Laserfiche WebLink
I WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NUN-KEFUNDABLE HERMIT CALL 209 953-7697 FOR INSPECTIONS <br />EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS _18667 <br />N. Jacob Brack Road <br />CITY/ZIP <br />Lodi, California <br />CROSS STREET <br />West Cotta Road_ APN 011090616 <br />PARCEL SIZE 151.12 Ac. LAND USE APPLICATION # <br />OWNER NAME <br />Trinchero Family Estates <br />PHONE 209-210-6001 <br />OWNER ADDRESS <br />18667 N Jacob Brack Road <br />CITY/STATE/ZIP <br />Lodi, CA 95242 <br />CONTRACTOR <br />NV5 <br />PHONE Chico, CA 95928 <br />CONTRACTOR ADDRESS 48 Bellarmine Court, Suite 40 <br />CITY/STATE/ZIP <br />530-894-2487 <br />SUBCONTRACTOR <br />V&W Drilling <br />PHONE 209-469-7700 <br />SUBCONTRACTOR ADDRESS 1133 Blackhurst Drive <br />CITY/STATE/ZIP <br />Galt, CA 95632 <br />LICENSE X C-57 <br />_ C-61 ❑ D-09 ❑ Other <br />NUMBER 720904 <br />EXPIRATION DATE 04/30/2022 <br />DOMESTIC WELL SAMPLING: ❑ General Mineral/Coliform Bacteria (4391) ❑ Dibromochloropropane (4392) ❑ Arsenic (4393) <br />NTENDED USE ❑ Domestic/Private ❑ Irrigation/Agricultural ❑ Industrial ❑ Water Quality Monitoring & Soil Sampling/Characterization <br />❑ Public Water System <br />If different from Owner: Water System Name Contact Name or Phone Number <br />TYPE OF WORK ❑ New Well ❑ Replacement Well ❑ Well Alteration/Modification ❑ Other <br />❑ Monitoring Well(s) # of wells ❑ Soil Boring(s) # of borings X Geotechnical 5 # of borings <br />❑ Out -Of -Service Well ❑ Out -Of -Service Well Renewal ❑ Cross -Connection Repair <br />Li New rum ❑ F-ump rte Iacement ❑ F-ump rte air ❑ rtaise vveii cash <br />WELL CONSTRUCTION <br />Drilling Method ❑ Mud Rotary ❑ Air Rotary X Auger ❑ Cable Tool ❑ Push Point ❑ Other <br />Proposed Well Depth 20 ft Excavation 8 in diameter ❑ Open Bottom I 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 20 ft X Neat Cement (94 Ib bag/5-10 gal water) ❑ Sand Cement sack mix/7 gal water <br />❑ Bentonite (20% solids) ❑ Other <br />Grout Placement Method IX Pumped X Free Fall ❑ Other [I Retardant / Accelerator (name) <br />'EDESTAL Installed By = Driller ❑ Pump Contractor = Other <br />Concrete Pedestal -]Dimensions: Width ft Length ft Thick <br />I ❑ Christy Box E Stove Pipe <br />PUMP ❑ Submersible❑ Turbine Other HP Pump Set ft Standing Water Level ft <br />Plot Plan Requirements: Attach a plot plan with the exact location of water well with respect to the following items: GPS <br />Coordinates, property lines, adjoining properties, water bodies or courses, drainage pattern, roads, existing wells, structures, <br />potential sources of contamination, sewers or private disposal systems. Include distance from two property lines. For Domestic, <br />Agriculture, Industrial well, provide location of any water wells or surface water within 200' radius of proposed well. <br />NIININIUNI 21 IIOUR .ADN ANCE NOTICE RI'QUIRED EOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />D E P A R T M ENT US E ON LY <br />Application Accepted By Date <br />Grout Inspection By Date 2 L 2,2 <br />Pump Inspection By Date <br />Soil Boring Inspection By Date <br />COMMENTS Tf c( :!(-)vJcaiPr IS r-I^J1er It I:ic( fn 61 <br />Area C/ l Employee ID# �I{ <br />❑ SPECIAL Well Permit <br />❑ WAIVER Received <br />Constructed Well Depth PA <br />Fli <br />PE SC Received Ch / Amount Date Permit/ Invoice # Wel Dt�o? <br />Codes Info B Cash Remitted Service Request # <br />1=3 70, )5-0 25 )0� ` 2 -g <br />NViROA,. C I- <br />2 LPZ hkW110H <br />4EP 7,44 <br />N7� <br />EHDO43-06 10/252021 Pae, I of, Well Pump Permit <br />