteria (4391) Dibromochloropropane (4392) 1 Arsenic (4393) <br />INTENDED USE n Domestic/Private r Irrigation/Agricultural I Industrial Water Quality Monitoring N Soil Sampling/Characterization <br />Public Water System <br />If different from Owner: Water System Name Contac(Name or Phone Number <br />TYPE OF WORK i New Well I Replacement Well IJ Well Alteration/Modification � Other <br />Monitoring Well(s) # of wells I Soil Boring(s) # of borings E Geotechnical one (1) # of borings <br />i Out -Of -Service Well Out -Of -Service Well Renewal I Cross -Connection Repair <br />I New Pump I Pump Replacement Pump Repair L Raise Well Casing <br />WELL CONSTRUCTION <br />Drilling Method -II. Mud Rotary i Air Rotary - Auger l Cable Tool i Push Point L Other <br />Proposed Well Depth 45 ft Excavation 8 in diameter -I 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 :I Steel I Plastic I Stainless Steel i Other <br />Grout Seal Depth 45 ft E Neat Cement (94 Ib bag,15-10 gal water) -I Sand Cement sack mix/7 gal water <br />Bentonite (20% solids) E Other up to 5% bentonite 174 T 1.0 E -G .?V Pf <br />Grout Placement Method 0 Pumped _ i Free Fall E Other Tremie Full -Depth -i Retardant / Accelerator (name) <br />PEDESTAL Installed By L Driller 7 Pump Contractor Other <br />Concrete Pedestal uDimensions: Width ft Length ft Thick in Fi Christy Box _I Stove Pipe <br />PUMP Submersible _I Turbine F Other HP Pump Set ft Standing Water Level ft <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 />MIt4IN7UM,48,1-PUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />r <br />j 60( fD <br />DEPARTMENT USE ONLY /wtI QQ <br />Application Accepted By ��✓ IZ O / Area 3 5 ��Em <br />Date , ployee ID# /'J!ti <br />Grout Inspection By Date SPECIAL Well Permit <br />Pump Inspection Byte WAIVER Received <br />//,, <br />Soil Boring Inspection By _7 V Date Corstructed Well Depth ft <br />COMMENTS- <br />EH043-06 6111/2019 W. 13,SS-,53 <br />WELL /PUMP PERMIT <br />ANT <br />FO <br />?02� <br />/vT' <br />MENT <br />