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SANJO n Q) I I N Environmental Health Department EXISTING WELLS INFORMATION Total Number Existing Wells an Pro e : 4 Please'complete the information below for every well on property.Use extra paper if needed. Well 01 Information Milk Barn Well,drilled 1993 Use of Well: ® Domestic ❑ Irrigation ❑ Small Public Waler Supply ❑Municipal Public Water Supply ❑ Industrial 0 Stock >� Other: Total Depth(ft): 320 _ _ 7a:zoo From:azo Casing,Dianne terin : a Screen Interval(ft): To: From: Pumping Rate m : To: From: Annual Extraction Volume{acre-feet:39 a Estimated ❑ Measured _ Speclffc Capaciti ailmihftt; Other Pumping Tests Performed: Test Result: Well#2 Information Milk Barn WQII,drilled 1993 Use of Well; ©Domestic C1 Irrigation 0 Small Public Water Supply ❑Municipal Public Water Supply ❑ Industrial El Stack ❑Other: Total f]e th(its: 265 To:245 From:285 Casing Diameter(In): a Screen Interval(ft): To: From: Pumping Rate m: To: From: Annual Extraction Volume(acre-feet:39 F E=stimated ❑ Measured Specific Ca actallminJft Other Pum in Tests Performed. Test Result: Well#3 Information Irrigatlon Well-well lop is likely the well within dalry production area.,drilled 1986 Use of Well; ❑ Domestic d Irrigation ❑ Small Public Water Supply ❑Municipal Public Water Supply ❑ Industrial ❑Stock ❑Other: Total Depth it: 160 TO:122 From:lBo Casing Diameter(in): 14 Screen Interval(ft): To: From: Pumping Rate To: From: Annual Extraction Volume(acre-feet: p Estimated 17 Measured Specific Capacity allminlft: Other Pumping Tests Performed; Test Result: There is no well log found for the 4th well on this ADN, very old well MAP INFORMATION A project site map must be attached to this form and shall include the following information: • Legal lot and parcel dimensions. • All well locations on legal lot and garcel with type and use information shown for each well. • All onsite sewage treatments stems,stormwater ponds,process water ponds,and other sources of potential contaminaflon. • Distance from proposed well to any potential sources of pollution onsite and on adjacent properfles, includin : o Existing or proposed onsite sewage treatments stems,wells,animal or fowl enclosures,transmission lines,sewer lines. o Distance from ponds,tabes, rivers and streams within 300 feet and navigable water was within one mile. o For wells below Corcoran clay, map must show location of canals,ditches,pipelines,utiii corridors, and roads within two miles. 2 al 2