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 1 YEAR FROM DATE ISSUED — <br />JOB ADDRESS 3590 W. Lehman Road ciTyizip Tracy, California i 6 30 11 <br />Ai\ k Y. iN CROSS STREET AP N 2530 14 (M - C PARCEL SIZE -3-2°L3 LAND USE APPLICATION # <br />OWNER NAME GloriAnn Farms PHONE <br />OWNER ADDRESS 3590 W. Lehman Road CITY/STATE/ZIP Tracy, Ca <br />Krazan & Associates, Inc 559-348-2200 <br />CONTRACTOR PHONE <br />215W. Dakota Avenue Clovis, CA 93612 <br />CONTRACTOR ADDRESS CITY/STATE/ZIP <br />SUBCONTRACTOR Krazan & Assoviates, Inc„. PHONE 559-348-2200 <br />215W. Dakota Avenue Clovis, CA 93612 <br />SUBCONTRACTOR ADDRESS CITY/STATE/ZIP <br />LICENSE X C-57 0 C-61 0 D-09 il Other NUMBER 499908 EXPIRATION DATE <br />10.31.2022 <br />DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria (4391) Dibromochloropropane (4392) Arsenic (4393) <br />INTENDED USE u Domestic/Private lill Irrigation/Agricultural E Industrial 0 Water Quality Monitoring 0 Soil Sampling/Characterization <br />0 Public Water System <br />If different from Owner: Water System Name Contact Name or Phone Number <br />TYPE OF WORK 0 New Well 0 Replacement Well 0 Well Alteration/Modification •.:. Other <br />D Monitoring Well(s) # of wells 0 Soil Boring(s) # of borings X Geotechnical 3 # of borIN )„ <br />Ei Out-Of-Service Well D Out-Of-Service Well Renewal EC Cross-Connection Repair (20-30 Feeiiir. 44$. <br />Ci New Pum • 0 Pump Replacement D Pump Repair C Raise Well Casing <br />WELL CONSTRUCTION <br />4 1/6 <br />Drilling Method 0 Mud Rotary 0 Air Rotary 0 Auger C Cable Tool E Push Point E Other 25 Sq <br />2n i <br />Proposed Well Depth ft Excavation in diameter Li Open Bottom C Gravel Pack/Gravel Size ' vA, ,./0in diammv,E2 4 4 QU IlIf Conductor Casing in diameter / Conductor Casing Depth ft /"Ixi Co/ Lri/L ,49 0A1,,,,I AI , <br />Well Casing Diameter in Thickness/Gauge/ASTM Sched E Steel c. Plastic Stainless Steel D •/;;!„,,, vt,1 <br />Grout Seal Depth ft ) Neat Cement (94 lb bag/5-10 gal water) . Sand Cement sack mix/7 -gbT , <br />E.:: Bentonite (20% solids) C Other <br />Grout Placement Method IS:j Pumped D Free Fall 1.3 Other 0 Retardant / Accelerator (name) <br />PEDESTAL Installed By 0 Driller 0 Pump Contractor E Other • <br />LI: Concrete Pedestal ['Dimensions: Width ft Length ' ft Thick <br />in 0 Christy Box 0 Stove Pipe <br />. . <br />PUMP 0, Submersible0 Turbine IC 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 INSPECT to N!•,: - PLEAtit': CALL (209) 953-7697 <br />Application Accepted By <br />fryl....:,RTMENT USEC‘)LY . <br />Date Z. L- Area 3 Ci Ct Employee ID# A ,,,Ahr,,.•_dia_./ _ <br />r <br />Grout Inspection By / Date SPECIAL Well Permit <br />Pump Inspection By Date WAIVER Received II c...)_______________ <br />, g-- <br />Soil Boring Inspection By f-I L Date Li .3 CZ- , Constructed Well Depth ft <br />COMMENTS <br />PE <br />Codes <br />SC <br />Info <br />Received <br />By <br />(Check& <br />Cash <br />Amount <br />Remitted Date , <br />Permit/ <br />Service Request # . Invoice # Well ID# <br />‘k3?-2. 15a d& 35q 7 VI I-0 Thel22- Lisi P1 b 2 1 <br />. <br />3„, <br />EHD043-06 04,07/2022 Page I of Well Pump Permit