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SAN 10AQUIN Environmental Health Department <br /> - -COUNTY----- <br /> Water Usage Information <br /> PROJECT INFORMATION <br /> Application Number: Application Type: Site Approval <br /> Project Address: 16996 Sexton Road, Escalon,CA 95320 Project APN: 229-03-045 <br /> Applicant Name: Gerard Van de Pol-G&H Dairy Title: Uwner pera or <br /> Applicant Address: 16996 Sexton Road City/Zip: Escalon,CA 95320 <br /> Applicant Phone: 209-765-6225 Email: gandhdairy@yahoo.com <br /> Property Owner Name: Gerard Van de Pol <br /> Property Owner Address: 16996 Sexton Road CitylZi : Escalon,CA 95320 <br /> Pro erty Owner Phone: 209-765-6225 Email: gandhdairy@yahoo.com <br /> SERVICES INFORMATION <br /> Please provide description below: <br /> Water Supply: 2 Domestic Wells, 1 Irrigation Well ❑ Surface Water(Attach Water Rights Information) <br /> Domestic Wastewater Disposal: Septic systems <br /> Process Wastewater Discharge: Ponds: 1 3 Wastewater Storage Ponds Applicable WDR: R5-2013-0122 <br /> Storm Drainage System: N/A <br /> WATER USAGE DATA <br /> Provide for total water usage at full buildout Number Persons/Day1Gallons/Person/Day Total Gallons/Da <br /> Domestic Water Usage by Employees/Customers: 19 1 25 475 <br /> Type of Processllrrigated Lands Total Gallons/Day <br /> Process Water Usage: Dairy Milk Barn Operations 122,000 <br /> Process Water Usage: Animal Husbandry 130,000 <br /> Irrigation Water Usage: I Irrigation District Water Only(SSJID) 0 <br /> Total Gallons Per Day: 252,000 <br /> PROPOSED WELL LOCATION <br /> Well Location Address: N/A-No wells proposed I Ci <br /> Well Location APN: <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: Well Elevation: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft):1 I Acres to be Served by Well <br /> Use of Well: ❑Domestic ❑Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industdal ❑Stock <br /> ❑Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity (gal/ft): Estimated Pumping Rate (gal/min): <br /> Anticipated Pumping Schedule gallda : Estimated Annual Extraction Volume(acre-feet): <br /> Estimated Cumulative Extraction Volume before January 1,2020 acre-feet): <br /> SITING INFORMATION <br /> Distance To Nearest ft): Onsite: Offsite: Distance To Nearest(ft): Onsite: Offsite: <br /> Wastewater Treatment System: Sources of Contamination: <br /> Other Wells: PondlLake: <br /> Sewer Lines: Stream/River: <br /> Animal or Fowl Enclosure: Navigable Waterway: <br /> Storm Drainage System:l Potential Recharge Features: <br /> GROUNDWATER INFORMATION <br /> Depth(ft): Source/Date of Reference: Groundwater Subbasin: <br /> Current Depth to Water: ❑ Cosumnes Subbasin(2-22,16) <br /> Highest Depth to Water: ❑ Eastern San Joaquin Subbasin(5-22.01) <br /> Lowest Depth to Water: ❑Tracy Subbasin(5-22.15) <br /> 1868 E. Hazelton Avenue I Stockton. California 95205 1 T 209 468-3420 1 F 209 464-0138 1 vw+nN.slcehd.com <br /> 1 of 2 <br />