Laserfiche WebLink
SAN10 A Q U f N Environmental Health Department <br /> C0UPQ,TY— I <br /> EXISTING WELLS INFORMATION <br /> Total Number Existing Wells on Property:1 I I Please complete the information below for every well on property.Use extra paper if needed. <br /> Well#1 Information <br /> Use of Well: cmestic 199 r igation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑ Other: <br /> Total Depth(ft): To: From: <br /> Casing Diameter(in): Screen Interval(ft): To: From: <br /> Pumping Rate gpm : To: From: <br /> Annual'Extraction Volume(acre-feet: ❑ Estimated ❑ Measured <br /> Specific Capacity al/min/ft:. <br /> Other Pumping Tests Pe rmed:1 Test Result: <br /> Well#2 Information <br /> Use of Well: ❑ Domestic ❑ Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Total Depth(ft): To: From: <br /> Casing Diameter(in): Screen Interval(ft): To: From: <br /> Pumping Rate m : To: From: <br /> Annual Extraction Volume(acre-feet: ❑ Estimated ❑ Measured <br /> Specific Capacity al/min/ft <br /> Other Pumping Tests Performed: Test-Result: <br /> Well#3 Information <br /> Use of Well; <br /> ❑ Domestic ❑ Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑Other: <br /> Total Depth(ft): To: From: <br /> Casing Diameter(in): Screen Interval(ft): To: From: <br /> Pumping Rate m : To: From: <br /> Annual Extraction Volume(acre-feet: ❑ Estimated ❑ Measured <br /> Specific Capacity aUminlft <br /> Other Pumping Tests Performed: 1 Test Result: <br /> MAP INFORMATION <br /> Aproject site map must be attached to this form and shall include the followinginformation: <br /> • Legal lot and parcel dimensions. <br /> • All well locations on legal lot and parcel with type and-use information shown for each well. <br /> • All onsite sewage treatments stems,stormwater ponds,process water ponds,and other sources of potential contamination. <br /> • Distance from proposed well to any potential sources of pollution onsite and on adjacent properties, including: <br /> o Existing or proposed onsite sewage treatments stems,wells,animal or fowl enclosures,transmission lines,sewer lines. <br /> o Distance from ponds,lakes,rivers and streams within 300 feet and navigable water was within one mile. <br /> o For wells below Corcoran C12y,map must show location of canals,ditches,pipelines,utility corridors, and roads within two miles, <br /> 2of2 <br />