WP0042804 - Laserfiche WebLink

Home Browse Search

Irc r,rer� WELL/PUMP PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 45206.6232(209)468-3420 NON-REFUNDABLE PERMIT www.sJgov.org/ohd EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS (30,23 Mnrltreq 38.021040".Log:-121 363676° CITrmP Stockton,CA,95206 CROSS STREET Mariners Dr/Hammer Ln APN 071-260-010 PARCELSIZE 5.0 LAND USEAPPLICATIONS Unknown OWNER NAME Adam Levin/xvereb G6411?S 4n / Cof;to TQ PHONE_(650)492.0934 OWNER ADDRESS 40 Hawthorne Avenue faoe. 14a hover' ST CItrISTATEmP___ Los Altos,CA 94022 /Ado Alt C)g3oy CONTRACTOR Gregg Drilling,LLC PHONE (925)313-5800 CONTRACTOR ADDRESS 950 Howe Road crrY/STATEIZIP Martinez.CA 94553 SUBCONTRACTOR/CONSULTANT Kleinfelder,Inc PHONE (209)993-2269 SUBCONTRACTORICONSULTANT ADDRESS 2001 Arch Airport Rd,Suite 100 CITY/STATErbP Stockton,CA 95206 LICENSE N C-57 I i C-61 i I D-09 Other NUMBER 1044456 EXPIRATION DATE 09/30/2022 BILLING PARTY: I OWNER I CONTRACTOR E SUBCONTRACTOR/CONSULTANT DOMESTIC WELL SAMPLING:I I General Mineral/Coliform Bacteria(4391)1,Dihromochloropropane(4392)l Arsenic(4393) INTENDED USE !Domestic/Private 1,InigationlAgricullural I Industrial :I Water Quality Monitoring ■Sod Sampling/Characterizalion Public Water System If rAgerent hom Owner. Water Syslem Name Contact Name or Phone Number —— TYPE OF WORK I I New Well 1:Replacement Well 'i Well Alteration/Modincation I Other I!Monitoring Well(s) sof wets I SOiI Borings) x er bonno& N Geotechnical two(2) 0 or borings I Out-Of-Service Well I Out-OfService Well Renewal Cross-Connection Repair !Now Pump Pump Replacomont Pump Reprar Raise Well CaslnU WELL CONSTRUCTION - — Drilling Method I I Mud Rotary ,I Air Rotary I I Auger I Cable Tool ,I Push Point I Other Proposed Well Depth 45 It Excavation B in diameter !I Open Bottom I Gravel Pack/Gravel Size in diameter I Conductor Casing In diameter / Conductor Casing Depth n Well Casing Diameter_in Thickness/Gauge/ASTM Schad I I Steel i:Plastic I!Stainless Steel 1,Other Grout Seal Depth 45 it ■Nest Cement(94/b bag/5-10 gal water) I i Sand Cement sack mix/7 gal water I.Bentonite(20%solds) M Other up W 5::heutwwtu Grout Placement Method 0 Pumped I I Free Fal N Other Trenlie FuI6Deoth Retardant/Accelerator(name) PEDESTAL Installed By Driller I Pump Contractor I i Other ! Concrete Pedestal HDimensions:Width fl Length fl Thick in I Christy Boz !Stove Plpe J PUMP Submersible- Turbine I!Other HP Pump Set fl Stantlmg Water Level fl I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMP NSATION L WS MI 1DVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)963-769 SIGNED TITLE ir DATE { 7111-07-16 R'�yM '04008 SEE ATTACHED BORING LOCATION MAP f S'4�V ? O . EN R0//V�� 021 y IQ D pq �N 4 Ty MFNT DEPARTMENT U8E NLY 1 L,�„ Application Accepted By _ Date Z 1 Areal 5TQ•^ mployee IDN_q Grout Inspection By Date SPECIAL Well Permit Pump Inspection By Date WAIVER Received Soil Boring Inspection By Date Constructed Well Depth COMMENTS PE SC Received Check#/ Amount D Permid Invoice M Well IDK CQdss Info ft, CASN Remitted Service Re st 4 7 � d WELL PUMP PERMITEHO N-06 6/11r101e �/�_�. / /j>✓��/ .