SU0013999 - Laserfiche WebLink

Home Browse Search

SAN10 A Q U I N Environmental Health Department r :J r\1 1 Y EXISTING WELLS INFORMATION Total Number Existing Wells on Propertfl 3 1 Please complete the information below for every well on property. Use extra paper ifneeded. Well#1 Information Potable Waterweii,DWS Permit No.3902213 =of Domestic ❑ Irrigation N Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock Other: Total Depth(ft)'. 280 To:240 From:280 Casing Diameter(in : a Screen Interval (ft): To: From: Pumping Rate(gpm)i 15o To: From: Annual Extraction Volume(acre-feet:NA a Estimated ❑ Measured Specific Capacity (gal/min/ft): 21.38 Other Pumping Tests Performed: Source capacity Test Test Result: 150.200 gpm Well#2 Information Irrigation Water Well Use of Well: ❑ Domestic a Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock ❑ Other: Total Depth(fly. 237 To:70 From:18o Casing Diameter(in): to Screen Interval(ft): To: From: Pumping Rate(gpm): l000 To: From: Annual Extraction Volume(acre-feet: 2 a Estimated ❑ Measured Specific Capacity al/min/ft _ Other Pumping Tests Pe rmed.1 I Test Result: Well#3 Information Domestic water well Use of Well: lE Domestic ❑ Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock ❑ Other: Total Depth ja Unknown To: From: Casing Diameter(in): s Screen Interval(ft): To: From: Pum in gRate pML 25 To: From: Annual Extraction Volume(acre-feet: Unknown ❑ Estimated ❑ Measured Specific Capacity al/min/ft Other Pumping Tests Performed: Test Result: 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 parcel with type and use information shown for each well. • All onsite sewage treatments stems, stormwater ponds, process water ponds, and other sources of potential contamination. • Distance from proposed well to any potential sources of pollution onsite and on adjacent pLoperties including: o Existing or proposed onsite sewage treatments stems,wells, animal or fowl enclosures, transmission lines, sewer lines. o Distance from ponds, lakes, rivers and streams within 300 feet and navigable waterways within one mile. o For wells below Corcoran clay, map must show location of canals,ditches,pipelines, Utility corridors, and roads within two miles. 2of2