Laserfiche WebLink
6 <br />1 WELL/PUMP PERMIT 1960 <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NUN-KEFUNDABLE PERMIT L+ALL (LUa) VO3-f DWI rVK Mbrtt.IFUNb CAPlr%rzo 1 i CHR rRUnit MAIC I0auLV <br />JOB ADDRESS 3295 N Alpine Rd CITY/ZIP Stockton/95215 <br />CROSS STREET E. Fairchild Rd. APN 10 1 -290-48PARCEL SIZE 32.65 LAND USE APPLICATION # <br />OWNER NAME Watanabe Bros - Contact Wayne Watanabe 1-t61shr `t 4;dek' PHONE 209-406-2762 <br />OWNER ADDRESS 3319 N. Alpine Rd CITY/STATE/ZIP Stockton/95215 <br />CONTRACTOR Delta Pump Inc PHONE 209-466-9625 <br />CONTRACTOR ADDRESS 646 S California St CITYISTATE/ZIP StOCktOn/95203 <br />SUBCONTRACTOR <br />SUBCONTRACTOR ADDRESS <br />LICENSE C-57 X C-61 D-09 Other <br />PHONE <br />CITYISTATEIZIP <br />NUMBER 1055434 EXPIRATION DATE 7/31/2023 <br />DOMESTIC WELL SAMPLING: D General Mineral/Coliform Bacteria (4391) D Dibromochloropropane (4392) 0 Arsenic (4393) <br />INTENDED USE Domestic/Private X 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 J New Well ". Replacement Well Well Alteration/Modification . Other <br />Monitoring Well(s) # of wells .-i Soil Boring(s) *of DOnng` Geotechnical 9 of borings <br />-1 Out -Of -Service Well G Out -Of -Service Well Renewal ; Cross -Connection Repair <br />I New Pump Pump Replacement X Pump Repair Raise Well Casing <br />WELL CONSTRUCTION <br />Drilling Method Mud Rotary Air Rotary :: Auger Cable Tool Push Point Other <br />Proposed Well Depth ft Excavation in diameter ;-. Open Bottom i I Gravel Pack/Gravel Size in diameter <br />I Conductor Casing in diameter / Conductor Casing Depth ft <br />Well Casing Diameter _ in Thickness/Gauge/ASTM Schad Steel Plastic Stainless Steel Other PAYMENT' <br />Grout Seal Depth It J Rc <br />Neat Cement (941b bag/5-10 gal water) : Sand Cement sackECEWED <br />I Bentonite (20% solids) I I Other <br />Grout Placement Method Pumped r, Free Fall Other _ Retardant / Accelerator (name) <br />PEDESTAL Installed By - Driller Pump Contractor Otherc INcouN ) <br />J Concrete Pedestal Dimensions: Width ft Length ft Thick ENVIRDN_ L <br />�in 7 Christy Box - Stove Pipe t <br />PUMP SubmersibleX Turbine Other HP __4D Pump Set 140 ft Standing Water Level 109 ft <br />Plot Plan Requirements: Attach a plot plan with the exact location of �satcr 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 hlo property lines. For Domestic, <br />:agriculture, Industrial provide location of any water wells or surface water within 200' radius of proposed well. <br />IIIA I: ut\ ,u EN(Tr1rF: RFOIIIRFDFOR INSPF:(-PKttis-PIF%sF rpt 1.12twi7tl_,r,�r+ <br />DEPARTMENT USE ONLY f/ <br />Application Accepted By �/�'—L L Date 3J .� Area r q / Employee ID# Fru M k <br />Grout Inspection By Date ❑ SPECIAL Well Permit <br />Pump Inspection By Date ❑ WAIVER Received <br />Soil Boring Inspection By Date Constructed Well Depth ft <br />COMMENTS <br />:Z o ----d <br />N <br />mm <br />D <br />0 <br />0 <br />m <br />N <br />PE <br />Codes <br />Sc Received Check#/ Amount Date Permit/ Invoice # Well ID# <br />Info B sh Remitted Service Re uest # <br />" 383• <br />L, <br />EI1M43•06 IQ.V20:1 P.— I "f: %eou . r—m r., n,., <br />