AP2501437 - Laserfiche WebLink

Home Browse Search

EMAILE[ 1 WELL/PUMP PERMIT c�' '4504 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205 - (209)468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED N JOB ADDRESS 1099 W. Sargent Rd. cITY/zIP Lodi/95242 m D CROSS STREET N. Davis Rd. APN 02902038 PARCEL SIZE 5.18 LAND USE APPLICATION# o M OWNER NAME Kelli McCarty PHONE 209-327-4866 vi OWNER ADDRESS Same as Above CITY/STATEIZIP CONTRACTOR Delta Pump Inc. PHONE_209-466-9625 CONTRACTOR ADDRESS PO BOX 70? CITY/STATE/ZIP Linden/GA/9.5236 SUBCONTRACTOR PHONE SUBCONTRACTOR ADDRESS CITYISTATEIZIP LICENSE ❑ C-57 X C-61 C D-09 I Other NUMBER 1055434 EXPIRATION DATE 7/31/2025 DOMESTIC WELL SAMPLING: ❑General Mineral/Coliform Bacteria(4391)❑ Dibromochloropropane(4392)❑Arsenic(4393) AbA INTENDED USE X Domestic/Private ❑ Irrigation/Agricuftural Industrial a Water Quality Monitoring ❑ Soil Sampling/Characterize n M ❑ Public Water System N (' If different from Owner: Water System Name Contact Name or Phone Number D TYPE OF WORK i- New Well ❑ Replacement Well -Well Alteration/Modificabon -; Other o Monitoring Well(s) #of wells Soil Boring(s) #of borings r 1 Geotechnical SA n jr of borings V e 2025 J ❑ Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair ENIr"qQU/N ri New PumpPumpReplacement PumpRepair Raise Well CasingyEq/-T RCNM COU ) WELL CONSTRUCTION RE T�Drilling Method ❑ Mud Rotary El Air Rotary 11 Auger u Cable Tool C, Push Point = Other lN!' Proposed Well Depth ft Excavation in diameter - Open Bottom Gravel Pack/Gravel Size in diameter ❑ Conductor Casing in diameter / Conductor Casing Depth ft C� Well Casing Diameter_ in Thickness/Gauge/ASTM Sched i Steel Plastic t 1 Stainless Steel ❑Orr M Grout Seal Depth ft 1-1 Neat Cement(94 lb bag/5-10 gal water) - Sand Cement EN VIROI%� .hack mix/7 gal water F! Bentonite(20%solids) r; Other �leNTA Grout Placement Method ❑ Pumped ❑ Free Fall =: Other ❑ Retardant/Accelerator(name) TIC . PEDESTAL Installed By o Driller ❑ Pump Contractor ❑ Other Concrete Pedestal❑Dimensions:Width ft Length ft Thick in [11 Christy Box D Stove Pipe PUMP X Submersible r:l Turbine 0 Other HP 3 Pump Set 60 ft Standing Water Level 32 ft Plot Plan Requirements: Attach a plot plan with the exact location of water well with respect to the following items: GPS Coordinates, property lines, adjoining properties, water bodies or courses, drainage pattern, roads, existing wells, structures, potential sources of contamination, sewers or private disposal systems. Include distance from two property lines. For Domestic, Agriculture,Industrial well,provide location of any water wells or surface water within 200'radius of proposed well. I VIINIe1a BSI I r tarlo r� �DNIA'e::t U ,"('E REQUIVI-11"I rr ,�a�o �F CAI� ,�„ _7697 DEPARTMENT USE ONLY /� Application Accepted By mow/\\ Date I � Area c' zL Employee ID# �A Grout Inspection By Date ❑ SPECIAL Well Permit ' Pump Inspection By Date 0 WAIVER Received Soil Boring Inspection By Date Constructed Well Depth ft COMMENTS PE SC Received heC Amount Date PermlU Invoice# Well ID# Codes Info B Remi Service R uest# v>'J i 9--25 A P a 50iA 31 EIiD043-0610/2$/2021 P,�� or, p oaded into Accela`yell:Pump Penurc