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New Well Permit Requirements—Rev: 12/28/99 Page 2 <br /> the following internet address: `www.dhs.cahwnet.govlpsJddwem' and look for <br /> DWSAP. <br /> A paper copy may be requested by contacting the Stockton district office of <br /> drinking water program. <br /> i ❑ 5. Well Plot Plans —Well location with respect to contaminants and pollutants shall <br /> be in conformance with the Department of Water Resources (DWR) California <br /> Water Well Standards, Bulletin 74-81 and its supplements. All potential sources <br /> of contamination, including all existing and abandoned wells and pertinent <br /> structures, within the source water protection area determined under Item 4 and <br /> no less than 200 feet of the well should be clearly located. The'plot plan must be <br /> prepared to a scale of no less than 1-inch equals 50 feet. Plot plans may be <br /> submitted in advance for site approval prior to drilling of test_ hole or drilling of <br /> production well. A sample plot plan is included. <br /> ❑ 6. Well Data Sheet -- (attached) A separate well data sheet is required for all new <br /> and rehabilitated wells. Note that this is the same data sheet that will also be <br /> used for conducting source water assessment_ <br /> ❑ 7. Chlorination Data Sheet— (attached) Required only if disinfection treatment of <br /> the well water would be practiced. . <br /> ❑ 8. Water Drilling Specifications — All new wells are to be drilled and constructed <br /> as per the Department of Water Resources (DWR) California Water Well <br /> Standards, Bulletin 74--81 and its supplements. In addition, all wells shall be <br /> plumbed and proper, electrical hookups provided in case of a bacteriological <br /> water quality failure. <br /> ❑ 9. Water Well Driller's Report (Well Completion Report) -- shall include the <br /> following information: owner, location, proposed use, equipment employed in the <br /> construction of the well, gravel pack, casing material and diameter, perforations, <br /> well seal material and depth, water levels, well tests, well log, date drilled and the <br /> name of driller. <br /> C7 10. Well Construction Features - (notes, schematic(s), or engineering drawing(s)) - <br /> Details of pedestal construction, surface seal, pump motor base seal, all vents, <br /> sampling taps, flush to waste provisions, well gravel pack, casing material and <br /> diameter, perforations, well (annular) seal thickness, depth, and material, static <br /> and pumping water levels, well pumping tests, etc. <br /> ❑ 11. Other Agency Approvals — If applicable for example State Well Number from <br /> Department of Water Resources, California Environmental Quality Act (CEQA) <br />