Laserfiche WebLink
1 WELL/PUMP PERMIT 5148 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205 - (209)468-3420 <br /> NON-REF DABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS Escalon-Bellota Rd. cITY/ZIP Farmington/95230 m <br /> D <br /> CROSS STREET Hwy 4 APN 18720026 PARCEL SIZE 20.34 LAND USE APPLICATION# o <br /> OWNER NAME Les Stroian PHONE 209-985-5346 rn <br /> OWNER ADDRESS PO Box 141 CITY/STATEIZiP Farmington/CA/95230 <br /> CONTRACTOR Delta Pump Inc. PHONE 209-466-9625 <br /> CONTRACTOR ADDRESS PO Box 702 CITY/STATE/ZIP Linden, CA 95236 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑ C-57 X C-61 ❑ D-09 ❑ Other NUMBER 1055434 EXPIRATION DATE 7/31/2027 <br /> DOMESnc WELL SAMPLING:❑General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392)❑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 ❑ New Well ❑ Replacement Well ❑Well Alteration/Modification ❑ Other <br /> ❑ Monitoring Well(s) #of wells ❑ Soil Boring(s) #of borings ❑ Geotech { mm <br /> 11 Out-Of-Service Well ❑ Out-Of-Service Well Renewal El Cross-Connection Re <br /> ��jjjj�� <br /> ❑ New Pump ❑ Pump Replacement XPump Repair ❑ Raise Well Casing <br /> WELL CONSTRUCTION SEP 2 92025 <br /> Drilling Method ❑ Mud Rotary ❑Air Rotary / 0 Auger ❑ Cable Tool 11 Push Point ❑ Other <br /> Proposed Well Depth ft Excavation in diameter ❑ Open Bottom ❑ Gravel Pack/Gravel Size in diamete <br /> ❑ ConductorCasing in diameter / Conductor Casing Depth fVNVI120NN1EN�AGAEALT <br /> Well Casing Diameter_ in Thickness/Gauge/ASTM Sched 11 Steel ❑ Plastic ❑ Stainless$Wp <br /> Grout Seal Depth ft ❑ Neat Cement(94/b bag/5-10 gal water) ❑ Sand Cement sack mW7 gal water <br /> ❑ Bentonite(20%solids) ❑ Other <br /> Grout Placement Method ❑ Pumped ❑ Free Fall ❑ Other ❑ Retardant/Accelerator(name) <br /> PEDESTAL -1-nstalled$y ❑ Driller ❑ Pump Contractor ❑ Other <br /> ❑ Concrete Pedestal❑Dimensions:Widthft Length ft Thick <br /> in ❑ Christy Box ❑ Stove Pipe <br /> PUMP ❑ Submersibles(Turbine ❑ Other HP 40 Pump Set 180 ft Standing Water Level 143 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 /> N11NINIUA1 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> DEPARTMENT USE ONLY T <br /> Application Accepted By /''�/�1500"-- Date 3� b Area Employee ID# 5/ <br /> Grout inspection By Date ❑ SPECIAL Well Permit <br /> Pump Inspection By Date ❑ WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depthft <br /> COMMENTS <br /> Pte- —SC--Received` Amount Date Permit) Invoice# Well ID# <br /> Codes Info B Cash Remitted Service Re uest# <br /> lfD mt zs 25m 11�-q <br /> RE MEWED <br /> ERD043-06 04/07/2022 Pa e I of 2 OCT 0 W Permit <br /> Uploaded into Accela SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL, <br /> "l A! <br />