Laserfiche WebLink
1 'P /lt� <br />WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE -STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 2600 W. Yosemite Ave _ CITY/ZIP Manteca / 95337 <br />UJ <br />D <br />CROSS STREET Airport Way APN 24131053 PARCEL SIZE 30.53LAND USE APPLICATION # <br />o <br />Acres <br />') <br />OWNER NAME Great Wolf Lodge 4-r/ PHONE <br />OWNER ADDRESS 350 N Orleans St. Suite 10000B �1C2J tA) C-hkl CITY/STATE2IP Chicago/ IL IA124JeM C/9 <br />33� <br />CONTRACTOR Kleinfelder PHONE 209-948-1345 <br />CONTRACTOR ADDRESS 2001 Arch Airport Rd Suite 100 CITY/STATE/ZIP Stockton/ CA/ 95206 <br />SUBCONTRACTOR Middle Earth Geo Testing Inc PHONE 714-633-5025 <br />SUBCONTRACTOR ADDRESS 954 N Lemon St CRY/STATE2IP Orange/ CA/ 92867 <br />LICENSE C-57 n C-61 -1 D-09 -1 Other NUMBER 899451 EXPIRATION DATE 06/30/2019 <br />DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria (4391) Dibromochloropropane (4392) Arsenic (4393) <br />INTENDED USE ❑ Domestic/Private -1 Irrigation/Agricultural -1 Industrial -1 Water Quality Monitoring ,; Soil Sampling/Characterization <br />❑ Public Water System <br />If different from Owner: Water System Name Contact Name or Phone Number <br />TYPE OF WORK -! New Well -1 Replacement Well ❑ Well Alteration/Modification Other <br />MonitoringWell(s) #of wells ❑ SoilBoring(s) #ot nngs Geotechnical 3 #of borings <br />Out -Of -Service Well ❑ Out -Of -Service Well Renewal 7 Cross -Connection Repair <br />New Pum -1 Pump Replacement ❑ Pump Repair -1 Raise Well Casing <br />WELL CONSTRUCTION <br />Drilling Method 11 Mud Rotary � Air Rotary -1 Auger "' Cable Tool XPush Point -1 Other <br />Proposed Well Depth 80-100 ft Excavation 2 in diameter 7 Open Bottom -1 Gravel Pack/Gravel Size in diameter <br />Conductor Casing in diameter / Conductor Casing Depth ft <br />Well Casing Diameter _ in Thickness/Gauge/ASTM Sched �] Steel J Plastic ; Stainless Steel _ Other <br />Grout Seal Depth ft XNeat Cement (94 /b bag15-10 gal water) -1 Sand Cement sack mix/7 gal water <br />Bentonite (20% solids) -1 Other <br />Grout Placement Method -1 Pumped 7 Free Fall Other Tremie -1 Retardant /Accelerator (name) <br />PEDESTAL Installed By 7 Driller -1 Pump Contractor — Other <br />❑ Concrete Pedestal Dimensions: Width ft Length ft Thick in ❑ Christy Box ❑ Stove Pipe <br />PUMP -1 Submersible) Turbine -1 Other HP Pump Set ft Standing Water Level <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SA <br />JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAWS. <br />M'NIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />AA A <br />F� <br />DEPARTMENT USE E O�/NLY I I <br />Application Accepted By 1 /1/�l� /V�. Date 3''' 0 Arae S It Employee ID# 0 fj't( <br />Grout Inspection By DeW ❑ SPECIAL Well Permit <br />Pump Inspection By Date ❑ WAIVER Received <br />Soil Boring Inspection By <br />COMMENTS <br />EHD43-06 8101/16 <br />Date <br />C,/) -4., �fa6,Z8D1 <br />Constructed Well Depth <br />ft <br />Service Request#® r I <br />WELL /PUMP PERMIT <br />11 <br />TH <br />