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 (209) 953-7697 FOR INSPECTIONS EXPIRES 'I YEAR FROM DATE ISSUED <br />JOB ADDRESSoRq cO <br />CROSS STREET /.1V irD rc4 APN <br />OWNER NAME City of Stockton <br />OWNER ADDRESS 425 N E1 Dorado St <br />CONTRACTOR Kleinfelder <br />}� (� CrrY/ZIP Stockton, CA <br />`s-) ?V 0001 PARCEL SIZE It -74 USE APPLICATION # <br />CONTRACTOR ADDRESS 2001 Arch Airport Rd, Suite 100 <br />SUBCONTRACTOR Taber Drilling <br />PHONE <br />CITYISTATE/ZIP Stockton, CA 95202 <br />PHONE 661-302-2054 <br />CITYISTATE/ZIP Stockton, CA 95206 <br />PHONE 916-371-8234 <br />SUBCONTRACTOR ADDRESS 536 Galveston St CITY/STATE/ZIP West Sacramento, CA 95691 <br />LICENSE A-57 C-61 D-09 nOther NUMBER 969927 EXPIRATIONDATE 2/28/202/44 <br />DOMESTIC WELL SAMPLING: ❑ General Mineral/Coliform Bacteria (4391) D Dibromochloropropane (4392) D Arsenic (4393) <br />INTENDED USE n Domestic/Private -1 Irrigation/Agricultural I- Industrial - Water Quality Monitoring /Soil Sampling/Characterization <br />_: Public Water System <br />If different from Owner. water System Name /Other <br />Name or Phone Number <br />TYPE OF WORK U New Well _ Replacement Well L Well Alteration/Modification /Other CPT <br />❑ MonitoringWell(s) #ofwells /SoilBoring(s) 3 #of borings Geotechnical 2 #of borings <br />Out -Of -Service Well D Out -Of -Service Well Renewal C Cross -Connection Repair <br />New Pump U Pump Replacement L Pump Repair _ Raise Well Casing <br />WELL CONSTRUCTION l\w <br />Drilling Method /Mud Rotary F- Air Rotary /Auger n Cable Tool r Push Point / Other Direct Push SAN <br />Drilling <br />Proposed Well Depth 130 (max) ft Excavation 8 (max) in diameter -1 Open Bottom r Gravel Pack/Gravel Size p <br />Conductor Casing in diameter I Conductor Casing Depth ft <br />Well Casing Diameter_ in Thickness/Gauge/ASTM Schad -1 Steel L Plastic L Stainless Steel I Other <br />Grout Seal Depth 130 (max) ft / Neat Cement (94 lb bag/5-10 gal water) L Sand Cement sack mix/7 gal wate <br />Bentonite (20% solids) Other <br />Grout Placement Method Pumped /Free Fall XOther Tremie n Retardant / Accelerator (name) <br />°EDESTAL Installed By n Driller n Pump Contractor -1 Other <br />F-1 Concrete Pedestal nDimensions: Width ft Length It Thick <br />n L Christy Box U Stove Pipe <br />PUMP L Submersible. i Turbine 7 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 RF.QITIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />DEPARTMENT USE ONLY <br />Application Accepted By L Date V.21 I �11-1� <br />Grout Inspection By Date <br />Pump Inspection By D Q� <br />Soil Boring Inspection By t ePe ✓ li�i. <br />COMMENTS <br />Area I i h fCk"r' Employee ID# _M1 <br />S <br />❑ SPECIAL Well Permit <br />❑ WAIVER Received <br />Constructed Well Depth ft <br />E A FNT <br />I VED <br />14R 22 W?? <br />ROHM COUN <br />' 0EPgRTMENT?' <br />EHD043-06 10@52021 I',g' I of -, <br />&V- --)� 1zh)731 ,� 07 <br />Well / Pump Permit <br />