Laserfiche WebLink
1 WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NUN-KEFUNDABLE PERMIT UALL <br />JOB ADDRESS Woodward Island <br />953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />CITY/ZIP Unincorporated San Joaquin County, CA 95219 <br />ARCEL SIZE 1929 LAND USE APPLICATION # <br />PHONE (510) 287-0575 <br />CITY/STATE/ZIP Oakland, CA 94607 <br />CROSS STREET Bacon Island Road APN 129-010-010-000 <br />OWNER NAME East Bay Municipal Utility District <br />OWNER ADDRESS 375 Eleventh Street, Mail Slot No. 610 <br />CONTRACTOR ConeTec <br />CONTRACTOR ADDRESS 820 Aladdin Avenue <br />SUBCONTRACTOR <br />SUBCONTRACTOR ADDRESS <br />LICENSE it C-57 ❑ C-61 ❑ D-09 ❑ Other. <br />PHONE (510)357-3677 <br />CITY/STATE/ZIP San Leandro, CA 94577 <br />CITY/STATE/ZIP. <br />NUMBER 1049248 <br />PHONE <br />EXPIRATION DATE 01-31-2023 <br />DOMESTIC WELL SAMPLING: ❑ General Mineral/Coliform Bacteria (4391) ❑ Dibromochloropropane (4392) Arsenic (4393) <br />INTENDED USE ❑ Domestic/Private ❑ Irrigation/Agricultural ❑ Industrial ❑ Water Quality Monitoring 18 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 ❑ Replacement Well ❑ Well Alteration/Modification ❑ Other <br />❑ Monitoring Well(s) # of wells ❑ Soil Boring(s) # of borings ® Geotechnical 2 # of borings <br />❑ Out -Of -Service Well ❑ Out -Of -Service Well Renewal ❑ Cross -Connection Repair <br />❑ New Pump ❑ Pump Replacement ❑ Pump Repair ❑ Raise Well Casinq <br />WELL CONSTRUCTION <br />Drilling Method ❑ Mud Rotary ❑ Air Rotary ❑ Auger ❑ Cable Tool ❑ Push Point 91 Other Cone Penetration Test/ Cone Penetrometer Test <br />Proposed Well Depth 75 ft Excavation 1.72 in diameter ❑ Open Bottom ❑ 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 ❑ Plastic ❑ Stainless Steel ❑ Other <br />Grout Seal Depth 75 ft ® Neat Cement (94 lb bag/5-10 gal water) ❑ Sand Cement sack mix/7 gal water <br />❑ Bentonite (20% solids) ❑ Other <br />Grout Placement Method ❑ Pumped ❑ Free Fall Z Other Tremie grouting ❑ Retardant / Accelerator (name) <br />PEDESTAL Installed By ❑ Driller ❑ Pump Contractor ❑ Other <br />❑ Concrete Pedestal ❑Dimensions: Width ft Length ft Thick <br />in ❑ Christy Box ❑ Stove Pipe <br />PUMP ❑ Submersible❑ Turbine ❑ Other HP Pump Set ft StandJUWa%rkeAffl6" ft <br />Plot Plan Requirements: Attach a plot plan with the exact location of water well with respect to the f$Ag�,udt Titems: GPS <br />SAN <br />Coordinates, property lines, adjoining properties, water bodies or courses, drainage pattern, roads, exislvrlr, 1 structures, <br />E L7H <br />potential sources of contamination, sewers or private disposal systems. Include distance from two prop'y lines. For Domestic, <br />Agriculture, Industrial well, provide location of any water wells or surface water within 200' radius of proposed well. <br />NIININIUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />D ARTMENT USE ONLY <br />Application AcceotecU3y Date June 1, 2022 <br />Grout Inspection By Date <br />Pump Inspection By Date d <br />Soil Boring Inspection By 's Date <br />COMMENTS <br />Area 3/99 Employee ID# M. Suszycki <br />❑ SPECIAL Well Permit <br />❑ WAIVER Received <br />Constructed Well Depth It <br />PE SC Received Check#/ Amount Date Permit/ Invoice # Well ID# <br />Codes Info By a Remitted i I Service Request # <br />4372 $150 $608 y <br />Eyp043-06 04/07/20 I (' ( U q ,� h '31 �.y� y Z Well /Pump Permit <br />W <br />M <br />D <br />0 <br />0 <br />A <br />M <br />