Laserfiche WebLink
I WELL/PUMP PERMIT 2105 <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NUN-KEFUNDABLE PERMIT <br />JOB ADDRESS "-(-0D G,! C r/ <br />UALL (21.1111) y03-fb`lf FUR INSPECTIONS rZArIKtJ "1 T tAK FKUM UA1 t IJJ <br />CITYIZIP Lodi/95242 <br />CROSS STREET 12 APN 025-10--003PARCEL SIZE 36(79.74 LAND USE APPLICATION # <br />OWNER NAME Coldani Farms - Steve Coldani E),,11� ci �� `-�T1��'�G; /'1 J TR PHONE 209-481-6121 <br />OWNER ADDRESS 13950 N. Thornton Rd CITYISTATEIZIP Lodi/95240 <br />CONTRACTOR Delta Pump Inc. PHONE 209-466-9625 <br />CONTRACTOR ADDRESS 646 S. California St. CITY/STATE/ZIP Stockton/95203 <br />SUBCONTRACTOR <br />SUBCONTRACTOR ADDRESS <br />CITYISTATE/ZIP <br />PHONE <br />LICENSE I C-57 X C-61 i D-09 I I Other NUMBER 1055434 EXPIRATION DATE 7/31/2023 <br />DOMESTIC WELL SAMPLING: ❑ General Mineral/Coliform Bacteria (4391) ❑ Dibromochloropropane (4392) ❑ Arsenic (4393) <br />INTENDED USE X Domestic/Pnvate 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 i Other <br />Monitoring Well(s) # of wells _. Soil BonnO(s) :!of borings Geotechnical a of borings <br />Out -Of -Service Well t.l Out -Of -Service Well Renewal I Cross -Connection Repair <br />New rump A rump Ke la Cement '' r-ump me air .. Kalse Vvell l.asln <br />WELL CONSTRUCTION <br />Drilling Method . Mud Rotary 1 Air Rotary Auger Cable Tool a Push Point Other <br />Proposed Well Depth it Excavation in diameter Open Bottom Gravel Pack/Gravel Size in diameter <br />Conductor Casing in diameter 1 Conductor Casing Depth ft <br />Well Casing Diameter _ in Thickness/Gauge/ASTM Sched " Steel I Plastic 7 Stainless Steel Other <br />Grout Seal Depth ft Neat Cement (94 /b bag/5-10 gal water,) Sand Cement sack mrx7g al water <br />Bentonite (20% solids) I ) Other PAYMENT <br />Grout Placement Method Pumped C Free Fall ❑ Other Retardant I Accelerator (name) RE <br />PEDESTAL Installed By _I Driller Pump Contractor Other_ MAR Il 1 71114 <br />Concrete Pedestal .:Dimensions: Width ft Length ft Thick <br />in Christy Box Stove Pipe wNcouNTY, <br />PUMP XSubmersible t' Turbine I' Other HP __J_ Pump Set 24 fl Standing WaterLR39l°EP°8 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 hodies 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 />N11N1XII'N1 24 HOUR 111X' XNCE NOTICE REQUIRED I -OR INSPECTIONS - PLEASE CALI. (2091953-761), <br />DEPARTMENT USE ONLY <br />Application Accepted By �- i'— �. Date 0". o' -'a Area / Employee ID# jvl7� <br />Grout Inspection By Date r/ ❑ SPECIAL Well Permit <br />Pump Inspection By Date 3�0 Z� ❑ WAIVER Received <br />Soil Boring Inspectioq Ay Date Constructed Well Depth ft <br />COMMENTS to—�Pld <br />W <br />0 <br />C <br />O <br />A <br />m <br />N <br />PE SC Received Check#/ <br />Codes Info Cash <br />Amount a Permit/ Invoice # Well ID# <br />Remitted Se ice Re uest # <br />C; <br />7 <br />l <br />1[1113u43.Gt, In:a2021 Payr 1 or- W01"Puny Prv:nt <br />