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SAN Q A Q U I N Environmental Health Department <br /> 1 (� <br /> COUNTY _.._..__ � 1u "(� <br /> 12 <br /> Water Usage Information <br /> PROJECT INFORMATION <br /> Application Number: Application Type: Site Approval <br /> Project Address: 14250 S.Jack Tone Road,Ripon,CA Project APN: 203-050-290 <br /> Applicant Name: Rick van unen,Jr. Title: CEO <br /> Applicant Address: 1671 Dickey Ct. City/Zip: Ripon,95366 <br /> Applicant Phone: 209-480-1102 Email:I rick@windmillind.com <br /> Property Owner Name: Windmill Septic,LLC <br /> Property Owner Address: 20504 S.HWY 99 Frontage Road,Ripon,California t City/Zip:I Ripon-95366 <br /> Properly Owner Phone: 209-823-1315 t Email: rick@windmillind.com <br /> SERVICES INFORMATION <br /> Please provide description below: Private Well <br /> Water Supply: Private Well ❑ Surface Water(Attach Water Rights Information) <br /> Domestic Wastewater Disposal: on-site Septic system <br /> Process Wastewater Discharge: Ponds: 1 o 1 Applicable WDR: I None <br /> Storm Drainage System: I Natural Drainage <br /> WATER USAGE DATA <br /> _ Provide for total water usage at full buildout Number Persons/Da Gallons/Person/Da Total Gallons/Day <br /> Domestic Water Usage by Employees/Customers: 5 120 100 <br /> Type of Process/Irrigated Lands Total Gallons/Da <br /> Process Water Usage: Truck Washing 200-300 <br /> Process Water Usage: <br /> Irrigation Water Usage: <br /> Total Gallons Per Day: 300-400 <br /> PROPOSED WELL LOCATION <br /> Well Location Address: I City: <br /> Well Location APN: <br /> Well Latitude: Well Lon its ude: <br /> Flood Plain Designation: Well Elevation: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft):1 Acres to be Served by Well: <br /> Use of Well: ❑ Domestic ❑ Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft)- Estimated Pumping Rate (gal/min): <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): o <br /> SITING INFORMATION <br /> _Distance To Nearest(ft): Onsite: Offsite: Distance To Nearest(ft): Onsite: Offsite: <br /> Wastewater Treatment System: Sources of Contamination: <br /> Other Wells: Pond/Lake: <br /> Sewer Lines: Stream/River: <br /> Animal or Fowl Enclosure:1 Navigable Waterwa <br /> Storm Drainage System:1 L Potential Recharge Features: <br /> GROUNDWATER INFORMATION <br /> Depth ft): Source/Date of Reference: Groundwater Subbasin: <br /> Current Depth to Water: ❑ Cosumnes Subbasin(2-22.16) <br /> Highest Depth to Water: ❑ Eastern San Joaquin Subbasin(5-22.01) <br /> Lowest Depth to Water: ❑Tracy Subbasin(5-22.15) <br /> 1868 E. Hazelton Avenue l Stockton, California 95205 l T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> 1 of 2 <br />