WP0043332 - Laserfiche WebLink

Home Browse Search

� y 1 WELL/PUMP PERMIT SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205 - (209)468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED Joe ADDRESS 3040 Novy , t2t.4J#9++5` CITY/ZIP Stockton, CA, 95206 m Navy Dr/W Washington St 14-502-019 10.28 a Unknown D CROSS STREET Y g APN PARCEL SIZE 0.AND USE APPLICATION# o A n OWNER NAME Melanie Rodriguez contact person:Gloria Ruiz PHONE 1209) 946-0246 ext 8281 �? OWNER ADDRESS 2201 W. Washington St CITY/STATE/ZIP Stockton, CA 95219 CONTRACTOR Gregg Drilling, LLC PHONE (925)313-5800 CONTRACTOR ADDRESS 950 Howe Road CITY/STATE/ZIP Martinez, CA 94553 SUBCONTRACTOR Kleinfelder, Inc PHONE (209) 993-2269 SUBCONTRACTOR ADDRESS 2001 Arch Airport Rd, .Suite 100 CITY/STATE/ZIP Stockton, CA 95206 LICENSE N C-57 7- C-61 ❑ D-09 C Other NUMBER 1044456 EXPIRATION DATE 09/30/2022 DOMESTIC WELL SAMPLING:: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392)i Arsenic(4393) INTENDED USE ❑ Domestic/Private ❑ Irrigation/Agricultural C Industrial ❑ Water Quality Monitoring 0 Soil Sampling/Characterization ❑ Public Water System If different from Owner: Water System Name Contact Name or Phone Number TYPE OF WORK ❑ New Well ❑ Replacement Well D Well Alteration/Modification ■Other one(1)cone penetrometer test soundings ❑ Monitoring Well(s) #of wells ❑ Soil Boring(s) #of borings EGeotechnical two(2) #of borings ❑ Out-Of-Service Well ❑ Out-Of-Service Well Renewal CI Cross-Connection Repair P,q ❑ New Pum O Pump Replacement ❑ Pump Repair 7 Raise Well Casing / 2v? WELL CONSTRUCTION / Drilling Method C Mud Rotary L Air Rotary :1 Auger -i Cable Tool Push Point 7 Other Proposed Well Depth 40 to 60 it Excavation 2 to 8 in diameter ❑ Open Bottom C Gravel Pack/Gravel Sized' rtste� L Conductor Casing in diameter / Conductor Casing Depth ft N JO l Well Casing Diameter_in Thickness/Gauge/ASTM Sched L Steel :1Plastic ❑ Stainless Steel ❑ O��NV qQU/ Grout Seal Depth 40 to 60 ft ■Neat Cement(94 lb bag/5-10 gat water) C Sand Cement sa k rN: Ty' ❑ Bentonite(20%solids) ■Other Up to 5%bentonite ART/y) Grout Placement Method ■Pumped ❑ Free Fall ■Other Tremie Full-Depth ❑ Retardant/Accelerator(name) T PEDESTAL Installed By ❑ Driller C Pump Contractor ❑ Other ❑ Concrete Pedestal❑Dimensions:Width ft Length ft Thick �in ❑ Christy Box D Stove Pipe PUMP ❑ Submersible:] Turbine L Other HP Pump Set ft Standing Water Level ft Plot Plan Requirements: Attach a plat plan with the exact location of water well with respect to the following items: GPS Coordinates, property lines, adjoining properties, water bodies or courses, drainage pattern, roads, existing wells, structures, potential sources of contamination, sewers or private disposal systems. Include distance from two property lines. For Domestic, Agriculture,Industrial well,provide location of any water wells or surface water within 200' radius of proposed well. MINI\II\I 24 1 10R \f)\ \V(1.NOT R 1.Ill(il IRf.0 FOR I\iPl.("I IONS-PI.E kNI ( \I.I.(209)953-7697 DEPARTMENT USE ONLY Application Accepted By L` Date Area sl0"k1Dh Employee ID# rns Grout Inspection By Date 2 SPECIAL Well Permit Pump Inspection By 4 4 Date D WAIVER Received Soil Boring Inspection By Date y� Constructed Well Depth ft COMMENTS PE SC Received Check#/ Amount Date Permit/ Invoice# Well ID# Codes Info B Cpsh Remitted I Service Re uest# 7F o CSR 6D rfIn043-0604107/2022 ��`"' '/' �! Paee I of? Well l Pump Permit