WP0043589 - Laserfiche WebLink

Home Browse Search

}°``��IJ SAN JOAQUIN COUNTY r_1 r Greatness grows herd. o V0 n M ca fi CE)� F X610 fi L) �, P� ) �� SITE MITIGATION WELL & BORING PERMIT APPLICATION NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 24 Hours Advance Notice Required For All Inspections CALL (209) 953-7697 For INSPECTIONS Application is hereby made to San Joaquin County for a permit to construct and/or install the work described. This application is made in compliance with San Joaquin County Development Title, Chapter 9-1115.3, and the San Joaquin County Well Standards. Job Address Cross Street C Street Main Street Property Owner* City of Stockton ROW Address Stewart -Eberhardt Building, 22 E Weber Ave #301 C-57 Contractor Cascade Drilling LP Address 3000 Duluth St ConsultantlSub-Contractor Antea Group Address 11010 White Rock Rd, Suite 140 City/State/Zip Stockton, CA 95205 APN near 153-102-100-000 City/State/Zip Stockton, CA 95202 License# 1058336 CitylState/Zip West Sacramento, CA 95691 License# 0116983 CitylState/Zip Rancho Cordova, CA 95670 Phone N/A Phone (209) 937-8411 Phone (707) 378-3768 Phone (763) 453-0183 CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELLIBORING NUMBER ❑ MONITORING ❑ ❑ EXTRACTION (Vapor/Water) ❑ ❑ SOILVAPORPROBE ❑ ❑ SOIL BORING ❑ ❑ INJECTION (Air sparge, Ozone) ❑ ❑ OTHER ❑ WELL/ SOIL BORING IDs INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS HOLLOW STEM BORING DEPTH ❑BOLTED TRAFFIC BOX ❑STOVE PIPE HAMMER/DRIVEN DIA, OF BOREHOLE ❑ MULTIPLE CASINGS ❑ MULTI-LEVEL WELL CASING DIA MUD ROTARY CASING THICKNESS TYPE OF CASING: ❑ STEEL ❑ PVC ❑ OTHER PUSH POINT (GP/ CPT) CONDUCTOR CASING ❑ Yes ❑ No Boring Dia: Casing Dia: Casing Depth: HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑ AUGERS ❑ HOSE ❑ PIPE OTHER: GROUT SEAL PUMPED? ❑ Yes ❑ No (Note: Maximum Freefall Depth is 30 Ft) GROUT SPECIFICATIONS DESTRUCTION WORK TO BE PERFORMED: #WELLS TO BE DESTROYED 2 WELL IDs MW -5 and MW -6 GROUT SPECIFICATIONS Neat cement (47 Ib bag/3.5 gal water) TREMIE TYPE TO BE USED ❑AUGERS ❑ HOSE 0 PIPE COMMENTS: Site has recently ended public comment period and is eligible for case closure. Two off-site wells of similar construction. Signed DESTRUCTION METHOD: (CHECK ALL THAT APPLY) � OVER -BORE DIAMETER of s.25 inches to depth of 45 feet ❑ PRESSURE GROUT To depth of feet below surface ❑ EXPLOSIVES From to feet below surface ❑ MUSHROOM CAP ❑ 3 feet below surface or feet below surface if >3 feet I hereby ce ify that I am authorized to complete this application and that the work will be done in accordance with San Joaquin County�C rdinance Codes and Standards, and all other applicable California laws. Print Name Regina Bussard Application Accepted By: Grout Inspection By/Dates: Destruction Inspection By/Dates: Facility/Site Information Title/Company Antea Grou Date 8/1/2022 DEPARTMENT USE ONLY Date Issued: 022. �z2 FA Name j ��dj FA PE � WP Reviewed By � Work Plan Date �u�, �'�'� C-57 ❑ C-57 Authorization for Other to Sign Permit ❑ Worker's Comp ❑ Worker's Comp Waiver ❑ Encroachmen Permit ❑ Access Agreement d Agency Approval MFR COMMENTS/CONDITIONS: �I� C � 6 o >� inn in 5 E, < J % eh c ro OE.ch Irvo Ir P mal o r — S C O .� 404 retro cab I e, brit i {`s on ,S,-� WP TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'DBrY DATE WELL PERMIT# INVOICE# Permit 2�0'L 3 lw:ro�jl 3 1 CC �W hoz poo* 3 T8 9 L�n�ffi-�n�crn o� 6 S� �� o a g S 3 1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sjcehd.com EHD 29-01 04-04-07 Site Mitigation Well Permit Application