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. S�i�`wl son... �-�-lT 45r► ah/�//� y -sem • ' WELUPUMP PERMIT SAN JOAQUIN COUNTY ENNRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue-STOCKTON CA 96205.6232-(209)468-341 Ib/V� NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED _N JOB ADDRESS 12000 Moncure Rd cln/LP Ripon 95366 a 0 CROSS STREET Sof Mohler Rd APN 257-290-12 PARCEL SIZE .I7�LAND USE APPLICATION# OWNER NAME Elinor Aufdermaur PHONE 209-599"6606 OWNERADDRESS 12000 Moncure Rd Cmr/STATEZP Ripon,CA 95366 CONTRACTOR Hennings Bros.Drilling Co., Inc. PHONE 209-545-1185 CONTRACTOR ADDRESS 1930 Ladd Rd cm/BTATEZP Modesto.CA 95356 SUBCONTRACTOR PHONE SUBCONTRACTOR ADDRESS CITY/STATEZP LICENSE N C-57 i�C-61 D-09 I Other NUMBER 290813 ExpIRATON DATE 05-31-2018 GEOGRAPHICAL INFORMATION: CoordinatesX V Township_ Range_ Section_ INTENDED USE R DomeSUC/PHVale ❑InIgation/Agdaltursl C Industrial ]Water Quality Monitoring ]Sail Sampling/Characterization Public Water System IfdlftereMeom Oenec er em No. conead Harre or Phone NUMIr TYPE OF WORK g NEW Well ❑Replacement WBII C Well Alteration/Modification D Other Monitoring Well(s) #ofwelis ❑Soil Bodng(s) #erbadn#a CGeotechnical aof Badnea Out-Of-Service Well C Out-Of-Service Well Renewal ❑CmsSCOnnCCtlOn Repair New Pum ]Pump Replacement ❑PUMP Repair ❑Raise Well Casing WELLCONSTRUCTION Drilling Method A Mud Rotary D Air Rotary C Auger ❑Cable Tool D Push Point ] Other Proposed WBII Depth 250 ft Excavation 14 In diameter ❑Open Bottom R Gravel Pad lGravel Size NOB in diameter l.. Conductor Casing_In diameter / Conductor Casing Depth ft Sand pack ^ ZW Wall Casing Diameter 8 In Thirkness/Gauge/ASTM Schad SDR26 D Steel 6i Plastic ❑Stainless Steel ❑Other�y p O Z Grout Seal Depthft ❑Neat Cement(94 lb b8g/5-10 gal water) ❑Sand Cement sack mixl7 gallyWr 0 F- M Bentonite(20%solids) ]Omer -v Z 2 a Grout Placement Method KPumped LFree Fell ❑Omer LRetardant/Accelerator(name) O Z pop PEDL Installed By ❑Dnller R Pump Contactor ❑ Omer [Q O �. Concrete Pedestal Dimensions:Width_ft Length ft Thick In ❑Christy Box ❑Stove Pipe L,g„l 0 � WW PUMP _Submersible❑Turbine ❑Omer HP Pump Set ft Standing Water Level ft = I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL i WORKERS COMPENSATION LAWS. MINIMUM 24 HOUR ADVA C ICE REQUIRED FOR INSPECTIONS ��r1 •E •�/ SIGNED TITLE Y•`Q• DATE iL-x— s 0.25 ku cwtonate' 'd T T Fig P RTMENT qSEjONLY �(( Application Accept d By Date Area 4q Q LIQ Employee I � VLA Grout Inspection By Date SPECIAL WGII PBrrrllt f Pump Inspection By Date WAIVER Received Soil Boring Inspection By Date Constructed Well Depth ft / C M TS S y I PE Sc Received Check#/ AmountPermit)Caries Info B Cash Remitted Date Service Request 9 Invoice# Well IN lay °' 2-17-117 r."070730 ; END rade WELLPUMP PERMIT WOODS