Laserfiche WebLink
1 ` WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL 12091 953-7697 FOR INSPECT <br />IONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 3507 Wilmarth Road CITY/zIP Stockton / 95215 <br />CROSS STREET Waterloo Road APN 087-160-03 PARCEL SIZE 12.60 LAND USE APPLICATION # <br />OWNER NAME Linden Unified School District <br />PHONE 209.887.3894 <br />OWNER ADDRESS 18527 E. Main Street CITY/STATE/ZIP Linden, CA 95236 <br />CONTRACTOR V & W Drilling - Contact: Karli Stroing, President PHONE 209.981.7755 <br />CONTRACTOR ADDRESS 1133 Blackhurst Drive CITY/STATE/ZIP_Galt, CA 95632 <br />SUBCONTRACTOR Condor Earth - Contact: Ron Skaggs, CA PE #44588/GE #2295 PHONE 209.601.1430 (Coll) <br />SUBCONTRACTOR ADDRESS 188 Frank West Circle, Suite 1 CITY/STATE/ZIP Stockton, CA 95206 <br />LICENSE XC -57 ❑ C-61 ❑ D-09 ❑ Other NUMBER 720904 EXPIRATION DATE 04/30/2022 <br />DOMESTIC WELL SAMPLING: ❑ General Mineral/Coliform Bacteria (4391) ❑ Dibromochloropropane (4392) ❑ Arsenic (4393) <br />INTENDED USE ❑ Domestic/Private ❑ Irrigation/Agricultural E 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 2 # of borings <br />1i Out -Of -Service Well Z Out -Of -Service Well Renewal C Cross -Connection Repair <br />❑ New Pump ❑ Pump Replacement ❑ Pump Repair C Raise Well Casing <br />WELL CONSTRUCTION <br />Drilling Method ❑ Mud Rotary ❑ Air Rotary X Auger ❑ Cable Tool = Push Point ❑ Other RFc <br />Proposed Well Depth 10' to 25' ft Excavation 4 1/2 in diameter ❑ Open Bottom 1'Gravel Pack/Gravel Size �% piameter <br />❑ Conductor Casing in diameter / Conductor Casing Depth ft/T <br />Q 3 <br />Well Casing Diameter in Thickness/Gauge/ASTM Sched Steel 71 Plastic Stainless Steel Othe ` <br />Grout Seal Depth _ft X Neat Cement (94 lb bag/5-10 gal water) ❑ Sand Cement sa�c",�❑ <br />' <br />Bentonite (20% solids) X OtherTremie HiAI ON <br />Grout Placement Method D Pumped LI Free Fall :I Other ❑ Retardant / Accelerator (name) A� <br />PEDESTAL Installed By ' Driller ❑ Pump Contractor C Other <br />❑ Concrete Pedestal ❑Dimensions: Width ft Length ft Thick <br />in Christy Box ❑ 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 />MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />DEPARTMENT USE ONLY <br />Application Accepted By fT Date 3 .2 ,7� Area y (� �0 Employee ID# �1, i I'' jc <br />Grout Inspection By Date Z Z. ❑ SPECIAL Well Permit <br />Pump Inspection By Date ❑ WAIVER Received <br />Soil Boring Inspection By Date Constructed Well Depth ft <br />COMMENTS <br />PE SC Received Check#! Amount Permit/ <br />Codes Info B Date <br />Cash Remitted Servic Request # Invoice # Well ID# <br />f�Uk'� <br />t <br />F}aiiiYll AA nnci�mi " /. <br />/ Page 1 oft <br />Wdl /Pump Pcrmii <br />1L3777/7sv <br />FNT <br />FD <br />D�[ <br />UNTY <br />N7- <br />